While neck lift with liposuction is a highly individualized procedure, it generally refers to excess fat removal combined with platysma muscle repair. However, older patients (i.e., 60 years and above) may need additional contouring in the form of lower facelift, which basically lifts up the skin.
It is important to note that the success of any facial plastic surgery boils down to meticulous physical or anatomical examination. The idea is to determine the underlying cause/s of the problem to come up with the best solution.
Dr. Tarick Smiley, a renowned Orange County plastic surgery expert, has explained the basic components of neck rejuvenation surgery.
- Liposuction-alone surgery
This is only reserved for patients with good skin elasticity, meaning it can snap back without any problem after removing the excess fat responsible for the appearance of “double chin” or excessive fullness of the neck. Hence, the vast majority of patients are relatively young (late thirties and forties).
It involves a small round incision beneath the chin, precisely made at the natural skin crease for optimal scar concealment.
- Neck lift with liposuction
Some patients have a poorly defined neck contour due to excess fat and loose platysma, which is a muscle that extends from under the chin all the way down to the neck and collarbone.
This approach starts with the creation of small incision beneath the chin to remove the excess fat. Then, the same opening is used to access the splayed muscle so it can be tightened in the midline with the use of internal sutures.
Basically, a lower facelift elevates the sagging skin (and remove any excess) that contributes to the appearance of jowl. In doing so, the patient can expect a tighter and more defined neck and jawline, and possibly improvement in the corners of their mouth.
As a more extensive approach, this favors older patients who typically require more correction. This may also serve well massive weight loss patients who are left with redundant skin, which not just affects their body but also their face and neck.
Poor neck lift results are generally caused by over-resection of skin and/or fat. Hence, the goal is not about removing optimal amounts of tissue, but more importantly, leaving behind enough to ensure that the results look natural and the scar will not spread or migrate.
Leading Orange County plastic surgery expert Dr. Tarick Smiley explains how he prevents poor neck lift results:
- Use the right incision pattern based on the underlying problems and anatomy.
In an attempt to minimize scarring, inexperienced surgeons use shorter or fewer incisions despite the presence of large amounts of hanging skin. It is important to note that for most neck lift patients with loose skin, a small incision behind the ear, specifically within the natural folds of skin, is used.
To further create a smooth and youthful angle between the chin and neck, a small incision is placed underneath the chin.
Interestingly, the use of correct incision pattern based on the underlying anatomies (even though the incisions seem long and extensive) results in favorable scars as they remain hidden within the natural skin folds.
- Over-resection of skin and fat must be avoided at all cost.
Poor neck lift results due to over-correction—i.e., removing too much skin and/or fat—is remarkably difficult to improve with a revision surgery. In fact, the patient might be advised to just wait for the skin to relax and “settle.”
However, qualified surgeons (i.e., they are board certified and are performing facelift and neck lift on a regular basis) know how to avoid the signs of over-corrected neck lift—e.g., skin asymmetries, gaunt appearance, and visible platysma muscle.
Skilled surgeons know that there should be at least 5 mm of fat beneath the skin to prevent surface irregularities and visible platysma muscle; hence, they will avoid over-aggressive liposuction.
- Tighten the weak platysma muscle.
In young people the platysma muscle is tight but with aging it becomes weak and splayed, leading to the appearance of vertical neck bands. This “cosmetic” problem can also be a result of massive weight loss.
To create a smooth, youthful angle between the chin and neck, the platysma muscle needs to be tightened in the midline with the use of internal sutures. This is possible by placing a small incision underneath the chin.
Aside from correct scar placement, proper wound closure will also play a critical role to prevent surgical stigmata. The goal is to eliminate tension on the skin to preclude the scars from migrating or “pulling.”
Neck lift after weight loss deals with more redundant skin than a surgery involving an “average” patient whose sagging neck is only caused by aging, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
While most MWL patients complain about their sagging tummy and breasts, many are also concerned about their “turkey neck appearance” that makes them appear older and heavier than they really are. Oftentimes, the jowling further aggravates their aged look.
