Stand-alone neck lift or stand alone lower facelift - Rippling with partial lifting?

Question

Is it ever a good idea to perform a stand-alone neck lift or stand alone lower facelift? I have been told that not lifting the whole face causes problems in the draping of the skin, like a ripple or wave that has no where to go. Is this inevitable with these stand-alone procedures or are there techniques that avoid these issues? Many thanks.

Stephen Prendiville, MD · Answer

Thank you for a question that I answer about 50 times per week. 
The answer is fairly one sided, but depends on the age and aging characteristics of the patient.  An individual in their mid-late 40's (or earlier) is usually the best candidate for an isolated neck lift because the obliquity in the neck is usually coupled with good skin turgor and ability to recover and accommodate deeper anatomical changes involved in a neck-lift.  An isolated neck-lift is a very poor way to remove skin excess in the neck and best accommodates for contour changes made by addressing the platysma and digastric muscles as well as removal of subplatysmal fat and sometimes partial removal of the submandibular gland. 
When skin laxity/excess is present (usually beginning in the 50's), the deeper neck changes mentioned above must be coupled with skin removal, which has to be dome accommodating an incision that also follow the ear.  More importantly, a neck-lift does not accommodate for addressing the jowls, which must be targeted via the SMAS, or in other words a facelift approach.  
The good news is that the best neck-lift is a well performed facelift. At this juncture, I ask patients to forget about the terminology and think about the result.  Both procedures have equivalent downtime and similar risk profiles.

Emre Guvercin, MD, FEBOPRAS · Answer

This is an excellent and very thoughtful question &mdash; and it shows you’re doing the kind of research that leads to good, lasting results.You're absolutely right that one of the common concerns with isolated lower face or neck lifts is skin “mismatch” or draping issues &mdash; especially when the rest of the face remains untreated.
But the truth is more nuanced.
When is a stand-alone neck or lower face lift a good idea?There are many cases where targeted lifting is both safe and effective, such as:Patients with early jowling or neck laxity, but good midface volume and skin tonePatients who have previously had an upper facelift or eyelid surgeryPatients seeking more subtle, natural rejuvenation rather than a dramatic transformation What are the risks of rippling or poor draping?Yes, if tension is poorly managed, or if facial vectors are not respected, skin can bunch or ripple at the transition zones &mdash; particularly in front of the ear, jawline, or submental area. But this is not inevitable.With the right technique, this can be avoided.
What techniques prevent this?In my practice, I use deep plane or SMAS-based techniques, which allow for:Layered repositioning of tissue (not just skin)Smooth, natural blending between treated and untreated areasMinimal tension at closure, reducing risk of rippling or visible scarsWe also carefully plan vector alignment, so that any transition between lifted and unlifted areas flows naturally with your anatomy.The key is personalized planningA successful result doesn’t require treating everything &mdash; but it does require:Choosing the right zone of intervention for your specific aging patternUsing techniques that respect facial dynamicsAvoiding over-pulling or “patchwork” effects through proper lifting depth and direction

Stand-alone neck lift or stand alone lower facelift - Rippling with partial lifting?

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Stand-alone neck lift or stand alone lower facelift - Rippling with partial lifting?

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Everything you need to know about Lower Facelift

Our mission is to create a world where every investment in modern beauty is Worth It.