I'm in the UK - not sure if you can help? Do I need a neck lift or lower face lift? (Photos)

Hi I am based in Brighton UK. I have always carried fat under the chin, even as a child and then in my twenties when I only weighed 120lb. Now at 45 it is starting to sag! I hate every photo of myself and would actually like to have 1 chin and a jawline! I have good skin for my age with few lines. I am constantly told, especially as I had surgical menopause due to cancer at age 40. I weigh 140lb and height 5' 3". Please advise me on my options. Many thanks! :-)

Doctor Answers 14

Neck lift versus face lift

Dear foxybrighton,

You would benefit from laser assisted contouring of the lower face and neck (laser liposuction to remove the jowls and excess fatty tissue in the neck and under the chin) with facelift surgery (to soften the folds around the mouth, highlight the cheeks, define the jawline and restore a youthful jaw-neck angle).  This is an in-office procedure requiring only IV sedation.  


Sarasota Facial Plastic Surgeon
4.6 out of 5 stars 28 reviews

Neck Lift vs. Liposuction vs. Kybella

Thank you for your question about Neck Lift. At 45 years young, there is a good chance you could postpone the time at which you would need a surgical neck lift.

Less invasive possibilities include:

  • Chin liposuction
  • Kybella

To be sure, see two or more experienced, board-certified Plastic Surgeons in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 150 reviews

Lower facelift

Hi Foxybrighton. Thank you for the post. Judging by the photos, a lower facelift will serve you best. It is not much more invasive than a neck lift and can lead to significantly better results but improving both the jawline and lifting the jowls - giving a much more harmonious and natural appearance to the face. I can see you have excellent skin quality, which puts you at a great starting point. Good luck!

Neck Skin and Platysmal Bands -- Neck Lift, VASER Hi Def Lipo/ThermiRF, Venus Legacy/Thermage/Ultherapy, Botox/Dysport, Kybella

Yes you would benefit from liposuction and neck lifting with platysmalplasty.  Please seek help from an expert.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 168 reviews

Neck Lift or Lower Facelift

I suggest you consider a full facelift including the neck to achieve a balanced rejuvenated result. This would include liposuction, tightening of the underlying lax facial muscles, and removing any excess skin.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Facelift vs Neck lift

I have found that  a neck lift  with selective liposuction of the jowls and jawline  can be very effective at reshaping the lower  face and neck. You already have excellent volume in your cheeks and a facelift would improve the one thing that you don't need. The pictures you posted suggest you have good skin quality, and I would not be concerned about excess skin along the jawline after liposuction and a properly performed isolated neck lift.

I also suggest that after the neck lift is done, that you consider Botox to the neck muscles  every 6-8 months to prevent relapse  of the neck bands that contribute to the  oblique angle of your neck.

This is my favorite procedure  for patients in their 40's and 50's, who present with relatively good skin quality . It accomplishes  the goals of a sharper jawline and defined neck profile without incisions in front of the ears and a simpler recovery than a facelift.

Best regards, Prashant Soni, M.D.

Prashant Soni, MD
Danbury Plastic Surgeon
5.0 out of 5 stars 8 reviews

Facial aging and what to do?

A full facelift which includes both th cheek and jowls as well as the neck is what u would do best with. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 32 reviews

Both

Although you are not bad in the lower face, if you have a neck lift, you will also want the smoother jawline produced by a lower facelift. I would consider both at the same time.

Brian K. Machida, MD, FACS
Ontario Facial Plastic Surgeon
4.1 out of 5 stars 22 reviews

Neck left versus lower face lift

 In our practice, a neck lift is usually performed on patient's less than 50 years of age to rejuvenate the neck. Patient's must have excellent skin tone in order to do so. When the skin tone is inelastic, a lower face and neck lift is required to tighten loose facial and neck skin. For many examples of both procedures, please see  the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

I'm in the UK - not sure if you can help? Do I need a neck lift or lower face lift?

