Lateral neck creases after face and necklift surgery can be a frustrating problem for patients. I’m sure it is especially frustrating for you as it is out of harmony with an otherwise youthful-appearing face. Sometimes these creases result from a less-than-ideal approach to skin redraping around the ear, but in some cases – primarily in patients who already have some lateral neck skin aging changes and associated laxity - they are difficult to avoid. They tend to be most prominent with the head turned to the side, as demonstrated by your photographs. Your jawline and anterior neck appear well-defined, so clearly the approach to this problem should not be another conventional face and necklift procedure, or some variation on that theme. The skin excess of your lateral neck is in parallel with the direction of the creases, and the ideal procedure for improving this issue for you would be skin excision in that local area that is designed in parallel with the creases. It should be designed as an ellipse that when closed produces a linear scar that is mostly or totally concealed by the collar of your dress shirt and your occipital scalp. There’s not much of a way around this. If you really dislike the creases, the skin excess has to be removed. Like many plastic surgery procedures, you are trading a cosmetic improvement for the scar or scars required to create the improvement. It’s a matter of deciding if the trade-off is worth it to you. Elliptical excision is a reasonable approach for most men as the neck skin is more ‘rugged’ in men – it’s thicker, more irregular and tends to have signs of photoaging which help to conceal the scar. It is also better concealed in men while healing as men tend to wear collared shirts, especially in social settings. Ultimately the scar should be minimally noticeable when not concealed by a shirt. And a scar in this position easily could also be from a skin cancer excision, a sebaceous cyst or lipoma excision, or an orthopedic surgery – so it is not obviously associated with a cosmetic surgical procedure. For women it’s different story: the skin is thinner, usually less affected by photoaging (longer hairstyles tend to shade the area) and female clothing tends to leave this area widely exposed. So this solution is not as easily applied to female patients.
