Danny Soares, MD

I smiled at the term "Pelican Pouch" as I had not seen the term applied to describe a person's neck :). Regardless of whether it's a Pelican Pouch or a Turkey Waddle, the ideal treatment is often a combination of techniques. Although the photo that you have provided is in the distance and there is no profile view or ability to palpate the neck tissues, it appears that you have some aging of the neck and lower face as well as moderate fat deposition in the chin region (submental area) of the neck. Rejuvenation of the neck always benefits from a surgical lift of the face, and in individuals with moderate to severe aging of the neck, a high-powered lifting technique, such as a deep-plane or high-SMAS facelift, is best suited to address faces in which a significant amount of tissue excursion is necessary. In addition, achieving an ideal neck profile also typically requires employing a procedure that tightens the anterior neck, such as an anterior platysmal plication. A platysma plication ensures that the convex appearance of the pelican pouch can be transformed in to a concave, youthful and slimmer neck profile. Based on the preliminary information provided by your photo, I suspect that the ideal technique, for you, would be a High-SMAS lift in conjunction with an anterior platysmal plication with simultaneous liposuction or open lipectomy (fat removal) from the neck. Please see the attached video if you'd like to learn more about how surgeons maximize rejuvenation of the neck in facelifting. Please also be sure to consult with at least two board-certified plastic surgeons with expertise in facial rejuvenation. Best of luck to you!

In my view, the concept of an isolated "Neck Lift" is a flawed concept. This is because at least 50% of the aging that occurs in the neck results from the vertical descent of the lower facial tissues, and only a vertical suspension of these tissues will correct that component of aging. If the goal is to truly treat AGING of the neck, then the ideal approach will always require suspension of the facial tissues. Without addressing the face, an isolated targeting of the neck may result in inadequate results and possibly the distortion of the lower face (as the neck is in tension, but the facial tissues remain droopy). There are instances in which an isolated surgical procedure targeting only the neck is beneficial, but these are rarely utilized to treat aging; rather, they are employed to maximize the results, such as enhancing the profile angle of the neck. Individuals with only mild aging and with slender necks and excellent bone structure can see the neck fully and thoroughly rejuvenated with only a facelift. In patients with bulky necks, platysmal bands, and moderate to severe aging of the face/neck, a combination procedure using a high-powered facelift technique (such as a Deep Plane or High SMAS lift) in conjunction with an anterior neck plication (anterior platysma plication) offers the most thorough rejuvenation. I firmly believe that there exists only one truly best "surgical recipe" for each patient, and that, as a result, each patient requires different, custom-made approaches that are designed to best fit their features. A one-size-fits-all approach is going to result in abnormal or inadequate results in a significant number of patients. In my practice I routinely employ a wide variety of lifting techniques designed for patients with varying degrees of facial aging, neck shapes, bone structure, and fat distribution. Please consult with at least board-certified plastic surgeons with expertise in facial rejuvenation before deciding to undergo facial rejuvenation surgery. Feel free to watch the video attached for more information on how surgeons employ adjunct procedures on top of facelifting in order to achieve maximal neck rejuvenation. Best of luck to you!

Based on the photograph provided, it is clear that there exists moderate aging of the lower face AND neck, and therefore achieving a natural rejuvenation of both will require a combination approach that handles the facial and neck aging. Many people fail to realize that a facelift targets the neck because lifting the face always improves the apperance of the neck; the procedure known as a facelift, termed a cervicofacial rhytidectomy, actually is designed to rejuvenate the lower face AND neck directly. In your case, focusing on a simple suspension of the platysma would likely be a mistake, as any approach to your neck that does not include a facelift will likely result in a distorted outcome. In other words, attempting to correct the neck without correcting the droopy mid- and lower-face will create an unnatural result. With that being said, you will likely benefit greatly from platysmal work, as the bulkiness of the neck will need an adjunct procedure to achieve maximal rejuvenation of the neck profile. From the photo provided, I would be most likely to recommend a High-SMAS facelift with an anterior platysmal plication depending on findings during the physical examination. Please be sure to see a board certified facial plastic surgeon with experience in these techniques and obtain at least two different opinions prior to choosing to undergo the procedure. Surgical procedures marketed as "mini-lifts" are not likely to benefit you sufficiently and the procedure that will achieve the most natural results may require a 2-3 weeks of "social downtime". Please see the video(s) linked below for additional information. Best of luck!

