In a Neck Lift, can you help me understand how skin is lifted & removed using incisions under the chin and behind the ear only?

I am trying to visualise how skin is tightened/removed without using incisions in front of the ear. If a submental incision and post-auricular incisions only are made, it's hard to understand how loose skin under the chin can be smoothly redraped without bunching or pleating at the lower ear. On the same subject, will a lateral/horizontal pull (rather than vertical, which presumably would need incisions in front of the ear and/or at temples) successfully address loose skin under chin?

Doctor Answers 12

Confused concepts, some clarifications

Facelift and necklift (aka cervicofacial lifting) is a mere conventionalism, just terms that arise in the 60s and 70s, well stablished from the 80s, when the heroic beginning of the cosmetic surgery for facial rejuvanation was only about tightening of the skin. Fortunately that is not the situation at present time, since the results were very unnatural and the patients looked "facelifted".

Nowadays the surgeons dealing with rejuvenation and facial surgery we came to a ground of understanding that the face has to be rejuveneted itself, with actions ON IT, and never again a tuck of the skin would try to rejuvenate a face and neck. Nowadays the skin is just another of the aging factors on face and neck, but no longer the skin is the tool to hold the face in place, the skin is only an additional issue which is addressed during the process of "rhytidoplasty", removing the excess of skin that is deemed adequate.

Facelifting is not anymore a mere lift of the skin, at least in good and experienced hands.

Spain Plastic Surgeon
5.0 out of 5 stars 31 reviews

Neck Lift

Good Afternoon Heartsease

Thanks for your question.

Neck Lift Surgery or Platysmaplasty is a cosmetic surgery procedure to help contour and reduce loose skin around the neck. A combination of excess skin excision, liposuction and internal tightening are used in Neck Lift Surgery to achieve your desired look and shape. We do the incisions right at the front of the ear so these hardly show.

For those who have excess fat under the chin but still have good muscle tone and skin, liposuction of the neck will be sufficient. If the skin has lost elasticity, removal of excess skin (Neck Lift Surgery) to tighten and tone the neck will also be required.

Tightening of the platysma muscle (also known as platysmaplasty) will require a small incision under the chin away from direct view to gain access to the front edge of the muscles on the neck; they are sutured together with permanent stitches. The muscles of the neck are the foundations and building blocks of the neck and are fundamental to achieving a tight and toned result.

Make sure you find a reputable and qualified plastic surgeon who can assess you properly to give you a realistic idea of what outcome you can achieve.

Amir Nakhdjevani, MBBS, MRCS, FRCS (Plast)
London Plastic Surgeon
5.0 out of 5 stars 44 reviews

Skin removal during a neck lift

The incision under the chin is used to correct the muscle laxity, then all of the excess skin is freed up.The skin  is then redraped, without tension and the excess skin can be removed via the incisions behind the ears. 

How Neck skin is lifted & removed in a Neck Lift?

In a Neck or a Face/Neck Lift the scars are intended as an access to allow surgical corrections and/or as where the seam lines are (where excess skin was removed). The length and locations of scars depend on the amount of skin that needs to be relocated AND on what work needs to be done. Obviously the neck of a 40 year old healthy, normal weighted woman would likely not require as much work as that of a 60 something old woman with a hanging neck OR a massive weight loss 50 year old neck with a residual fat pad and a "Turkey Gobbler" deformity. In MILD necks, the acuity of the jaw-Neck angle MAY be restored without opening the neck while in other more serious oblique neck cases the neck may have to be opened. The question of the scar ALSO depends on the extent of skin. Little to no excess skin can be removed with a superior lateral vector with an incision along the back of the ear and or the hair line while a large hanging neck can only be corrected by an incision along the front AND back of the ear to allow skin liftingand distribution without pleating.

Hope this helped.

Good Luck
Peter Aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 101 reviews

How do neck lift incisions work?

Hi Heartsease, trying to visualize how a surgical procedure creates results can be very difficult. In a necklift, the incisions behind the ear allow the skin to be elevated off of the underlying muscle all the way to the chin. The muscle is then pulled back, and up, and anchored with suture in an elevated position behind the ear. The excess skin is then re-draped. Areas of overlapping skin are removed in such a way that the skin is closed under no tension. The lateral pull that you speak of cannot be performed using the submental incision. 

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

In a necklift, how is the skin lifted and removed?

This is a great question that many patients ask.  The incision underneath the chin is usually used to remove any fatty deposits that you may have under your chin as well as treat any 'neck bands' that you may also have.  The incisions around and behind your ear are used to 'tighten' and excise the loose skin under your neck.  During the procedure, the surgeon will 'lift' all your neck skin and gently reposition it in a superolateral direction (essentially in a gentle upwards and posterior direction).  The unneeded skin is then outlined and excised.  This all is achieved with incisions just around your ear.  Imagine if someone lifted up the carpet and then gently pulled it and then trimmed any excess carpet.  I hope this helps!

Natalie Attenello, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 4 reviews

In a Neck Lift, can you help me understand how skin is lifted & removed using incisions under the chin and behind the ear only?

Hello heartsease,
Thanks for your question.
Using the incisions you mention, a surgeon is able to use special facelift scissors to lift up the skin off the muscle of the neck.  This creates a sheet of loose skin that is pulled tightly behind the neck and cut off.  After muscles are tightened under and on the side of the neck, the skin incision is closed with sutures.
In some cases, there is pleating at the lower ear that needs a short extension incision in front of the earlobe to smooth out.
If you have significant loose skin under the neck then incisions in front of the ear are often necessary, and this is what is termed a facelift (vs. a necklift.)
I hope this helps.
Dr. Shah

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.7 out of 5 stars 45 reviews

Neck lift versus face neck lift

 In our practice, a neck lift does not involve any skin removal. A neck lift involves removal of fatty deposits above and below the platysma muscle and a platysma plasty. When patient's have excess skin in the neck and are over 50 years of age, a face and neck lift is required to remove and tighten excess loose skin in the neck. The incisions for the skin removal are placed in front and behind the ear. For many examples of both procedures, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

In a Neck Lift, can you help me understand how skin is lifted & removed using incisions under the chin and behind the ear only?

Hello Heartsease,

During the neck lift the incision under your chin helps to elevate the skin off of the underlying muscle to allow it to be redraped.  This is also how liposuction can be performed to help with the fat in the submental area.  The incision behind the ear is where the lifting will occur.  This is also where the extra skin will be removed from as part of the lift.  These incisions are designed to help with the neck.  If the incision is not going in front of the ear there will be minimal if any improvement in the jowl area and none in the cheek.  The best approach for you depends on what your face looks like.

I'd recommend you consult with a facial plastic surgeon to determine what is the best option for you.

I hope this helps and good luck.  

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

Necklift concept

Great question

Depending on the DEGREE of skin excess, the neck skin can be fully undermined [lifted away from the underlying tissues] and swept upward and laterally toward the back of the ear and trimmed away.

As you suggested, if the excess is great enough, there MAY need to be an extension of the incision in front of the ear, in order to avoid an ugly pleat or bunching

Richard A. D’Amico, MD, FACS
Englewood Plastic Surgeon
4.9 out of 5 stars 12 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.