When is a standalone neck lift appropriate?

Question

I'm trying to plan and save now for anti-aging procedures I expect to need in a couple years. I've had a couple tentative, preliminary conversations with surgeons, and they seemed reticent about male facelifts and to want to steer me toward a standalone neck lift. I have some aging in the lower face, but the changes to my neck are occurring more rapidly. How do you determine whether to do a facelift, a neck lift, or both, and is the answer different between male and female patients?

Lucian Ion, FRCS · Answer

Thank you for your question. It covers a topic that I am frequently asked about in consultation.

There is no established answer to this so I'll explain the guidance I generally offer.

There are some aspects of the neck contouring that the facelift does not cover and viceversa, and some overlap zones.

For the neck, volume problems and platysma bands are not solved by facelift surgery. To some degree, skin laxity in the neck is improved by facelift surgery, but it depends on the extent of the facelift scars.

Laxity along the jawline and visibility of the marionette lines are not covered so well by neck lift surgery and are better addressed by facelift surgery but this is an overlap area.

Laxity for the mid-face is not covered by neck lift surgery but can be helped by facelift surgery. This is generally the forward movement of the skin around the corners of the mouth when leaning forward.

If the area around the jowl and marionette lines has moderate to significant laxity, I find that a facelift procedure, or a facelift and neck lift procedure produce more pleasing results for both female or male patients.

To get a sense of what a facelift procedure can offer, I suggest to patients to lie down completely flat and look in the mirror at the facial shape and compare it with the appearance sitting up. If they feel there is enough value to them to pursue this change, it is likely to make the facelift intervention worthwhile.

For the neck lift intervention 3D imaging and computer simulations can help to understand the potential changes. Computer simulation in 2D or 3D don't seem to work well for facelift simulations.

A final consideration is that  the anterior deep plane neck lift procedure can be use for some male patients even later in life as the beard makes the skin slightly firmer.

Overall, for both men and women, regular use of sun block on the face and neck will protect the skin elasticity and provide aesthetic benefits.

J. Timothy Katzen, MD, FACS · Answer

A standalone neck lift may be suitable when aging signs are predominantly present in the neck area, with minimal changes in the facial region. This procedure effectively targets issues like sagging skin, excess fat, or a 'turkey neck' appearance.

Key considerations in choosing between a facelift, neck lift, or both include:

Extent of Aging Signs: If aging signs are more pronounced in the neck with fewer changes in the face, a neck lift alone might be sufficient. If aging is significant in both areas, a combined approach may be recommended.

Patient Goals: The decision also depends on your specific aesthetic goals. If your primary concern is the appearance of your neck, a neck lift might be ideal.

Skin Quality and Elasticity: The condition and elasticity of your skin can influence the decision. Good skin quality often leads to more favorable outcomes.

Anatomical Differences Between Genders: The approach might differ slightly between male and female patients due to variations in skin thickness, hairline, beard growth, and aesthetic preferences. Men's typically thicker skin and stronger ligamentous attachments may affect surgical techniques and recovery.

Surgeon’s Expertise: Surgeons may have different approaches based on their experience. It’s crucial to discuss your concerns and expectations with your surgeon for a personalized recommendation.

In your situation, with more rapid aging changes in the neck than the lower face, a neck lift might be more appropriate. However, a detailed discussion with your plastic surgeon is essential. They can evaluate your individual case and provide a recommendation tailored to your goals and the unique aspects of male facial anatomy.

Sincerely,
Dr. Katzen

John L. Burns Jr., MD · Answer

Men have more hair follicles in their face/neck skin and for this reason tend to bleed more.  Men also have less scalp hair to hide the incisions so there are differences between male and female incisions and facelifts.  Generally the face and neck look better if done together.

Jacob Tower, MD · Answer

Hello, hope you are well. This is a great question, but the answer is highly individualized so I can only reply in the most general terms. Neck lifts can be done for various reasons: excess skin, excess fat, muscle banding, ptotic salivary glands, etc. When there is excessive skin--think "turkey neck"--a combined facelift/neck lift approach with incisions around the ears usually becomes the preferred approach. This is even more logical when visible signs of aging are present in the lower face (i.e. jowling). The same principle applies to men and women alike. The added challenge with men is generally managing facial hair, which could account for some of the reluctance that you encountered in your preliminary conversations--who knows. It sounds from your description that a facelift (which includes treatment of the neck) is the logical approach, but photos would be necessary to give any further advice.
Best,Dr. Tower

Jeffrey H. Spiegel, MD · Answer

This is an easy question and a hard one.  The short answer is you know based on years of training and experience.  The long answer is we need to see your face, consider the areas of change, look at the bone, look at the skin, etc...

Connie Hiers, MD, FACS · Answer

There are many differences in anatomy and hairstyles in men and women, so facial surgery has to be aware of these differences. We now have great alternatives to facial surgery in those younger with radiofrequency, like Renuvion, plus liposuction if needed.

William Portuese, MD · Answer

In our practice, a standalone neck lift is performed on patients less than 50 years of age who do not have a skin tone issue. We're simply removing fat deposits located both above and below the platysma muscle which also includes a platysma plasty. Most patients over 50 years of age are going to have some degree of inelasticity of the skin, which is going to require a lower face and neck lift to tighten loose facial and neck skin.

Nhan Ho, MD - Account Suspended · Answer

Firstly, a stand-alone neck lift procedure is typically performed when someone wants to address sagging or excess skin, muscle laxity, or excess fat specifically in the neck area without addressing other areas of the face. It's often done for patients who have significant aging in the neck but minimal signs of aging in the rest of the face.
Secondly, The decision between a facelift, a neck lift, or both depends on several factors including:1. Goals: What specific concerns do you have? A facelift primarily targets the lower two-thirds of the face, including the cheeks, jowls, and jawline, while a neck lift focuses on the neck area, addressing sagging skin and muscle bands. 2. Aging patterns: If you have significant sagging in both the face and neck, a combination of both procedures might be necessary to achieve the desired outcome.3. Skin laxity: If your skin has lost elasticity and is sagging both in the face and neck, a facelift and neck lift combination might be recommended.4. Muscle laxity: If there are prominent muscle bands or excess fat deposits specifically in the neck area, a neck lift may be sufficient.5. Consultation: A certified plastic surgeon can assess your specific anatomy, concerns, and goals to recommend the most appropriate procedure(s) for you.
Finally, the main differences between male and female facelift procedures include incision placement, muscle handling, fat redistribution, and outcome expectations. Male facelifts focus on maintaining masculine features like a defined jawline, while female facelifts often aim for smoother contours and a softer appearance.

When is a standalone neck lift appropriate?

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