At 37 Do I Really Need a Neck Lift? (photo)

Question

Hello! I am a thin healthy 37 yr old with a neck that adds years to my age! I have never gained or lost a large amount of weight so I am unsure why I have this loose skin directly under my chin. Its most noticeable when I turn my head from side to side. It seems a bit extreme to have a neck lift, is this my only option?

Kenneth Hughes, MD · Answer

A neck lift is probably the best option.Find a plastic surgeon with ELITE credentials who performs hundreds of 
facelifts, necklifts, facelift revisions, and facial procedures each 
year.  Then look at the plastic surgeon's website before and after photo
 galleries to get a sense of who can deliver the results. Kenneth 
Hughes, MD Los Angeles, CA

S. Larry Schlesinger, MD, FACS · Answer

Ethnicity, sun exposure, life style, these factors can outweigh age for determining when someone's skin and facial muscles lose their elasticity and begin to sag.  Since you have what appears to be reddish hair, a lot of freckles, and very fair skin, I am going to make the assumption that your ethnicity is at least, in part, of Celtic derivation.  Celtic skin, while beautiful, tends to lose elasticity at an earlier age, especially if other environmental factors are at play as well.  Therefore, 37 isn't all that young to have some looseness of the skin on your neck.  What is really hanging down is the muscle of your neck (the platysma muscle).  This muscle is dragging down your skin, and your photographs also show some early aging to your face. 

	I would recommend a face and neck lift, fat grafting to the face to give you back some of your youthful fullness, and also a Mittelman chin implant to correct your retrusive chin.  That being said, you should seek an in person physical exam and consultation from a Board Certified plastic surgeon experienced in facial cosmetic surgery.

Jason Emer, MD · Answer

"These are all natural parts of the aging process. What we can do is try preventative treatments or get a neck lift / face lift earlier in the aging process. There are numerous non-surgical options available, and some can be used in combination to get best outcomes, but you would need a consultation with an expert.

Some options for skin tightening include:

- Thermage radiofrequency to heat the skin, tighten it over time, and prevent the aging process
- Ultherapy high-intensity ultrasound to contract the muscle, tighten the face and neck, and prevent the aging process
- PDO NovaThreads or InstaLift threads for immediate lifting without surgery and long-term collagen production
- Sculptra injections for collagen production to areas of the face and neck with crepey skin or early sagging
- BTL Exilis Ultra, Venus Legacy, and Thermi250 for monthly collagen stimulation with facials
- ThermiRF, Renuvion (J Plasma), or Inmode BodyTite for internal heating and tightening with or without surgery
- Fillers (or facial implants) to contour the jawline and chin to improve the appearance of the neck
- Face lift / neck lift with fat grafting and fillers if you need a significant improvement​

​I would suggest getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer​​​​"

Jed H. Horowitz, MD, FACS · Answer

A neck lift is a general term used for rejuvenating the neckline to create a more youthful attractive appearance. Factors which are considered during your consultation to determine if you are a #candidate for #rejuvenating the neck include: •Visibility and amount of excess fat below the chin and along the neckline.•The presence of banding down the front of the #neck.•The amount of #excess skin and condition of your skin.•Chin Deficiency.•Presence of Prominent Digastric Muscles (a.k.a. submandibular gland fullness).Patients who desire facial rejuvenation that is affordable, quick, and effective should also consider the Lite-lift™. Like the Life-Style™ facelift, this is a modified facelift, individualized for each patient, that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.The best candidates for #LiteLift are non-smoking patients 35-60 years old with early changes of the lower face and the neck. But whose skin has elasticity with well defined bone structure. Older patients who cannot or do not wish to have a longer operation or general anesthetic can be improved with a Lite Lift™. If you are not a candidate at the time of your #consultation, your board certified plastic surgeon can recommend non-surgical alternatives to address your concern. Consulting with a board-certified plastic surgeon who specializes in #neck lift procedures is important to ensure you are receiving the best advice, care, and surgical experience possible.

Brian K. Machida, MD, FACS · Answer

A neck lift is your best option. Make sure platysmal work is done as well. I would see a qualified surgeon for a complete evaluation.

