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This article has been medically reviewed for accuracy by New York board-certified facial plastic surgeon, Dr. Dilip Madnani on September 28, 2020.
It seems to happen rather suddenly: for years, your neck is firm, with a crisp jawline outlining your face—and then one day, you notice that the skin from your chin to your chest just looks loose. What’s to blame? It could be age, genetics, gravity…the list goes on. But at the end of the day, no number of expensive creams, facial exercises or at-home jawline sculpting tools will significantly tighten up jowls.
Luckily, there are two prominent in-office procedures that can deliver visible neck-correcting results: a lower facelift and neck lift. While both can create more definition along the jowls, there are a few major differences between them. Here, we break down each procedure and its potential risks so that you can decide which one is right for you.
First, what is a lower facelift?
“A lower facelift corrects the jowls and the neck [by repositioning the skin and muscle],” says New York City facial plastic surgeon Dr. Jennifer Levine. During the procedure, the upper portion of the platysma muscle—which extends from the upper chest, over the collarbone and along the sides of the neck—is often adjusted. The platysma muscle is connected to a layer of firm tissue, or fascia, called the superficial musculoaponeurotic system (SMAS). “By repositioning this layer, tissues and fat pads that have descended are put back to their original positions,” explains Southlake, Texas, facial plastic surgeon Dr. Jordan Rihani. “This also allows improvement in the appearance of the nasolabial folds and marionette lines.”
While a full facelift can treat sagging along the upper face, midface and lower face, a lower facelift specifically targets loose jowls, laugh lines and sagging cheeks. The incision for a lower facelift typically begins near the front of the ears and extends to the hairline. Skin, fat tissue, and the platysma muscle are then pulled into a lifted position in order to give the jawline a much tighter appearance.
What is a neck lift?
A neck lift is similar in concept to a lower facelift, but the main goal is to improve the appearance of the neck—not laugh lines or sagging cheeks. “The incisions are continued further behind the ear and into the hairline, to remove excess skin of the neck,” says Dr. Rihani. “The SMAS layer is repositioned in a similar fashion [as a lower facelift] but extends further down [the neck].”
Additionally, if a patient has prominent bands in the front of the neck, these are addressed through a small incision under the chin during a neck lift. As we age, the platysma muscles tend to separate and create two distinct vertical bands that run from the chin to the chest. Because of this, doctors often opt for a platysmaplasty—aka neck lift—in order to sew these two ropey-looking bands together and smooth the area.
For those trying to address a double chin, liposuction is often combined with a neck lift in order to remove excess fat from the area and improve the angles of the jaw. Finally, patients who struggle with skin laxity—which is the main cause of the dreaded turkey neck—will undergo skin trimming during a neck lift, to sharpen the jawline.
“Patients who have a lot of skin laxity in the neck and wide separation of the platysmal bands in the midline, will inevitably require a lower facelift at the same time,” says New York board-certified facial plastic surgeon, Dr. Dilip Madnani. “It’s very difficult to address just the neck banding without addressing the jowling, the face and neck skin and muscle layers are continuous.”
What are the main differences between a lower facelift and a neck lift?
While some people use these terms interchangeably, there are clear differences between the two procedures. According to Dr. Levine, a classic neck lift will not address the jawline and jowls—it affects only the neck. “The difference is also in the incision,” she adds. “In order to reposition the lower face, there needs to be an anterior incision, meaning an incision in the front of the ear, as well as behind the ear.” This incision can be extended higher up to also include lifting the cheek area. On the other hand, a neck lift includes incisions that are generally around the ears and below the chin. According to Dr. Madnani, for patients with minimal skin laxity, sometimes a neck lift can be performed just via an anterior approach- under the chin and can give fantastic results, especially when combined with liposuction. “A lower facelift cannot be addressed via this approach,” he adds.
Related: 5 Signs You’re a Good Candidate for a Facelift—and 4 Signs You’re Not
Who is a good candidate for a lower facelift, and who would be a better candidate for a neck lift?
“Most [good candidates for these procedures] need a lower facelift and a neck lift,” stresses Dr. Levine. Many patients require some correction to the neck and the lower face since, anatomically speaking, the muscle extends from the lower face to the neck—it’s all connected. “In order to have harmonious results and not [have] discrepancy between the face and neck, both should be performed,” adds Dr. Levine.
Dr. Rihani agrees: “When patients develop enough skin laxity to warrant a neck lift, many of them have enough skin that will probably need a lower facelift as well,” he says. However, for patients concerned about the location of the incisions or for patients with only mild jowling, then a neck lift may be performed alone. If the patient has a lot of visible platysmal banding, then a neck lift done under the chin, to bring the muscle bands together, is necessary—not a lower facelift.
On the other hand, the ideal candidate for a lower facelift is a patient with some jowling but only minimal sagging or extra skin along their neck. Patients who need a lift along their mouth to correct laugh lines, in addition to lifting the skin around the jawline, are better suited for a lower face-lift. Ultimately, the individual anatomy of the patient directs the doctor’s course of treatment.
Do the risks differ between the two procedures?
As with any surgery, there are risks to getting a lower facelift or a neck lift. Between them, the risks are very similar. “The main risk is a hematoma, which is a collection of blood under the skin,” explains Dr. Levine. “The patient should avoid aspirin, Advil, Motrin, and all medications and supplements that cause increased bleeding [before surgery].” Dr. Madnani advises his patients to refrain from exercising, heavy lifting (more than 10 lbs), bending over, or walking up many flights of stairs for two weeks after surgery to further reduce the risk of hematoma.
Patients should also stop smoking several weeks before the surgery. “This is important to prevent wound healing complications and necrosis, or death of the skin flaps,” explains Dr. Levine. Risk of injury to the facial nerve is uncommon but possible, and Dr. Rihani warns that sensation in the skin may be temporarily altered post-surgery. To help ensure a favorable outcome, these procedures should always be performed by an experienced plastic surgeon who is familiar with facial anatomy.
