A neck lift constitutes the lower half of what I call a facelift. Although there have been many claims circulated that sutures alone can be used to lift and smoothen the neck, I have found these to be overstated and unsatisfactory. If you do not actually reposition the skin and tighten the underlying muscle in some way, the results will not last. Also, if you do not remove the excess skin, bunching will result under and behind the ears. The bunching may not go away or may take a long time to do so, resulting in an abnormal appearance for months.
For these reasons I believe that an adequate neck lift for a patient that has excess skin can only be done by making incisions behind the ears and down along the hairline, under the chin and lifting all the skin off the underlying tissues. I sew the anterior border of the platysma muscles together (the muscles in the neck seen when you pull down the corners of your mouth) under the chin to smoothen that area. Excess skin is pulled back, measured and removed. If there is any extra fat, I break it up and remove it using liposuction.
There are large dressings and drains used after neck lifts or facelifts. These are removed and the hair is washed the day after surgery. A chinstrap is worn for another four days without removal. After day five, some of the sutures are removed and the chinstrap may be removed for periods of time as necessary. The remaining sutures are removed after two weeks. Most patients return to work after five days.
The best plan for each individual can only be formulated after discussing all these alternatives with the patient and I spend a large amount of time making sure that the advantages and disadvantages of each approach are fully understood. Most patients are very satisfied with this procedure.
Neck Contouring or Cervicoplasty
A cervicoplasty is an operation that directly removes excess skin in the neck (often referred to as “turkey gobbler skin”). The skin is sewn back together in a zigzag manner in order to prevent bow stringing of the scar. Most of the scar is placed under the chin with a small extension down to the Adam’s apple. Although the scar heals well and is minimally visible, women are not interested in exchanging an improved neck contour for a scar. Older men, however, are excited to get rid of the large amount of excess skin using a technique that requires only local anesthesia. The operation takes a fraction of the time of a facelift, does not require large dressings, beautifully restores a youthful neck contour and men do not find the scar objectionable. Although the number of patients that are good candidates for this procedure is limited, those that have had it done are among my happiest patients.