The purpose of a neck lift is to reverse the laxity that time, gravity and sun exposure have taken on the vulnerable skin of the neck. This is one of the primary areas to reflect the signs of aging. A neck lift does not stop the aging process, but it can significantly turn back the clock. This is achieved by the removal of excess fat, tightening the underlying structures, trimming excess skin and re-draping the skin of the neck. A neck lift can be done in conjunction with eyelid surgery, a brow lift, or other facial procedures.
A neck lift is most commonly performed in men and women between the ages of 50 and 60 years of age. However, some people may consider this earlier due to genetics that predisposes to early neck aging. This may result in imbalance, due to a small jaw (chin) or a short neck and may encourage a person to seek out surgical correction earlier.
The change people often first notice in their necks is the loss of skin elasticity, as evidenced by a new slackness of the skin. The skin under the chin loosens and sags with fat deposits and the platysma muscle bands in the neck, formerly invisible and confined beneath firmer skin, become obvious as they flex behind a softer, looser wall. The sleek contours of the neck disappear, giving way to loose bands of skin that may even form a fold as they reach the base of the neck. Eventually, this laxity of the skin can extend into the upper chest as well. The jaw line loses its definition as the collagen in the cheeks decreases, allowing the skin to slip lower and lower below the jawbone, forming a small pouch or jowl along the jawline. Some people are genetically prone to a turkey neck appearance, well before the aging process has set in and in spite of maintaining an otherwise trim and fit physique.
Some people may first be bothered by the appearance of fat under the chin that is unrelated to any weight gain, making them appear heavier than they actually are. Others are more distressed by the aged appearance of platysma bands, formed by the platysma muscles that run from the chin down to the upper chest. Thin vertical bands or cords that lend a distinctive time worn look to the front of the neck. Any one of these signs of aging in the neck is enough to prompt many people to seek out the correction that can be achieved with a neck lift. A simple test to determine whether a neck lift would be helpful is to pull the neck skin posteriorly towards the ears and see if this demonstrates the improvement you seek.
Before Neck Lift Surgery
At your first consultation, you and Dr. Delgado will discuss your concerns about the appearance of your neck. With the aid of computer imaging, he will show you realistic images of your neck before and after a neck lift. This will demonstrate the changes that can be accomplished with this procedure. If you are a good candidate, Dr. Delgado will explain the best type of neck lift to achieve your goals. He may suggest a lower facelift if the mid-face has significant laxity.
Before surgery, you will be given a detailed preoperative instruction booklet that will explain your medications and any preparations you need to make at home. This preoperative booklet has a comprehensive list of medications, including aspirin products and anti-inflammatories, which need to be discontinued two weeks prior, as well as the two weeks following your surgery. However, Tylenol (acetaminophen) can be safely taken during this time. However, do not exceed 1 gram over 4 hours or 4 grams per day from all sources since this can cause liver damage You will also be given a list of vitamins and homeopathic drugs you can choose to take before and after your surgery to reduce bruising and swelling.
Neck Lift Surgery in San Francisco
DAY OF SURGERY
The surgery takes place at Marin Cosmetic Surgery Center, Dr. Delgado’s private surgery suite, located in his Marin County office on the Sutter Marin County Community Hospital campus. This allows Dr. Delgado to offer his patients private, concierge medical care, while providing the extra measure of safety and reassurance afforded by the surgery center’s contiguous location to the hospital.
Before anesthesia is given, Dr. Delgado marks your neck for the incisions with a special surgical felt tip marking pen. This creates the customized map that will guide him during your procedure.
A neck lift can be done in one of four ways, depending on the patient’s individual needs.
The first approach is liposuction only. This is a good technique for a young person with a fat deposit under his/her chin, but with good skin elasticity and no platysma banding. Liposuction does not actually lift the neck, though it gives that appearance. By extracting fat content below the chin and with good contractility of the skin, the skin will contract upward, re-drape around the chin area and a classic, youthful jaw line will emerge.
The second technique is liposuction and tightening of the platysma. The platysma is a muscle that runs from the chin to the neck and then down towards the chest. Over time, it becomes loose, appearing as fine cords that visibly protrude from beneath the neck skin. The platysmaplasty technique will re-approximate these muscles to create a smooth contour of the neck and an attractive, defined angle between the jaw and the neck region. This procedure will reduce the fat component of the neck and tighten the superficial neck muscles.
The third type encompasses liposuction, platysmaplasty and the placement of a mastoid suture. This stay suture runs from the midline of the neck at the neck crease, to attachment just behind the ear. Its purpose is to increase the jaw definition and create a more sleek neck-jaw contour by giving it additional support. This is not a long lasting suture but creates definition and some scar tissue is created to hold the skins position.
