43 years old with saggy neck. Can I avoid a full neck lift? (Photo)

43 years old with saggy neck. Help. I've tried creams, Botox, nova threads, none of which have worked. My career has me carrying weighty equipment around the shoulders/neck area which has taken a toll. My face looks young. One PS told me to come back in ten years. One PS said he would do the full neck lift, but the scars scare me. My neck makes me so insecure. I hate looking in the mirror.

Doctor Answers 19

Neck Lift

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Thank you for your question. You seem to be an ideal candidate for the laser-assisted weekend necklift, which is an exciting new way to improve the look of your neck and jowl regions because the procedure is less invasive and offers a quicker recovery than a full neck lift. I suggest that you move forward and consult with a board certified facial plastic surgeon.

Best wishes,

Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

43 years old with saggy neck. Can I avoid a full neck lift?

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I suggest that you meet for a face-to-face consultation with an ABPS board-certified plastic surgeon or experienced facial ENT plastic surgeon to discuss options.  For your age the muscles/skin bands in your neck are unusually prominent and would be best addressed with a necklift if they have not responded to appropriate injection with botulinum toxin.  In my practice I usually use only incisions behind the ear and usually though not always avoid a submental incision but see no objection to someone else approaching it in that direction.  I think you cannot expect perfection however with your strong jaw line I think you should have a nice result from platysmaplasty and neck skin excision.  Best wishes,

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California
IG: jonperlmanmd

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 32 reviews

FaceTite makes it possible

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FaceTite is a technology that tightens the skin (several studies done and published in peer reviewed journals) 25-35%.  In someone as young as you, FaceTite should provide adequate tightening of the skin without posterior incisions behind the ear and into the hairline.  FaceTite is performed through needle holes, similar to those made when blood is drawn from your arm. It also can tighten the jowls.  

A platysmaplasty can be performed for the bands that you have under your neck, through a small incision under the chin.  We have performed many of these combination techniques, and they work well, particularly in the 40-55 year old age group.

These procedures can be performed under local or general anesthesia.  There is very little bruising or bleeding.

Gregory S. Keller, MD, FACS
Santa Barbara Facial Plastic Surgeon
4.9 out of 5 stars 15 reviews

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Neck looseness, minimal results with nonsurgical treatments

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Hello Sukipie - it sounds like you have tried a few of the nonsurgical options for neck tightening. Unfortunately you have very little fat which can make skin looseness and visualization of platysmal bands more obvious. The most effective solution to this problem is to address the bands in the front of your neck through a small incision under the chin. Depending on the amount of extra skin you have, you may also need a neck lift. Scars typically heal well but given your occupation, it sounds like you would likely need to take some time off of any heavy lifting while at work. 

Jordan Rihani, MD
Southlake Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

43 years old with saggy neck. Can I avoid a full neck lift?

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 Hi, I have performed many facelifts  and neck lifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  From the photos, jowls are present and there is excess skin under the chin.  

  Along with the minimally, invasive SMAS facelift described below, some of the excess skin below the chin can be removed using a small, curved incision under the chin.  This along with skin removed in front and behind the ear will tend to reduce the skin excess by around 70% or more.

 If anterior platysmal bands are present or the maximum amount of neck skin is to be removed, a "formal" neck lift can be done.  In this procedure, the face and neck tissues are elevated using a curved incision around the front (explained later) of the ear that continues in the crease behind the ear and then 3 inches into the posterior hairline.  The tissue is dissected from that point all the way across the entire neck to the same position on the other side of the head in a dissection that is as long vertically as the entire neck.  The Platysma muscles are tightened using a curved incision under the chin and each side is pulled upward and back again being tightened at a line behind each ear (under the tissues).  Since the skin flap pull is up and back, this will pick up any tissue laxity along the jaw line or "jowls" which must be dissected and flattened out using a lower facelift (incision around the front of the ears).  If this isn't done, pleats of excess skin will appear below each ear.  This is an extensive surgery taking 4 1/2 to 5 hours with large incisions, possible hair loss and months of recovery.

 If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.

 My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:

  • very small incisions and no incisions extend or are placed within the hair.
  • minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed from the face and neck
  • excess skin removed from the face and neck
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op

 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.

 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Insecure about neck

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Thank you for the question and pictures.   I think that your neck does appear more "aged" than your face, and that a neck lift may be a good option, though only a physical exam with an in depth discussion about your goals and expectations in the context of your anatomy would tell what surgery you are a candidate for, and which surgery is best for you.  Good luck! 

Summit Kundaria, MD
Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

What to do for saggy neck skin

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Thanks for your question and photos.  You are certainly not alone with this concern.  From your photos, it does indeed appear that you have a disproportionate looseness of the neck immediately under your jaw.  I think you might be an excellent candidate for some form of mini-facelift combined with skin-tightening laser/radiofrequency microneedling. This could be done easily without general anesthesia, with small, well-concealed incisions, and very rapid recovery.

David Hartman, MD, FACS
Dover Facial Plastic Surgeon
5.0 out of 5 stars 9 reviews

Neck lift

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There are non-surgical tightening procedures, such a the Viora Reaction, that can help tighten the neck skin. The biggest risk is really just a financial one. Will i work well enough for you to feel as though yoo have gotten your money's worth? Fillers and Botox are not the answer. An isolated necklift is a great procedure with very minimal scars. It really depends on your anatomy and what you don't like. At this point I recommend going fo some consults. Good luck.

What can help my neck laxity?

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The limited view on your pictures shows the laxity of your neck under the chin. An in person examination will show if the two bands under your chin are skin laxity or platysma muscle bands. It looks like the problem could be solved by a short scar cheek lift. This should eliminate the excess skin under your chin without an incision behind you ears. If the bands are muscle related they can be taken care of through a small incision under your chin. I do this under local anesthesia with some sedation and the recovery is fast. if you like to send full face pictures from front and the sides, I can give you more information about what can be done. I don't think there is anything short of surgery to help you. The main question is, how can surgery be done with the shortest scars, quickest recovery and the best results. 

Your neck

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Thanks for posting photos with your question. I am not surprised to read that creams, tox, and threads did not solve your problem. Your skin and platysma (underlying muscle) are loose. In this setting, surgery is your answer. You should have a lower facelift and neck lift. Doing the neck alone will be imbalanced. Dont fear the scars! Just have a deep plane lift so the tension is on the underlying musculature. This will allow for awesome healing of the skin and avoidance of a "pulled" look. Best of luck!

Benjamin C. Paul, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 40 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.