Do I Need a Neck Lift or Liposuction of the Neck? (photo)

How do you know if you need a Neck Lift or Liposuction of the neck? What is the cost?

Doctor Answers 31

Both are good options, but a necklift (platysmaplasty) may help prevent muscle bands from occurring prematurely

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Hi tmonkey,

Photos can be deceiving ... so a physical exam will be very important

You look young in your photo, and most likely will still have good skin elasticity.  Photographs can be deceiving when it comes to where exactly the fat is located, so a proper physical examination during a consultation would be most beneficial prior to deciding on surgery.  What appears to be fat can sometimes be deceiving, and there may actually be some fat under a thin muscle along the front of the neck, which is not accessible with Liposuction.  This thin muscle is called the platysma muscle, and plastic surgery of this muscle is called a platysmaplasty.

Liposuction under the chin is a good solo procedure, but ... 

I think that if you do have a significant amount of fat under the chin that can be pinched with your finger, then liposuction alone is a real option.  One observation that I have made with my older patients in their mid -40's to mid-50's who had liposuction under their chin in their mid-30's to 40's is that they develop muscle cords along the front of their neck earlier.  They reported that their necks looked really good for the first several years but they noticed that muscle bands showing soon after.  Without the additional thicker layer of fat between the skin and platysma muscle, these muscle bands can show up earlier in patients who have had under chin liposuction.  If the fat is left in, the muscle cords may never show up, but the excess fat may become a double chin.  So, you would need to pick your poison.

Submentoplasty AKA mini-necklift

A Submentoplasty is a hybrid of liposuction under the chin alone, along with finding and tying together the middle edge of the platysma muscle using the same incision under the chin.  The incision for liposuction only may only be 1/8" to 1/4", whereas, the submentoplasty incision is longer, and usually 3/4" to 1"+.  This should be enough for the surgeon to first liposuction prior to finding and isolating the platysma muscle edges prior to sewing them together.  In its natural state, there are two platysma muscles, a left and right side, with a widening gap between them as it runs down the neck.  These exposed edges are what forms the muscle bands as people age.  If the platysma muscles are sewn together under the chin then it can form a platform or corset which can support the area under the chin,

I think that increasing the incision from 1/4" to 3/4" at the same time as the liposuction is potentially an ideal time to tie those muscle bands together so that they are less likely to be a problem in the future.

If liposuction is performed alone, then the patient may end up wanting the platysmaplasty to clean up the front of their neck several years after the liposuction.  If the patient is older, then the platysmaplasty sewing could be combined with a lower facelift and/or full necklift if the patient also has excess skin.

Skin elasticity of the neck will be important in the decision making

If the patient ends up with a significant amount of excess skin after the neck liposuction and platysmaplasty, then additional incision behind the ears may be necessary to "redrape" or "smooth out" the extra skin, to prevent wrinkling or pleating.  Young skin can accomodate or "shrink" some of the excess skin similar to what you may see in weight loss before and after photos.  The skin simply shrinks in younger people, and has a nice shape; however, if you pinch that formerly overweight person's skin it may not have as much "snap" or elasticity to their skin as someone who was always thin.  In these cases, the additional incision behind the ears to smooth out and trim off the extra skin helps to complete the nice neck result.

Good luck to you.


Dr. Yang

New York Facial Plastic Surgeon
4.8 out of 5 stars 35 reviews

Liposuction Not Neck Lift Is All That You Need

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Thank you for your question.

You are young and your skin looks good. I do not see sagging neck skin or Platysmal Bands.

Therefore Liposuction, not a Neck Lift should give you a satisfactory result.

Personally I use Laser Assisted Liposuction because I believe I get better skin tightening than with standard Liposuction alone.

Neck lift vs Neck Liposuction

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Though it is not technically part of the face, a neck with loose, sagging skin can age the face dramatically. A neck lift is a standard part of most facelift surgeries, as the neck skin is mobilized in continuity with the lower face.

Immediately under the skin of the neck is the platysma muscle, which you can easily see in a mirror when you clench your teeth and tighten your jaw. In youth, this paired muscle meets in the midline below the chin. With age, the right and left sides of the platysma often separate, producing vertical 'cords' in the anterior neck. The platysma can be divided anteriorly and tightened during neck lift cosmetic surgery to permanently eliminate these 'cords' and improve the neck contour. One tightened in the midline below the chin, lateral traction on the platysma then creates a 'sling' which elevates the soft tissues below the jawline.

