Long Island Neck Lift doctors

In addition to redraping skin with a necklift, several other issues may need attention depending on you as an individual.  Excess fat in the neck can be removed without a significant incision using liposuction.  Banding from the platysma muscle required the incision under the chin in order to join the muscle bands back together in the midline.  Not all patients require this, it is specific to how you've aged.  An experienced facelift/necklift surgeon can advise you on the necessity of the midline incision.  This is usually performed in conjunction with a facelift or necklift but is occasionally performed as a stand along procedure -platysmaplasty -in patients who have already undergone a facelift or necklift or who don't yet have alot of skin redundancy but who have muscle banding in the neck that is not responding to Botox.

Hi saxophone1,

An isolated submentoplasty does not remove any skin from the area under the chin; therefore, good skin elasticity is crucial for a submentoplasty to contract the skin under the chin to reduce any hanging.  An isolated submentoplasty is essentially a platysmaplasty (sewing together the thin muscles under the chin to create a firm foundation for the skin to lay over) with or without liposuction or fat reduction.  If the patient is already very thin, I am reluctant to further defat their neck, because the fat under the skin helps to prevent crepey skin.  Keeping a healthy layer of fat is helpful in keeping the texture of the neck skin youthful. My guideline age cut off for an isolated submentoplasty is 45 years old, some patients younger than 45 may have so much sun damage and loss of elasticity, that a regular necklift may be of more benefit for these patients, while some patients older the 45 years old with minimal sun exposure and baby like skin may be the exceptions to the 45 year old cut off age.

The nice thing with the submentoplasty is that there is only a single incision in a crease under the chin.  I have seen some surgeon make a 1-1/2" to 2" incision under the chin, which would make the incision under the chin appear to be a negative; however, with a good headlight and retractors, I am routinely able to perform the submentoplasty in a 1/2" to 3/4" incision.  A simple liposuction incision may already be 1/4" in width, so the additional 1/4" more to sew the muscle bands together seems to be a good risk/benefit ratio.

I'm assuming that you were asking about a direct necklift when you asked about a direct submentoplasty.  This is a direct skin removal under the chin.  Essentially the hanging skin is removed and the cut edges are sewn together.  While the skin is open, the platysmaplasty can also be performed.  Of note, if a direct necklift or submentoplasty extends beyond the transition from the area under the chin to the beginning of the neck (the cerviomental angle) then the incision should not be a straight line.  Some kind of zig zag incision may need to be performed right at the junction of the chin to the neck to prevent a contracture scar which forms a web along this incision.  This procedure requires more sewing of the skin than the isolated submentoplasty, as well as care in designing the incision properly to prevent a web from forming along this incision.

The price ranges will vary from the middle of the country as compared to parts of the East and West coast.  My guess is the range would be as low as $2000 for liposuction alone to up to $5000 and upwards for a direct submentoplasty.  This typically may not include any operating room or anesthesia fees if performed in an ambulatory surgery center.  Their fees also vary from region to region and are typically billed by a flat first hour rate, then by the half hour for the remaining time.  Having said that, on a thin patient with minimal excess skin and fat, this could also be performed as an office based procedure under local anesthesia with oral sedation (valium).  Since this is essentially a skin and fat surgery, once the skin is injected with local anesthesia, the patient doesn't feel any pain, only the pushing and pulling of the soft tissues to perform the operation.

I hope this helps.  Good luck with everything!

Best,

Dr. Yang

Hi Philadelphia7808,

When examining a patient with loose hanging skin under the chin, I check to see if the skin band is actually the platysma (neck muscle) band protruding through the skin.   I will ask the patient to clench their jaw and flex their neck so they feel pressure pulling up on their collar bones.  The platysma muscle is attached from the collar bone to the sides of the jaw.  If the skin band protrudes even further, then I would not perform a necklift by only pulling on the skin from the sides.  Why?  The surgeon can tighten the outer part of the platysma muscle behind the ear and then the excess skin can be trimmed from the incisions behind the ear; however, the platysma muscle does not like to be pulled to the side, and the platysma muscle will want to return to its original position.  When the muscle returns to the original position, since nothing was done to the muscle band, it can protrude again and it will look like the skin band has returned.  

I think that you bring up a good point regarding just removing skin.  The main reason why there is a "lateral necklift" which is pulling on the platysma muscle from the sides in order to trim off the extra skin, is that if the skin were simply separated, there may not be much "slack" to trim.  By not separating the tissues under the chin and pulling on the deeper structures allows the surgeon to use the strong tissues under the skin to pull on the skin itself.  However, in my experience these stronger tissues may have a tendency to return to its original position and subsequently pull the skin back with it.  This can result in a return of skin laxity under the chin as well as thickened scars behind the ears in some cases.

There is a new technology called tissue glue (Tisseal and Artiss).  Tissue glue is a product processes human blood products which clot the blood, and use it as a glue to hold tissues together.  Tisseal has been FDA approved for heart surgery, brain surgery, and other medical uses, but more recently a diluted version of Tisseal, called Artiss was FDA approved for skin grafts for burn victims.  Baxter, the medical company which makes Tisseal and Artiss, recently got an FDA approved indication specifically for Face and Necklift surgery called Artiss.  

By using tissue glue, the extra skin can be freed from under the chin and all the way to the back of the ears, and the excess skin can be pushed back without performing a corset platysmaplasty, as you suggested.  The Artiss tissue glue can help to hold the extra strength needed to support the skin removal, without pulling on the deeper tissues.  If I were to perform a skin only necklift, this would be the way that I would do it.  If I didn't use the Artiss Tissue Glue, I would worry that the skin incision would be holding all of the strength of the skin removal, and cause an ugly scar.  Using the tissue glue allows the skin to stick down like "duct tape" and then the incision itself, doesn't have much pull on it, and can make for a finer scar.

I hope that helps.  Good Luck on your plastic surgery journey.

Best,

Dr. Yang