Buyer beware: a number of ‘limited incision’ and ‘quick recovery’ facelift procedures are currently marketed to patients with names like “The Quicklift”, “The Lifestyle Lift”, “The Weekend Facelift”, “The S Lift”, “The MACS Lift”, etc. As with most things in life, if it sounds too good to be true, it usually is. In my opinion, the results of surgery are in direct proportion to the time and effort that the surgeon has put into the procedure. Most of the procedures I have listed above cut corners to arrive at a shorter surgical time and quicker recovery (which, by the way, isn’t always the case), and most of them undertreat or do not at all improve the neck. Additionally, ‘cutting corners’ in the neck almost always leads to distortion of the neck area skin, which often is quite readily apparent in ‘before and after’ images of these procedures with gimmicky names. Look for abnormal and unnatural-appearing skin tension lines in the lateral neck as well as below and behind the ears.
Even in the absence of other signs of facial aging, a poorly-defined or sagging neck can add years to a patients overall facial appearance. When performed expertly and with great attention to detail, a necklift surgery can dramatically restore a natural and youthful neck profile, with no outward evidence that surgery has been performed. The adjective that immediately comes to mind when I review ‘before and after’ images of my necklift patients is elegant – for restoring a youthful neck contour truly makes the patient appear not just younger but also refined and elegant.
Necklift surgery can consist of a variety of surgical techniques that are carefully selected to meet each individual patient’s particular needs. It is therefore important to select a qualified physician with a great deal of experience in numerous necklift procedures. In younger patients with good skin tone, submandibular liposuction alone may produce a dramatic improvement. For some patients with good skin tone but poor definition at the angle of the neck, I add a suture-suspension necklift to sharpen the angle between the jawline and neck. This procedure is minimally invasive, produces no easily visible incisions, and has a very quick recovery. It will not, however, improve the situation if a true excess of skin is present.
Patients with more advanced aging changes in the neck generally require tightening of their neck skin as well. The neck is the one area in facial rejuvenation where a tighter and more toned surgical result looks natural and aesthetically ideal (as opposed to the face where ‘tight’ and ‘tighter’ just looks like surgery). Neck skin removal is accomplished through incisions around the ears which can be extended a short distance into the scalp if necessary. If the incisions are created and closed correctly and without undue tension, a very natural looking result can be obtained with no obvious signs that a necklift has been performed. A great deal of experience and expertise is required to avoid distortion of the ear and surrounding skin.
Producing a level and youthful contour below the jawline often requires treatment of the soft tissues that are deep to the subcutaneous fat layer. Through a small, hidden incision below the chin the subcutaneous fat layer is thinned, delineating the anatomy of the platysma muscles which form the two parallel anterior neck ‘bands’ in many patients as early as their forties. The anterior borders of the platysma muscle can be sutured together in the midline of the neck, permanently eliminating the platysma bands and creating a sling effect which lifts and supports the neck soft tissues. This procedure is called a ‘platysmaplasty’. In some patients a prominent fat pad exists deep to the medial border of the platysma muscles which cannot be reduced by liposuction, and if necessary it is directly reduced prior to platysmaplasty to further improve the submandibular contour.
As the jawline and neck are immediately adjacent, patients with jawline aging issues such as jowls can have those issues addressed at the same time as a necklift. The skin of the jawline can be elevated in continuity with the neck skin to restore a smooth jawline contour. For many patients I combine this with structural fat grafting of hollow areas and conservative liposuction of excessively full areas to produce a jawline contour that is as smooth and youthful as possible.