No other field has been as distorted, in my opinion, with regard to the technical details of the procedure or eligibility, than the facelift. There appears to exist significant misunderstanding, in general, on what facelift, lower facelift, neck lift, etc actually are. First of all, I would like all readers to note that ALL facelifts should address both the excess jowling and neck skin laxity completely. In essence, all facelifts are lower face and neck lifts. Some facelifts also elevate the midface (known as the deep plane facelift, or High-SMAS techniques) and/or the brow (composite facelift; really a facelift and browlift together) but these are  less commonly performed and more advanced techniques. So, currently, in the modern Era of facial rejuvenation, the modern facelift aims primarily to address the jowling and the excess skin of the lower face and neck. Ideally, the surgeon is very attentive to the patient's midfacial aging, as a good proportion of patients will require a more advanced facelift in order to create a more natural result. Facelifts have been performed for about 100 years now, but they started out by basically pulling on the skin only, until surgeons in the 1970's realized that the muscle layer of the face is the reason for underlying facial aging and should be the target of the lifting. Since then, the gold-standard of facelifts is one that lifts the muscle layer. I would love to tell you that 100% of all facelifts performed today address the muscle layer, but in reality, there are still many surgeons who are content with performing a "quick lift" that mostly only addresses the skin. Any facelift technique that does not adequately resuspend the facial musculature is doomed to fail often within one year. This is the most important question to ask your surgeon "do you plan on re-suspending the muscle layer?". If a surgeon is performing a facelift in under 1 hour, he/she most likely is not performing a sufficient amount of muscle work. Now, there are many other reasons why a facelift, even if it resuspends the facial muscle layer, can fail. The surgeon should pay attention to the degree of aging and laxity of the lower facial soft tissues. In addition, it's important to assess the position of your hyoid bone, which determines the potential improvement in your neck. Looking at your photos, it's clear that there is significant blunting of your neck angle, but it is impossible to determine if it's largely due to skin excess and fat deposition, or if an inferiorly-positioned hyoid bone is also contributing to this appearance. There is also a mild amount of jowling and marionette line formation, which should ideally also be fully corrected by a surgical lift. Great features that will serve you well should you proceed with a surgical lift include excellent skin quality that is also youthful and probably fairly elastic, as well as a good jawline and absence of excessive fat deposition in the lateral neck and face. When to proceed with a surgical lift is largely dependent upon the patient, but your surgeon should seek to guide you through this decision making process. I often like to see both photos of the patient's appearance in their 20's as well possibly their mother/father, to grasp the severity of aging. Although the rate at which your face ages is heavily dependent upon external factors, such as weight fluctuations, sun exposure, smoking, hormonal variations, etc; it is also strongly dictated by genes, and your parents' appearance are often quite insightful in determining where you might be in 10 years. Several factors immediately rule out a patient as a facelift candidate, 1) poor health and smoking, 2) connective tissue disorders or known significant risk of severe keloid or hypertrophic scarring, and 3) obesity with planned significant weight loss in the near future. If none of those apply to you, then you are a candidate for the procedure. However, you should know that the majority of facelift patients are 50-55 at the time of their first facelift. Although I would recommend doing the procedure while the skin is elastic and youthful, I also have to counsel you on possibly waiting in order to obtain a more significant improvement from the lift, essentially to get a better "return on investment". Ultimately, it is dependent upon you, and the degree to which the mild degree of lower facial aging, and apparent moderate degree of neck aging, bother you. I recommend that you seek two individual expert opinions from board certified cosmetic surgeons with expertise in facial plastics and review before and after photos of patients with faces with similar structure and aging compared to yours. Finally, remember, that "mini" or "quick" lifts, if they target the skin only, are not ideal procedures for first-time patients. These procedures may be short, but they can induce as much dermal scar tissue formation as a conventional facelift, and often patients will return for revision within the first 1-2 years only to then have the surgeon still have to dissect through the scar tissue. Mini or quick lifts involving mostly skin pulling are ideal for patients who have had a traditional facelift and have only a slight amount of excess skin laxity in the neck. I wish you best of luck!

Danny Soares, MD
Clermont Facial Plastic Surgeon
5.0 out of 5 stars 5 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.