One of the most common facial surgery questions we receive is “how do I know whether I need a neck lift - or a lower facelift?”
Online forums and surgery websites provide conflicting information and terminology for these procedures; what they entail, and what they address for the ageing face - causing greater confusion. What is colloquially known as a ‘neck lift’ may not technically refer to the surgical procedure that this title traditionally entailed.
The face and neck age together and for the most part a neck lift should include elevation of the lower face. Conversely a lower facelift should includes tightening of the neck. In modern times where facelift and neck lift surgery aims to be less invasive, the operation has been discussed as one of the same. The one exception is an isolated platysmaplasty which can tighten the mid line neck without having any effect on the face. When performed on its own it is used to improve a sagging neck in a young patient who has no other signs of facial ageing.
A neck lift - or lower rhytidectomy - aims to improve the signs of ageing in the neck and lower jawline area, including:
- Loose neck skin or ‘turkey wattle’
- Excess skin in the lower face and jowls
- Excess fatty deposits under the chin
- Visible muscle bands running down the neck, which created abnormal contours
- Horizontal lines running across the neck
- Depending on your desired result, your neck lift surgery can be performed through a traditional complete neck lift incision, or a limited-incision neck lift.
- A limited-incision neck lift may involve incisions only around the ear. While the incisions are shorter and scars less visible, the results of this approach can be more limited.
If there is excess skin below the jawline, on the neck - or small deposits of fat accumulated under the chin area - a neck lift procedure may also be required. This procedure is tailored to the patient’s desired outcome. In some cases, liposuction may be used to remove excess fat, while in slim patients, only the platysma muscle is usually tightened and excess skin removed. The neck lift incision is made across the front of the neck, and the scar is often integrated into the lines of the skin to reduce its appearance.
What does a neck lift procedure involve?
A traditional neck lift incision starts in the hairline at the level of the hair in front of the ear, proceeds down and around the ear - and ends in the scalp around the back of the neck. Fat may be transferred, sculpting the jowls and neck - or dermal fillers can be used to recreate bone structure and fat that ageing has depleted.
The tissue underlying the neck skin is repositioned and if the platysma muscle is lax, it may be tightened. Skin is placed back over the uplifted contours and the excess skin is cut away. Often liposuction is also used to remove fat. A separate incision under the chin is usually necessary for liposuction and muscle repair, as mentioned above.
What won’t neck lift surgery address?
As a facial rejuvenation procedure, a neck lift will not change your overall appearance - and will not halt the ageing process. Neck lift surgery will not improve the condition of the skin on your neck or décolletage; non surgical skin treatments, including laser, micro needling and specialist skincare will address the pigmentation and deterioration of the skin health in these areas.
A neck lift can only be performed surgically; non-surgical rejuvenation treatments cannot achieve the same results in lifting and tightening the skin, but may help delay the time at which a neck lift becomes appropriate.
Often, people think they need a neck lift to address their jowls and sagging skin in their lower face, however the cause of their concerns actually begin with the loss (and migration) of their underlying facial support structures, such as fat - causing skin and tissue to hang around the lower face. In this case, a facelift - and subtle use of dermal fillers to replace lost bone structure and fat in the upper mid face - may address these issues, and a neck lift might not be required.
Is neck lift surgery performed on its own?
The aim of all facial cosmetic and plastic surgery should be to create as much balance and harmony as possible, while retaining a natural, healthy and realistic appearance. When the neck area doesn’t match the upper facial appearance, a neck lift may be a good solution; in some cases a neck lift may be performed on it’s own in cases where the neck has visibly aged quicker than the face. Usually, the face and neck age together, meaning a facelift and neck lift are often integrated into a single procedure, to harmonise the facial features and balance the results. A facelift might restore your facial appearance back to that of a 45 year old, but if your neck still looks like it’s 60 with protruding vertical platysmal bands and horizontal lining, the face and neck may look at odds beside each other, which is what we sometimes see in the notorious Hollywood plastic surgery tabloid media, that’s dead giveaway for facelift surgery - without consideration of the adjacent ageing neck.
When is facelift surgery performed with neck lift surgery?
Most neck lift surgery performed by Dr Sharp is coupled with a facelift that particularly focuses on the lower face, to ensure seamless aesthetic and functional results. Facelift surgery is often performed on its own in patients who are in their 40’s and 50’s, but if a patient is having their first facelift in their 60’s, Dr Sharp may recommend a neck lift as well, as this area will be demonstrating advanced signs of ageing.
By eliminating loose, sagging facial skin and repositioning underlying support structures, facelift surgery can create a ‘lifted’ effect that significantly reduces the visible signs of ageing like no other treatment or procedure can. When combined with neck lift, a facelift can compliment the reversal of visible signs of ageing on the neck as well - including sagging skin, loss of definition in the undercroft of the chin, neck wrinkles and thick bands.
What other procedures are commonly performed alongside a neck lift?
Rejuvenation procedures that are routinely performed in conjunction with a neck lift include fat transfer, liposuction, genionplasty (chin implant surgery to create chin projection where a deficit exists), lips and cheek enhancement or eyelid surgery, to rejuvenate ageing or excess skin above the eyes.
before and after facelift surgery and Fraxel treatment with Dr Sharp (at 12 weeks post surgery)
Dr Sharp’s advice for those considering any facial surgery:
Ask your surgeon to explain:
- the steps of the procedure
- what it aims to accomplish
- the location of incisions
- potential pitfalls and complications.
And ensure you don’t sign anything until you understand explicitly what you are consenting to!