Am I ready for a necklift? (photos)

I am tired of Botox in my neck, which doesn't work for the crepiness that is beginning to appear. I have gotten several consultations which were all over the board from do nothing, to Kybella, to sculptra in front of the ear to bring things up, but only one recommended a neck lift, while one recommended submental lipo with platysmal tightening. I have done Thermage twice, and I like the "ironing" effect, but it doesn't make enough difference. Suggestions on correcting neck crepiness and jowls?

Doctor Answers 16


What is best for you, if anything, depends on what result you want, and what you're willing to give up to get it, in terms of cost, risk, and recovery time.  Ultimately, it's YOUR decision what you're ready for, it's the professional's job to arm you with the information you need to comfortably decide.  All of the possibilities you've been offered remain, each associated with a benefit:risk profile.  My general impression from your photos:  less is more.

San Diego Plastic Surgeon
5.0 out of 5 stars 46 reviews

Neck lift or not ?

Thank you for your pictures and the question. A few initial comments-  

-its great that you have been doing some treatments, such as those you have mentioned, as they have all delayed the aging that would have occurred.

- the picture you have shown are really not the best angle as you have purposely exaggerated the neck laxity by bending and turning your neck. This exacerbates the little bit of neck laxity making it appear worse. 

The reason for this is that we all need some laxity in our skin in order for us to be able to do the things we do, such as turn our heads, swallow, look up and down, smile etc. That being said, the good news is that your neck laxity is mild to moderate at best, so that is why for all the suggestions that are all over the place. Different physicians will suggest different options based on what they have available. Your best option is to speak to someone who has all the options available, that way there is no bias as to the treatment offered. 

To examine your neck in person would be the best option and to take some standard photos in a neutral position- (you can look at the profile pictures on my befores and afters for examples), will give the best photo-idea of what you are a candidate for.

That being said, the range of treatment options for patients with mild to moderate neck laxity vary from some type of energy based tightening device (ultherapy-ultrasound energy, thermage, or radio frequency based energies) which produce heat that leads to a tightening response- it looks like you have already done this. A mini lift/neck lift could also be an option, but it all depends on the extent of neck laxity you have- I have had great success with all the above mentioned options after discussing with my patients the pros and cons of each treatment (ultherapy- no downtime, neck lift-5-7 days downtime) etc

hope this helps a bit. 

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
4.9 out of 5 stars 79 reviews

Lower Facelift and neck lift are your right option!

Thanks for your question. Based on your photo and info given, I would recommend you do lower face lift and necklift surgery altogether to remove your excess skin at the sides of your neck and chin area. This will help tighening and firming your loose neck skin.

Whereas the above procedures are for the sides of your neck and chin, Submental Lipo with platysmal tightening is a right procedure to the submental or lower chin area. This procedure will help you get a submental firmness.

Am I ready for a necklift?

Your photos are not adequate for one to give you a valuable opinion and a face to face exam is needed.  From the photos at least, I personally doubt that I would recommend a necklift.  I have had several patients thrilled with correction of the pair of horizontal neck wrinkles with injection techniques IF this would be of interest to you.  

I'd suggest that you meet with bd certified docs until you meet one who gives you confidence and a trusted recommendation.  Best wishes,

Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery 

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016 

Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Neck Skin and Platysmal Bands -- VASER Hi Def Liposuction/ThermiRF/ThermiTight, Venus Legacy/Thermage/Ultherapy, Botox/Dysport

I suggest a formal consultation.  Some people are best with just vaser lipo/ thermi followed by ultherapy or thermage.  If there is enough laxity you can do a neck lift procedure with face thermiRF and then do maintenance treatments to prevent your investment.  See an expert.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 167 reviews

Am I Ready for a Neck Lift

I need to see a full set of pictures as described on my website for evaluation of your neck and jowls. A neck lift is certainly a procedure to consider because you have not been satisfied with other less invasive techniques that you have tried. In properly selected patients a neck lift can remove lax skin, tighten relaxed platysma bands, and lift early jowl formation.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Treatment of early facial aging?

it is impossible to answer this question without an examination. Having said that I would be quite careful if I were you about having  light both suction, Kybella or Sculptra . These will probably make what you have worse and create a problem worse than what you have already. See a very experienced facelift surgeon for an examination. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 32 reviews

Necklift necessary?

Due to the neck banding and stretched appearance of the earlobe it would appear that this patient has had tightening of the neck already. A face-to-face consultation would be necessary to analyze the need and propose a solution. For this reason the patient should see an opinion from a surgeon who has many options available.

Richard O. Gregory, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 11 reviews

Are You Ready for a Necklift?

You raise a question that many patients ask in their 40's and early 50's" "I have had a number of minimally invasive procedures performed and am underwhelmed by the results.  Is it time for surgery?"  The answer in full would require a consultation.  However, the procedure I frequently utilize in patients with this question is a modified facelift with lateral platysmaplasty, which we describe as the Prelift.  As long as the surgery is performed well, early indication patients like yourself can achieve great results which are long lasting and appear natural.  I have posted a review of one of my patients who had the same dilemma. 

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 82 reviews

Am I ready for a necklift?

 Hi, I have performed facelifts and neck lifts for over 30 years and have performed many minimally, invasive type facelifts.  From the photos there is excess fat around the cheeks,  jowls are present, there is excess skin in the neck and the chin is weak.  These factors combine to create a rectangular shaped face. 

 Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.  Liposuction would help shape the cheeks and lower face.

 When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.

 "Jowls” are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.

My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:

  • very small incisions and no incisions extend or are placed within the hair.
  • minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed for the face and the neck
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op

I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.  There are two options for reducing the excess skin in the neck.  One is the minimally, invasive SMAS facelift as mentioned above, using a chin implant to provide the proper forward projection to the chin while removing skin below the chin.  This would take about 2 hours to perform, could be done under a local anesthetic and has a very quick recovery time.

 The other option is a formal neck lift where the incisions must be extended three inches into the posterior hairline for about four inches on both sides, the neck dissected from one side all the way across the neck to the opposite side.  The lower face would still require some version of a SMAS facelift due to the upward vector of elevated neck skin in order to avoid pleating by the ears.  A chin implant would still be required to balance the lower face. This version of a face and neck lift would take about 5 1/2 hours to perform, requires drains, pressure dressing and a recovery that can take months.  While this no doubt would give you the smoothest neck, there are no in between methods and this last one will be a much longer recovery due to the amount of tissue dissection required.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

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.