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.