This outpatient surgery is performed under either local anesthesia with IV sedation or general anesthesia, depending on surgeon and patient preferences. Some surgeons, like Dr. Mesa, perform traditional or deep plane neck lifts with the patient awake, under local anesthesia (without any IV sedation or general anesthesia). If you and your surgeon are comfortable with this approach, it’s well worth considering to lower your cost and avoid the risks associated with general anesthesia.
Based on the extent of your procedure, it will take one to three hours.
The three common issues targeted by the procedure are excess fat, muscle laxity (loose platysma muscles), and sagging neck skin. Not all surgeons define or perform a neck lift in the same way, so have a detailed conversation about your goals and your surgeon's technique during your initial consultation.
Also ask where they’ll place your incisions, so you’ll know what kind of neck lift scars to expect. “A skilled surgeon usually can disguise your incisions by placing them behind your ears or along your lower hairline, so you should expect minimal visible scarring from a neck lift,” says Seattle facial plastic surgeon Dr. William Portuese.
For patients with minimal excess skin, the neck anatomy can often be accessed through a small incision hidden under the chin (the submental area).
If excess skin needs to be removed, however, surgeons typically need to make incisions around the ears, sometimes in addition to the submental incision. When a neck lift is performed alone (not combined with a facelift), those incisions can usually be limited to the backside of the ears, to make the subsequent neck lift scars less visible.
Once the incisions are made, here’s how a neck lift is done.
Fat removal
Surgeons can use a few different methods to remove the excess fat that creates a heavy-looking neck, double chin, or jowls.
- When there’s fat only above the platysma muscle, attached to the skin, liposuction can remove it through three small incisions—one below the chin and one behind each ear.
- Most patients have fat both above and below the platysma muscle. In this situation, the surgeon removes the deeper fat manually, using direct visualization (usually with a lighted retractor). They then remove the excess fat above the platysma with liposuction.
Platysmaplasty
The platysma muscle separates and loosens with age, which creates thin vertical bands (generally two). As the muscle ages, it presses and stretches against the skin, making these ropey neck bands more obvious and softening the jawline. Platysma muscle cords also contribute to turkey neck.
To address these bands, a surgeon performs a platysmaplasty. This involves:
- Sewing the two sides of the platysma muscle in the front of the neck and under the chin together like a corset (in fact, it’s often called a corset platysmaplasty).
- Possibly removing some excess platysma, to further tighten it.
- Attaching it more tightly to other neck muscles or structures.
Cervicoplasty
Aging or weight loss (or gain) can create loose skin, so most neck lifts involve this procedure, which entails:
- Removing excess skin.
- Tightening the remaining skin, to smooth wrinkles and create a more youthful contour.
Some surgeons also use a technique called a "short scar neck lift," to improve contours without removing excess skin. They make a small incision under the chin to modify the underlying neck structure, creating more surface area for the skin. The result is a sharper jawline and smoother neck.
Once the procedure is complete, incisions are closed with tiny, dissolvable sutures.
