When is a surgical neck lift needed?

The neck is an area particularly prone to aging changes specifically the neck skin is thinner than facial skin and it has fewer oil and sweat glands than the face people concerned about the appearance of their aging neck often ask me when a surgical neck lift would be appropriate

I’ll discuss the different ways aging affects the neck different treatments to improve the neck appearance and when a surgical neck lift is worth considering.

I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in practice in New York City and Long Island for over 25 years

I routinely perform surgical neck lifts often in combination with facelift surgery such as deep plane facelift i also perform procedures for neck enhancement such as platysmaplasty for prominent neck bands as well as minimally invasive neck procedures such as suture suspension

In addition we also do non-surgical neck treatments to improve skin quality and volume in the neck area generally surgical neck lifting is for sagging skin in the neck area there are several neck procedures that can be done to improve neck sagging for people with less advanced sagging neck skin prior to any neck procedure i perform an examination of the neck and specifically look at things such as neck skin thickness the absence or presence of fat below the skin the amount of excess neck skin if any the elasticity of the neck skin and the presence and absence of platysmal bands

I also look at facial volume loss particularly in the areas of the cheekbones chin jawline and jaw angle if the neck skin has thinned and the skin quality is reduced but there isn’t a significant amount of sagging surgical neck lift is generally not indicated what can be done is to improve the quality and thickness of the neck skin with non-surgical procedures a treatment to improve skin thickness and quality by stimulating the body to generate collagen is the application of platelet-rich plasma or PRP platelet-rich plasma is made up of the concentration of wound healing and growth factors that exist naturally in your blood

We prepare PRP with a blood draw similar to what you would have done in a routine lab test PRP is prepared by spinning the blood in a centrifuge to concentrate the platelets into a yellow serum when PRP is delivered into the neck skin these wound healing and growth factors can help thicken the skin and improve skin quality texture and appearance for the neck

I often combine PRP with hyaluronic acid and use a device which creates micro channels into the skin we call this procedure Skin Boosting unlike with microneedling

Skin Boosting there’s no bleeding and requires no downtime skin laxity with excess fat can also be treated not surgically for example we use a long pulsed 1064 YAG laser to deliver heat in a way that results in fat reduction and skin tightening simultaneously

This procedure takes from 10 to 30 minutes to do and there is no downtime patients come for sessions depending on their individual situation people who come for neck enhancement are often unaware of how facial aging can affect the neck appearance one of the first signs of facial aging before their significant skin laxity and descent is facial volume loss this is defined as loss of volume affecting the bone muscle fat and soft tissue in particular volume loss in the chin area can cause a loss of forward projection which can cause the appearance of sagging neck skin

An important concept to understand is that the jawline cheekbone and chin are all pillars which support the face and neck skin this means that enhancing the volume of these three strategic areas can improve the appearance of the neck particularly below the chin this bone volume enhancement is called Structural Volumizing which is performed using long-lasting hyaluronic acid fillers with the technique derived from facial implant surgery this procedure is performed routinely in an exam room with local anesthesia and typically without any bruising situations where there is laxity that is too much to treat with laser-based tissue heating can be treated with a minimally invasive surgical procedure called suture suspension neck lift

It’s important to distinguish suture suspension from a thread lift a thread lift is the passing of barbed sutures in an attempt to build collagen in the skin to create a tightening effect which is minimal at best

When I perform a suture suspension procedure I’m using some of the same sutures i would employ in an open surgical neck lift and engage the sagging neck skin and anchor the sagging skin to a deeper bone level a lot of my patients come in concerned about the appearance of their neck bands also known as platysmal bands the platysma muscle is a long vertical muscle which originates from the clavicle and extends up the neck when you’re younger the platysma muscle is flat and smooth aging changes the muscle tone and it appears to separate into what is seen as platysmal bands if there is little to no loosening of the overlying skin then treatment can be done with a neurotoxin like Botox or Jeuveau to relax the muscles so the bands are less prominent particularly with movement if the platysmal bands are too loose then i can perform a surgical procedure called a platysmaplasty to improve the neck angle

A platysmaplasty can be performed as a standalone procedure or with a more extensive neck lifting procedure when there is significant neck laxity a surgical neck lift can be the best option for this particular issue a surgical neck lift can be performed as a separate procedure or in combination with the facelift i routinely discussed in consultation that the neck does not age in isolation but rather some of the skin under the chin is caused by sagging of the facial skin downward the patient will often recognize that when they lift their cheeks upward and the skin below their chin looks much better the purpose of a face-up surgery is to restore the anatomy of the cheeks jawline and neck which have descended due to age-related tissue laxity a typical facelift incision is placed strategically in front of and behind the ear

When a neck lift is performed at the same time the incision is extended further behind the ear in order to be able to redrape the neck skin and remove any excess skin that overlaps it is sometimes confusing for people to understand which type of facelift is best for them due to the wide use of proprietary names regardless of the branding of different facelifts there are some basic principles that apply when a surgeon is determining the optimal strategy for you basically the type of facelift you need depends on the degree of facial skin muscle and soft tissue laxity a mini lift for example or short scar facelift has a shorter incision and is typically performed when there is minimal skin laxity characteristically seen in people who are in their 50s or early 60s for people in their later 60s and older a more extensive facelift like a deep plane facelift and neck lift can be necessary in order to address more extensive cheek descent and excessive neck skin since a large proportion of facelift and neck lift surgery is performed under general anesthesia patients are often concerned about prolonged recovery very often people coming for a facelift surgery consultation are familiar with someone who they know who underwent surgery and it was their experience was characterized by significant bruising swelling and weeks of recovery

In my practice i perform face and neck lift surgery under local anesthesia with LITE IV sedation so our patients are comfortable in a twilight state of consciousness breathing on their own throughout the surgery

This is to contrast with general anesthesia where patients are temporarily paralyzed and need to breathe with the assistance of a ventilator patients under general anesthesia often have to stay overnight at a facility after surgery with skilled nursing assistants for monitoring and wound care such as needed when there are drains in our practice when i perform these procedures using local anesthesia and light iv sedation patients go home afterwards and with the basic facial dressing

Generally my patients return to work about a week to two weeks after surgery depending on the type of facelift we performed surgical neck lifts are usually indicated for advanced aging when neck skin muscle and soft tissue laxity is too extensive to address with more conservative procedures neck rejuvenation can be effectively performed with minimally invasive procedures ranging from the application of platelet-rich plasma long-pulsed laser neurotoxins such as Jeuveau and suture suspension these procedures can also be combined for more optimal minimally invasive neck rejuvenation the marketplace is saturated by medical retailers pedaling procedures and devices which mostly over promise and under deliver on any given day

I see patients who went from one place to another having different brand name non-surgical miracle neck tightening devices procedures only to be disappointed by their results and frequently distressed because they feel that their neck skin is actually even worse than before there’s never been a greater need for people considering neck rejuvenation to find an unbiased cosmetic doctor who can help them develop a neck rejuvenation strategy

I hope you found this information helpful thank you for your question