The fourth type includes liposuction, platysmaplasty, stay suture and a skin excision from behind the ear and into the hairline. This is performed with a patient who has redundant skin in the lower neck area and would like additional skin tightening. If the neck laxity is too severe in that it impacts the upper face region, Dr. Delgado will suggest a lower facelift to achieve the most natural appearance.
There are various combinations of techniques that can be employed in a neck lift. Dr. Delgado, with the use of computer imaging, will assist you selecting the best procedure that fits your needs at this stage of your aging process.
The vast majority of neck lift procedures are done under light general anesthesia. At Marin Cosmetic Surgery Center, only a physician who is board-certified in anesthesia administers anesthesia. Dr. Delgado and the anesthesiologist will assist you in making the best decision for your anesthesia. (See credentials for Randy Gaynor, MD on our website.) The anesthesiologist will call you the night before your surgery to review your medical history, confirm last minute instructions and answer any questions you may have relating to your anesthesia.
After Neck Lift Surgery
The first few hours after surgery will be spent in the recovery room. When you are completely alert, you will be able to go home with someone to assist you. To control swelling, cold packs should be placed around the neck area for 48 hours and you should sleep with your back and head elevated at 45-60 degrees for seven nights.
Some patients will spend the first night in the recovery room, especially if other facial procedures are performed. If you are staying overnight, Dr. Delgado will inspect your incisions the following morning and then you may go home with a responsible adult.
The following day, you may shower, wash your hair as usual and reapply the compression band, a four-inch wide elasticized band that circles under your chin and attaches with Velcro over the top of your head. This light compression discourages the accumulation of fluid swelling under your chin.
There is minimal discomfort with neck lifts. Pain medication is prescribed, but it is unlikely it will be needed for more than a day or two following your procedure.
Patients will experience swelling, but the primary sensation is that of numbness on the neck, the sides of the face and even the lips. The lip numbness resolves in about 24 hours and the remaining numbness steadily subsides over the subsequent weeks. If a drain is placed, you may experience a slight pinching in that area when you move your head, but that is relieved with the removal of the drain, probably a day or two after your procedure.
Your sutures may feel like stiff little bristles, as you try to find a comfortable position on your pillow to sleep, but again, this vanishes when the sutures are removed five to seven days after your procedure. Suture removal can be done at either Dr. Delgado’s San Francisco office or his Marin County office near Santa Rosa.
As the swelling may cause soreness in your jaw hinge (temporal mandibular joint) you should plan on eating soft foods the first two days after your procedure. You may also be aware of mild, intermittent discomfort in your throat, a result of irritation caused by the breathing tube that was in place during your procedure. Throat tissue heals very quickly and this feeling will also disappear after a couple days.
Probably the most challenging part of your recovery will be getting comfortable enough to sleep in the recommended elevated position. A recliner is very helpful for this, but you can replicate one fairly well with a good supply of pillows. Rest your back and head against a stack of three or four pillows and place one or two pillows under your knees to keep your lower back comfortable and to avoid sliding down out of the elevated position. Adhering to this regimen for the first week after your surgery is the most effective way to keep your swelling at a minimum.
Most of the swelling will resolve in four to five days, as long as you sleep elevated and wear the compression band continually. By the eighth night, you may reduce use of the compression band to nighttime, during your sleeping hours. It is advisable to sleep with the compression band in place for one or two months following your procedure as this will continue to keep fluid from accumulating in the chin area, especially following a day of excessive activity.
The bruising will be entirely gone by two weeks, or even sooner. Makeup may be applied after one week.
Most patients return to work or social activities after ten to fourteen days. Strenuous physical exercise should be avoided for four to six weeks following surgery as it can trigger swelling.
RISKS AND COMPLICATIONS
Risks and complications are usually minor when a board-certified plastic and reconstructive surgeon performs a neck lift, yet the possibilities of complications must be considered. Like all surgeries, the risks of bleeding, infection, scarring and adverse anesthesia events are always present.
WHAT IS THE COST OF A NECKLIFT?
The cost of a neck lift can vary depending on the technique to be used. At the time of your consultation you will be given a personalized quote showing a breakdown of all fees.
The result of a neck lift procedure is rejuvenation of the neck and jaw line and their relationship. The angle of the neck will have a more accentuated and youthful contour as a result of the removal of fat and the tightening of the muscles. You will enjoy a straight, uninterrupted jaw line and a new smoothness in the texture of your neck skin. The frontal view of your face and your profile will speak years younger than your actual age. These improvements can be expected to last many years. Although you will continue to age and gravity will still take its toll, the area will always look more rejuvenated. A neck lift can be repeated in the future, when it may be appropriate to combine it with a facelift.