There exist different techniques for removal of excess fat in the submental region (under the chin), with the ideal technique depending upon the location of the fat. In the majority of patients, a substantial amount of fat is located in the subcutaneous layer, or underneath the skin; subcutaneous fat can be easily removed via liposuction, which requires only 5 mm incisions and heal nearly imperceptibly. In a small percentage of patients, there may also be significant fat located underneath the platysma muscle, meaning that the fat is completely out of reach of liposuction. In these patients, an open submental lipectomy is required. This procedure typically employs a 2-3 cm incision that is well concealed in the submental crease. Although the procedure is more aggressive than liposuction, the recovery is fairly simple and the incision heals typically very well in fairly inconspicuous fashion. Individuals who are tall are more likely to have a noticeable submental incision, but for the most part it is a scar that is barely visible. Please see the video linked below for additional information of neck rejuvenation procedures. Best of luck!

Neck rejuvenation is a more complex science than most realize, because it merges together features of the lower face, such as the continuity of the jawline, the projection of the chin, as well as the neck, such as the position of the larynx + hyoid bone, and the degree of fat accumulation in the chin and any amount of aging of the muscle layer (platysma + SMAS). As a result, there often are a variety of treatments that can help rejuvenate the neck or enhance the profile appearance. Based on the photo that you have provided, which does not truly provide a complete lateral view, there indeed seems to be a mild to moderate degree of under-projection of the chin in VERTICAL dimension. It's important to note that the chin appears sufficiently projected in the horizontal dimension, but in order to be certain, an in-office evaluation with 3D scanning and morphing of the face would be very helpful. Although one would need to palpate the area under the chin to be certain, there does not appear to be excess fat in the submental region. However, there is prominence of the submental musculature, which includes the anterior digastric musculature, but that may be fully concealed with chin augmentation vertically. The hyoid bone appears to be very favorably positioned, meaning that you may do well from an aesthetic standpoint. Sometimes individuals have deposits of fat underneath the platysma muscle even though they are fit, this tends to be hereditary, so the fact that your are fit does not exclude abnormal fat deposition. Palpation of the area should allow one to determine if subplatysmal fat exists. If there is subplatysmal fat, then this fat needs to be removed surgically via an open approach, as it is completely out of the reach of liposuction; I do not expect that you have significant subplatysmal fat however. As a result, the procedure that may benefit you the most would be a VERTICAL chin augmentation, known as an alloplastic augmentation genioplasty. There are implants specifically designed for vertical chin augmentation, made by Implantech, which offer superb results. These implants are incredibly well suited for males with vertically hypoplastic chins. The surgical procedure is relatively straightforward and can be done with minimal anesthesia. I strongly recommend that you see a board-certified facial plastic surgeon with a 3D scanning photo morphing capabilities in the office. The VECTRA scanner is one of the most commonly employed tools, but there are others available. In my office, I employ the Vectra scanner to obtain a 3D image of the patient's face; next, I morph the patient's chin to a degree that both me and my patient agree is most aesthetic; finally, I obtain exact measurements regarding the degree of projection necessary. Based on these measurements, I then select the ideal implant type, shape, and size. Silicone implants (silastic) are the most commonly used type. I always have all sizes and shapes available during the surgery to trial just to make sure the absolute best implant is used. In about 50% of individuals, I will also carve the silicone implant to ensure a quality result. Please see the video attached to this answer for more answers on neck rejuvenation. Best of luck!