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

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.

Best,

Dr. Yang

"These are all natural parts of the aging process. What we can do is try preventative treatments or get a neck lift / face lift earlier in the aging process. There are numerous non-surgical options available, and some can be used in combination to get best outcomes, but you would need a consultation with an expert.

Some options for skin tightening include:

- Thermage radiofrequency to heat the skin, tighten it over time, and prevent the aging process
- Ultherapy high-intensity ultrasound to contract the muscle, tighten the face and neck, and prevent the aging process
- PDO NovaThreads or InstaLift threads for immediate lifting without surgery and long-term collagen production
- Sculptra injections for collagen production to areas of the face and neck with crepey skin or early sagging
- BTL Exilis Ultra, Venus Legacy, and Thermi250 for monthly collagen stimulation with facials
- ThermiRF, Renuvion (J Plasma), or Inmode BodyTite for internal heating and tightening with or without surgery
- Fillers (or facial implants) to contour the jawline and chin to improve the appearance of the neck
- Face lift / neck lift with fat grafting and fillers if you need a significant improvement​

​I would suggest getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer​​​​"

The best recommendations to improve your neck appearance depend on your needs, desires, and most importantly an examination to determine the best procedure for you. Your plastic surgeon will evaluate you for five main features that will determine your best options for neck line improvement:
Amount of excess fat typically found beneath the chin, and in the upper neck. This requires liposuction with small cannulas or direct removal especially if the fat is beneath the platysma muscle.Presence of Significant (Platysmal) Banding – this requires bringing the muscles together in the upper/mid neck to a more youthful position and occasionally their release. This procedure is called a platysmaplasty or platysma plication. Mild banding can be treated non- surgically with Botox or Dysport but this requires injections 3-4 times a year for maintenance.Amount of excess/redundant skin (cutis laxa) and condition of your skin. In advanced stages this is called a Turkey Waddle or Gobble deformity. For example, younger age, darker skin colors and no large weight loss history most likely means there will be better elasticity and therefore better post-surgical contraction. In milder cases if not too much fat is present there will be enough skin shrinkage with just lipo alone. Mild to minimal skin tightening using non-surgical means like the Sciton Laser SkinTyte procedure, Ultherapy or Thermage could also be considered. My personal preference for non-surgical skin tightening of the neck is the Sciton Laser BBL SkinTyte® procedure as there is no down time, more comfortable procdure, is effective and is a more targeted treatment. For redundant upper and mid excess neck skin: I prefer the LiteLift® (lower facelift ) procedure or MACS for skin re-draping for mild to moderate excess skin management as there are minimal scars and the skin is lifted vertically allowing for minimal hidden scars resulting in a natural appearance “non pulled” appearance. However: for moderate to severe skin redundancy , a neck lift or traditional lower facelift (e.g.Lite Lift®, MACS and others) is needed with or without lipo for best results. For advanced Turkey Waddle correction wither a traditional facelift or posterior neck lift often with a platysmaplasty is required with more extensive scars that extend at the hairline behind your ears. The advantage of a facelift procedure rather than a posterior neck lift is that your lower jawline (e.g. jowls and marionette lines) are also improved at the same time.Chin deficiency. If you have a weak chin then you will not have adequate chin support to your neckline skin which affects your entire neck line. Sometimes especially in younger individuals this is all that is required and this can be done in the office under local anesthesia. There are a number of different sizes and shapes and your plastic surgeon will pick the optimal one for you.Presence of prominent Digastric Muscles or Submandibular gland fullness from laxity or enlargement. Although not a major concern for most patients, if present then partial resection is usually the best solution.

It's best to begin by consulting with a surgeon in-person. The presence of banding down the front of the #neck, and, amount of excess skin and condition of your skin are among some factors which determine what treatments will best rejuvenate your neck . Necklifts are designed to remove only deep grooves and #wrinkles, not fine ones. Smoothing out every tiny line in your face would leave you with an eerie, unnatural, and undesirable result. The goal should be to make your necklift look as natural as possible, simply turning back the clock a few years.  #Liposuction is often used during the neck lift if necessary. 
During your initial examination, your chin will be evaluated along with the neck and jawline. A weak #chin implies a lack of chin support for the skin along the neck line. In younger individuals a chin implant alone is usually all that is needed to improve the appearance of the neck. Subsequently, it will also improve the overall #balance of the face and can create the illusion of a smaller nose. As a stand-alone procedure, chin augmentation can be performed in the office under local #anesthesia. For individuals with signs of #aging in the neck, a chin implant added to one of the recommended procedures above, will provide optimal results.
If you are not a candidate at the time of your #consultation, your board certified plastic surgeon can recommend non-surgical alternatives to address your concern. Consulting with a board-certified plastic surgeon who specializes in #neck lift procedures is important to ensure you are receiving the best advice, care, and surgical experience possible.

From your photo you look fairly young and like you have good skin elasticity, so liposuction would probably be the best choice. Neck lifts are appropriate for people who have excess sagging of their neck skin, while liposuction helps to remove excess subcutaneous fat. An examination by a board-certified facial plastic surgeon will help determine which procedure is best for you. I hope this helps.

Generally, a neck lift is needed when there is excess skin sag in the neck.  If you're younger than your mid-forties, you can generally get away with neck liposuction as the skin has enough elasticity to 'shrink wrap' back down.  After that age, skin begins to sag and a lift is required to tighten the skin in addition to removing the fat with liposuction.  Kybella has been recently introduced as a drug that can help with both if you're in your mid 40's to early 50's.  

Neck liposuction is a good option for patients with good skin elasticity and no platysmal banding.  Patients with excess and poor skin elasticity or platysmal banding should choose a neck lift.

It is possible that you may be a candidate for what I have termed, "The Laser Assisted Weekend Necklift:" It is a minimally invasive procedure. Cervicofacial Liposculpture is first employed to contour the unfavorable fatty changes seen in the face and neck as time passes by, such as the ‘Turkey neck’ and ‘double chin’.Careful attention is then turned to tightening the neck muscles and eliminating neck bands. Finally, I employ laser technology to ‘resurface’ the underside of the neck skin, thereby ‘shrinkwrapping’ the skin of the neck restoring a youthful contour.A consultation with a board certified facial plastic surgeon will help determine which procedures will provide the best results for you.

Facial aging can cause significant changes in the neck area. These changes include excess saggy skin, fat accumulation, laxity of the muscles, and separation of the neck muscles. Your pictures suggest fat accumulation in the neck. Unfortunately, it's impossible to assess your skin quality without performing a physical examination.There's a high probability that liposuction alone will provide an excellent result, but if poor skin tone is present, residual skin sag may require a neck lift procedure. For this reason, consultation with a board-certified plastic surgeon is appropriate. This surgeon should be able to formulate an appropriate treatment plan. The fees associated with these procedures vary widely and depend on the exact procedure chosen. 

Based on the photo you have uploaded, it appears that you do not have significant jowling, neck bands or neck skin laxity. You would likely be a good candidate for liposuction under the chin (submental liposuction). This is a 30-40 minute surgery to improve the neck and jawline and eliminate the dreaded "double chin". The procedure can be performed under local anesthesia, with or without mild sedation. Of course, careful examination of your neck would be required to fully assess your needs. 

Best Regards,

Dr. Mehta