In my medical spa we offer many non-surgical options for aesthetic enhancement. For the right indication, many of these non-surgical options are quite effective. However, If there is skin excess, surgery is the only effective option. If a person’s neck does not appear youthful, the face – no matter how limited the aging changes are – will often not be perceived as youthful either, unless the aging neck is concealed.Even in the absence of other signs of facial aging, a poorly-defined or sagging neck can add years to a patients overall facial appearance. When performed expertly and with great attention to detail, a necklift surgery can dramatically restore a natural and youthful neck profile, with no outward evidence that surgery has been performed. The adjective that immediately comes to mind when I review ‘before and after’ images of my necklift patients is elegant – for restoring a youthful neck contour truly makes the patient appear not just younger but also refined and elegant.Necklift surgery can consist of a variety of surgical techniques that are carefully selected to meet each individual patient’s particular needs. It is therefore important to select a qualified physician with a great deal of experience in numerous necklift procedures. In younger patients with good skin tone, submandibular liposuction alone may produce a dramatic improvement. For some patients with good skin tone but poor definition at the angle of the neck, I add a suture-suspension necklift to sharpen the angle between the jawline and neck. This procedure is minimally invasive and has a very quick recovery. It will not, however, improve the situation if a true excess of skin is present.Patients with more advanced aging changes in the neck generally require tightening of their neck skin as well. The neck is the one area in facial rejuvenation where a tighter and more toned surgical result looks natural and aesthetically ideal (as opposed to the face where ‘tight’ and ‘tighter’ just looks like surgery). Neck skin removal is accomplished through incisions around the ears which can be extended a short distance into the scalp if necessary. If the incisions are created and closed correctly and without undue tension, a very natural looking result can be obtained with no obvious signs that a necklift has been performed. A great deal of experience and expertise is required to avoid distortion of the ear and surrounding skin.