This is a very good question and brings up a number of very good points.
The two general types of procedures that would be discussed with you in my practice are a "Minimal Incision Necklift" and a Facelift; I will explain the difference. Direct removal of skin via a Z plasty is also possible but generally only applies to a small sub-category of patients willing to have a mid-line scar.
A "Minimal Incision Necklift" involves an incision just under your chin, below the chin crease, roughly 2.5 cm in length (this will vary according to the patient) and a 1.5 cm incision behind each ear. The general concept is to judiciously remove fat excess, stitch together the platysma muscle ( a paired, thin, long sheet of muscle visualized when you strain your neck) and place an interlocking suspension suture from side to side to help to maintain the contour of the neck. No skin is removed, because generally more skin is required to fill a concavity than to maintain a convexity. This axiom holds true up to a certain limit. I would agree that wth other posters on this topic that most patients in their late 50's are getting to to the point where the degree of excess skin cannot be addressed by this technique and skin removal becomes necessary.
For patients with this certain degree of skin excess, a traditional facelift is generally the best approach because it allows for removal of excess fat, a platysmoplasty/ muscle resuspension, and removal of skin excess via concealed incisions. Any good facelift surgeon should be able to make the incisions look inconspicuous by following a number of time honored surgical principles. As I tell my patients: If your incisions don't look good, I don't look good, and I do not want to have that happen. A responsible, ethical surgeon who takes pride in his work has a vested ineterest in an excellent outcome for his/her patients.