Stefan Mark Szczerba, MD · Answer

At your age I would consider all non-surgical options first. In our office we would recommend Ulthera first. An additional treatment would be skin tightening with an IPL machine. We use the Sciton BBL Skintyte for these "fotofacial" treatments however Ulthera first. If these don't improve your situation, consider a visiting a plastic surgeon who performs corset platysmaplasty surgery with necklift surgery.

Sam Naficy, MD, FACS · Answer

Based on your description it appears that you are a good candidate for neck lift surgery.  Non -surgical options (Thermage, Ulthera) have limited long-term effects

Larry S. Nichter, MD, MS, FACS · Answer

The lax skin in your upper neck and platysma banding can be approached directly by a platysma tightening (platysmaplasty) withe either a facelift, mini-facelift, or neck lift. The least invasive would be a mini-facelift. The one I prefer and one of the least invasive is a Lite Lift which is performed in my office under local anesthesia with some oral sedation without the need for IV sedation or general anesthesia

Farhan Taghizadeh, MD · Answer

The issue that you pose is a critical one in my opinion about the large number of younger women and men who have early neck laxity and ponder surgical correction. The concerns are valid as most patients in their 30s I meet want to discuss and explore non-surgical options first. Besides invasiveness of surgery, younger patients often do not want to face surgical revision in the future to maintain their new look.

	 

	To this end, the aesthetic industry has spent alot of energy and money to try and find technologies to address your unique concern. Here is my approach based on where the industry stands today:

	 

	1. New RF systems as well as Ulthera are becoming more effective at dealing with neck laxity. The way these newer devices deliver energy is much better than previous generation of devices, and I have personally seen very good results with some of these systems. Given the minimally invasive nature of these technologies, there is no harm in trialing these systems and seeing if they work, or in the least, temporize your laxity to some later point when you may want something more definitive done.

	 

	2. Advanced liposuction like laser lipolysis has the potential to provide excellent results in this arena. The ability of these systems to efficiently warm the skin as well as melt fat allows for very good results with minimal invasiveness in the submentum. There is variability in surgeon experience with these devices, but I have personally seen excellent results using laser lipolysis.

	 

	3. There are new neck lifting options that one can combine with traditional or advanced liposuction that I have reviewed and seen very good results, especially with patients in their mid 30s to mid 40s. The technique I have been most impressed is the ImplicitCare Trampolene Lift.  The publicaitons on this techology have shown very good results, and I think there will be more options using technologies like this in the future.

	 

	4. Finally, there are a host of short incision, short flap lifts one can consider in their late 30s to early 50s. The one factor I have seen in making these lifts last longer is the quality of suture, and the ability of the surgeon to get a good vertical component to their lifts. Here, I really think the Quill suture offers a distinct advantage for these types of lifts.

	 

	Hope this helps. Good luck.

Michael Law, MD · Answer

Though it is not technically part of the face, a neck with loose, sagging skin can age the face dramatically. A neck lift is a standard part of most facelift surgeries, as the neck skin is mobilized in continuity with the lower face.

	Immediately under the skin of the neck is the platysma muscle, which you can easily see in a mirror when you clench your teeth and tighten your jaw. In youth, this paired muscle meets in the midline below the chin. With age, the right and left sides of the platysma often separate, producing vertical 'cords' in the anterior neck. The platysma can be divided anteriorly and tightened during neck lift cosmetic surgery to permanently eliminate these 'cords' and improve the neck contour. One tightened in the midline below the chin, lateral traction on the platysma then creates a 'sling' which elevates the soft tissues below the jawline.

	In cosmetic surgery patients that do not have a sharp transition in profile between the submental area (area below the jawline) and the anterior neck, and in patients who simply want that transition enhanced, I add a 'suture suspension necklift'. A permanent suture is passed subcutaneously across the anterior neck, at the level corresponding to depth of the angle between the submental area and anterior neck, and is then anchored to the deep soft tissues behind each earlobe. This suspension cosmetic surgery procedure can dramatically enhance the definition between the jawline and anterior neck, producing a more elegant profile.

	The neck is without question the primary 'facelift' aesthetic area where subtractive (excisional) and tightening procedures restore a truly youthful contour. Once again, take a look at the fashion magazines: essentially every neck you'll see demonstrates something close to a right angle between the neck and jaw. When it comes to the neck, and only in the neck, flat is good.

At 37 Do I Really Need a Neck Lift? (photo)

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