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.
- Proper wound closure
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.”