After significant weight loss, i.e., 80-100 lbs., the skin and other soft tissue sag since they have been stretched to the point that their elasticity or “shrinkage” is lost. Hence, no amount of laser skin treatments or other non-surgical procedures can produce the desired improvements.
The only way to remove the excess skin is through an excision-based neck lift surgery. This typically entails the creation of incisions behind the ear, along the hairline for optimal scar concealment.
Occasionally, the excision-based neck lift is combined with a standard facelift in which the jowl and sagging cheeks are corrected as well, leading to a more balanced and more rejuvenated appearance. For this reason, Dr. Smiley always highlights the importance of extensive physical examination, lengthy consultation, and strict patient selection process to determine the best surgical approach that will produce the most satisfying results.
For the vast majority of surgeries involving neck lift after weight loss, a skin-only operation is not enough to produce a good angle between the jawline and neck. To further create a tighter and smoother result, the separated or weakened platysma muscle must be sutured in the midline as well.
It is of critical importance to tighten and suture the platysma muscle during neck lift after weight loss to eliminate the unsightly vertical bands. Also, by reinforcing the deeper structures of the neck one can achieve a more stable, longer-lasting rejuvenating effect.
Oftentimes, neck lift for MWL patients also involves liposuction to remove the excess fat, which does not respond to further weight loss. As a stand-alone procedure, it rarely provides good results for these individuals because they have poor skin shrinkage to begin with.
Contrary to popular belief, liposuction is not about removing the optimal amount of fat. In neck lift rejuvenation, it is particularly important to preserve some layer to “cover” the platysma muscle and prevent it from becoming visible beneath the skin, warns Dr. Smiley.
Male facelift techniques are designed to provide natural-looking and gender-appropriate results. In no way they should lead to a wind-tunnel effect or any reminder of the surgery, says Dr. Tarick Smiley who has recently posted a Snapchat video showing one case study.
In the Snapchat video post, the leading Beverly Hills plastic surgeon was seen performing simultaneous neck lift, facelift, and eyelid lift in one male patient.
Dr. Smiley created an incision starting from the temple area concealed by the hairline, which was extended into the ear’s front (very close to it in order to hide the scar) and behind the earlobe before it reached the nape, still hidden by the patient’s natural hairline for optimal scar concealment.
To avoid the wind-tunnel effect in male facelift techniques, Dr. Smiley said the right amount and angle of pull was of critical importance. The skin adjacent to the temple and upper ear was gently pulled downward, while the skin near the neck area was tightened in a more upward manner, he explained during the surgery.
After pulling the skin in the ideal direction, Dr. Smiley then removed a small amount of loose skin mostly in front of the ear. The scar was positioned very close to the ear-face junction so there is no detectable reminder of plastic surgery.
He also removed the excess fat in the neck with tumescent liposuction, a technique known to minimize bleeding. Then, he carefully lifted off the skin to access the platysma muscle in the neck to tighten it in the midline, ultimately creating an improved angle between the chin and neck.
To avoid injuring or cutting the skin, Dr. Smiley said he used blunt scissors while separating this layer to the muscle. To further gauge the skin’s thickness, he lifted it at a certain angle so the surgical lamp could illuminate it properly.
In addition to neck lift and face lift, the patient also requested for upper and lower eyelid surgeries.
For upper eyelid lift, Dr. Smiley removed the excess skin and a small amount of muscle and fat using incisions placed inside the natural lid for optimal scar concealment.
And for lower eyelid lift, he removed the excess skin with the use of incisions adjacent to the lash line so the scar would blend well with the eyelashes. But instead of removing the excess fat entirely, he “rearranged” it to create a smoother lower lid-cheek junction.
He also performed fat transfer to the tear trough and nasolabial folds, or more commonly referred to as “laugh lines.”
An immediate revision neck lift is quite rare after a properly executed surgery. The goal is to remove just the right amount of excess skin and possibly some fat, and tighten the deeper muscle to achieve a stable result that can last for many years.
