From an aesthetic standpoint, the neck begins just above the jaw line, extends down to the collar bones, and reaches laterally to just beyond the occipital hairlines and the anterior borders of the trapezius muscle. A youthful appearing neck has a sharp, well-defined cervicomental angle.
The most important structure responsible for the appearance of the aging neck is the platysma muscle, which extends from the upper chest to the lower face and jaw; it forms the lower face and neck superficial musculoaponeurotic system (SMAS) plane which provides deeper support for the overlying skin and fat. There are a variety of platysma muscle variants that directly affect the appearance of the aging neck. If the platysma muscle is separated in the midline, early banding (“turkey gobbler”) formation is expected. The neck ages slowly and gradually, following the medial to inferior vectors of aging and the gravitational force from superior to inferior. As skin laxity and platysmal bands begin to appear, there is progressive blunting of the cervicomental angle. This may then progress to thicker more prominent platysmal bands, submental fat pads, and moderate jowl formation. As skin laxity increases, platysma bands become thicker, and deep tissue support is lost, the defined edge of the mandible is lost and the cervicomental angle becomes obtuse. The aging may be accentuated even further by dyschromia ruddiness of poikiloderma.
A neck lift is a surgical procedure that recontours and rejuvenates the neck. Neck lift may be performed as an isolated procedure or it may be combined with a face lift.
The removal of excess subcutaneous fat is often the most important part of neck rejuvenation. This helps flatten the submental contour and improve the cervicomental angle. Removal of excess preplatysmal fat may be performed with liposuction through a small incision under the chin and/or just behind the earlobe. An adequate layer fat must be maintained beneath the skin so that the soft tissues under the chin retain a normal look and feel. If there is minimal skin laxity or excess and no platysmal banding, then the neck skin will may redrape satisfactorily following preplatysmal liposuction alone.
If there is excessive fat or to gain better definition of the cervicomental angle, a subplatysmal lipectomy may be performed. To modify the central sub-platysmal tissues, an open lipectomy through a submental incision, rather than closed liposuction, is generally preferred because it offers precise control of the subcutaneous layers of the neck. The amount of skin laxity and excess will determine whether skin excision will be necessary for proper contouring.
When platysma bands are present they create an unflattering obtuse cervicomental angle, blunting the definition that defines a youthful neck contour. The corset platysmaplasty produces a snug jaw line and a right-angled neck contour. Through a submental incision, the platysma muscles are approximated in the midline, downward to within a few finger breadths of the suprasternal notch. The corset platysmaplasty eliminates static paramedian muscle bands, flattens the submental plane, and tightens the front of the neck.
When neck skin excision is required, a post auricular sulcus incision that may extend downward along or behind the occipital hairline is performed. The use of this incision efficiently and naturally tightens the surface of the neck, because it is oriented perpendicular to the jaw line and the natural transverse skin creases of the neck.
The contour of the chin is also an important part of neck rejuvenation. The chin provides the visual reference point for the contour lines and angles that define nearly all of the aesthetic attributes of the lower face and neck. Therefore, to properly remodel the neck, the chin should be evaluated as well. If a small chin (microgenia) is present then augmentation with a chin implant may be helpful in providing improved lower facial and neck contour.
If you would like to schedule a consult to discuss whether a neck lift is right for you please call our office at 414-443-0033.
- Keep your head elevated (~30° or more) when lying down or sleeping for the next 2 weeks. It is very important that your head be elevated without neck flexion. Try to keep the pillow underneath your shoulders, as well as your head, so that your chin isn’t tucked down on your chest.
- A compression dressing for your face, chin, and neck is worn for support, comfort and to reduce swelling; this should be worn for at least the next 7 days, and additional recommendations will be provided by your doctor.
- Everyone experiences bruising and swelling; the swelling will probably start to improve on the 5th post operative day, and bruising may last 2 weeks. On average it takes 2 to 3 weeks for patient’s to feel comfortable going out socially or going back to work
- You may shower and shampoo your hair after your first post-operative visit. Be sure to keep your head elevated.
- Your neck may feel quite tight for the first few days; and your jaw may also feel somewhat stiff. Then, for awhile following surgery, the neck will feel numb and firm to the touch; it may even feels somewhat bumpy in places. It may take months for sensation to return and for the tissues to regain their normal suppleness.
- Sometimes a small amount of gentle massage helps speed the softening process. There may be some residual numbness still present at one year.
- Occasionally a midline ridge will form along the suture line where the two sides of the platysmal muscle have been sutured together under the chin.
- Frequently this only occurs when the patient’s head is tilted back. Over time, this tends to soften and will subside.
- Do not participate in any strenuous exercise or activity, heavy lifting (restriction 5 lbs), or bending or stooping, for at least 2 weeks following your surgery. This will give the neck time to begin to heal and avoid any episodes of new bleeding, swelling, or soft tissue disruption. You may usually begin very light activities 2-3 weeks after surgery, upon the recommendations of your doctor. Return to strenuous activities should begin slowly and guided by comfort. However, it is still important not to participate in any strenuous activity for a total of at least 4 – 6 weeks following your surgery.
- It’s a good idea to get your hair colored just before surgery so that it will last for several weeks. You can usually color your hair or have a permanent again about 3 to 4 weeks following surgery.
- Make-up should not be worn for 7-10 days following surgery; do not wear make-up until all sutures are removed and any crusts or scabs are gone.