Cervical / submandibular liposuction

Some individuals have 'sagging' necks primarily due to fat accumulation below the jawbone (mandible). In some cases, liposuction alone can significantly improve the neck appearance. Liposuction is also frequently combined with surgical neck rejuvenation, and in selected cases some direct excision of fat (through a hidden incision below the chin) is performed. The reduction of fat in the area below the jawline and in the anterior neck almost always makes the neck appear longer, and makes the patient's profile appear more elegant or refined.

Suture suspension neck lift

In cosmetic surgery patients that do not have a sharp transition in profile between the submental area (area below the jawline) and the anterior neck, and in patients who simply want that transition enhanced, I add a 'suture suspension necklift'. A permanent suture is passed subcutaneously across the anterior neck, at the level corresponding to depth of the angle between the submental area and anterior neck, and is then anchored to the deep soft tissues behind each earlobe. This suspension cosmetic surgery procedure can dramatically enhance the definition between the jawline and anterior neck, producing a more elegant profile.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Liposuction should be all you need.

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Hi! You look young enough and your skin looks elastic enough and the fullness under your chin does look like subcutaneous fat. So from your picture, you look like a great candidate for liposuction alone.

But the physical exam is crucial. There are about 8 different anatomical reasons for having a "bad neck". Liposuction only deals with excess fat UNDER THE SKIN (if the fat is deeper, then you need a neck lift). So the operation has to be individualized to the anatomy.

Fees vary widely. In New York, it would cost you $4000 to $6000. Of course, this includes surgical fee, operating room fee, and anesthesia fee. People often quote just the surgical fee.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Neck Lift Options

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To a certain extent this is a judgement call based on the amount of fat, the elasticity of the neck skin, and whether or not the patient has anterior (platysmal) banding. If there is any question a liposuction could be done and if not successful the patient could have a neck lift (preferably within 6 to 12 weeks) in order to get the best skin drape. There may be other alternatives such as Thermitight, an internal radiofrequency tightening.

Richard O. Gregory, MD
Orlando Plastic Surgeon
4.6 out of 5 stars 13 reviews

Liposuction should be enough

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Liposuction should be enough. As others have said, under 40 years old and you should be fine. However, a physical exam is very important. The great thing about neck liposuction is the miniscule post-op recovery time and the ability to see the results almost immediately.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 34 reviews

Depends on your goals and skin elasticity

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Most patients under 40 with good skin tone will get a very satisfactory result from liposuction alone--and it is much cheaper. If the fat is removed and the elasticity of the skin is not good, then the skin will sag a bit. When a necklift is done in conjunction with the liposuction the excess skin can be removed. This of course is more costly. Prices vary depending on the skill and experience of the surgeon.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Consider Neck Lift for best results

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During a neck lift, fat is removed, the muscle layer is tightened (platysmaplasty) and skin excess removed. In addition, I commonly reduce the fat deep to the muscle (this is not available for liposuction).

If all this sounds too much for you, neck liposuction is an option.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 48 reviews

Good results from neck Lipo in younger patients

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The short answer is yes. Neck liposuction in younger patients with good skin tone is very powerful and can give very nice results. The tend not to give DRAMATIC results but I have found almost all patients to be extremely please with the procedure. Personally, I think a neck lift in younger patients is often not necessary.

I agree that cost should be secondary to the qualifications of the surgeon. Make sure the surgeon is well trained, spends time with you, and that you trust him/her.

Good Luck!

Vineet Mehan, MD
Washington DC Plastic Surgeon

It depends on your skin and your expectations

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For sure, a neck lift will give you a better neck - no doubt about that because the fat is removed and the muscles are tightened. In your case, it looks like your skin elasticity might be reasonable so liposuction could also be done but it won't give you quite as much depth and angularity as a neck lift. So, realize that one operation is a bit bigger than the other but will give you a better result. Cost should always be secondary to getting the procedure you really need and costs depend on where you live and who does the procedure.

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.