Nonetheless, aging continues after surgery although how long the sagging returns will depend on several key variables such as the inherent skin elasticity, sun exposure, diet, and patient’s weight. But one way to postpone the need for a revision neck lift is to take care of one’s skin.
Avoiding drastic weight fluctuations, sun’s UV rays, and smoking can prevent or at least slow down the aging of skin, as suggested by several studies conducted by Los Angeles plastic surgery experts.
In the event that an immediate revision neck lift is warranted, oftentimes the culprit is the incorrect execution. Sometimes, poor healing could also get in the way of achieving optimal results from the surgery.
It may be safe to surmise that under-corrected surgery is much easier to address than over-corrected operation. Once the skin, tissue, or fat is depleted, the revision becomes complicated that the surgeon will employ techniques more commonly used in reconstructive plastic surgery—e.g., skin grafts, fat transfer, etc.
In revision involving under-corrected neck lift, doctors use additional incision or possibly extend the existing scar to remove additional skin. Inexperienced surgeons may commit the mistake of using liposuction-alone approach to address jowling and turkey neck appearance without realizing that the problem is caused by the excess skin and not just by the extra fat.
The only way to remove the excess skin that contributes to the jowling and saggy neck appearance is by making incisions behind the ear, particularly within the ear-face junction for optimal scar concealment.
Revision dealing with under-corrected surgery may also involve additional scar beneath the chin, which is the only way to access the separated neck muscle responsible for the unsightly vertical bands. Evading this additional step results in less than optimal “angle” of the chin and neck.
Over-corrected, meanwhile, is typically more difficult to improve. Sometimes, the only way to address the problem is to do nothing—i.e. wait for the skin to relax and settle.
Scar revision is another reasons for touch-up following a neck lift surgery. While most patients have no visible scars after surgery, some individuals may experience poor healing or their surgeons have failed to remove the tension on the skin during the initial surgery, leading to scar migration or aggressive scarring.
Ideally, revision neck lift is performed 6-12 months after the initial surgery to ensure that all the swelling has dissipated and the skin has settled to its final shape.
Lower facelift and neck lift: Are they the same?
Most Los Angeles plastic surgeons consider lower facelift and neck lift to be the same thing, hence the difference is nothing but semantics. In general, the incisions are positioned behind the ears to tighten the jowls and sagging neck skin.
Because each surgeon uses different surgical techniques and terminologies, a prudent patient should do her homework, which should always include ensuring that she only deals with a facial board plastic surgeon who performs facelift and its ancillary procedures on a regular basis.
Instead of the technical terms, what matters most is the “actual” effects of facelift. For this reason a lenghty, honest discussion is critical to produce the results that will make the patient happy with her new appearance.
Lower facelift or neck lift is a highly customized procedure to produce natural-looking results and to avoid surgical stigmata such as overly tight appearance. Nevertheless, women in general require more contouring along their jaw line than men.
With incisions behind the ears, the surgeon can remove the excess skin that contributes to the appearance of jowling and “fleshy” neck.
While a lower facelift may not always entail a small incision beneath the chin, most neck lifts require this approach to tighten the loose platysma muscle that contributes to the unsightly bands. To create a smooth chin-neck junction, this muscle is tightened and sutured in the mid line with internal sutures.
Meanwhile, it is not uncommon to combine standard facelift and neck lift to achieve more rejuvenating effects. This approach is particularly ideal for patients who need an extensive amount of work.
Any type of surgical dissection that aims to rejuvenate the face will not just depend on the techniques and the surgeon’s skill set. It is important to note that the patients’ underlying anatomies, particularly the quality of their skin, will have a significant impact on the final results as well.
According to California Surgical Institute website, patients with good skin elasticity and minimal facial fat generally achieve optimal results from facelift and neck lift.
Aside from proper skin care that should always include regular use of sunscreen and healthy lifestyle, keeping a stable, healthy weight is one of the most critical ways to preserve the results of facelift and neck lift.