How Do You Get the Sagging Neck Muscle to Go Back Where It Used to Be?

i am a thin girl, 46 years old, never had face work done, i have loose skin under neck, but even more so, i have saging muscle tissue???? what type of sergicle persedure is best???

Doctor Answers 13

Restoration of Sagging Neck Muscle Requires Platysmaplasty

Thank you for your question.

A procedure called a Platysmaplasty is used to restore a sagging neck muscle back to it's original position.

In some cases this can be done through only a small incision under the chin, called a Corset Platysmaplasty. The neck muscles are sutured together to tighten them.

However, in most cases an incision is also made behind the ears to further tighten the skin and muscle.

Neck lift techniques

vary considerably.  If you are trying to avoid a visible scar, which I would assume you would at your age, you would benefit from either a full facelift or corset platysmaplasty.  Both procedures will address lax skin and you should discuss these alternatives with your surgeon.  If you were older and did not care about a scar over the front of your neck, a direct cervicoplasty works quite nicely.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Facelifts remove sagging skin and muscle.

Facelifts remove sagging skin and muscle. See an experienced facelift surgeon for the best and natural results.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

How Do You Get the Sagging Neck Muscle to Go Back Where It Used to Be?

  Photos of your face and neck would be helpful in the evaluation.  Tightening the neck muscle (Platysma) is preformed as part of a formal Neck Lift surgery.  Because the neck skin is elevated up and back, the lower face (Jowls) typically is tightend (SMAS) with skin removal as well.  Be sure the plastic and cosmetic surgeon, you select, understands and follows the proper aesthetics of facial beauty for the creation of a naturally, more attractive face. 

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

A necklift helps with both sagging skin and sagging muscle bands

Hi Heidi250,

Some patients have a tendency for sagging necks, due to their family genes.  Often times if these patients look at their parents and grandparents, they will see that their necks and lower faces are quite saggy.

A procedure that can treat the neck in isolation is either a submentoplasty, which I also like to refer to as a mini-necklift, or a regular necklift.  I will expand on both procedures.

A Submentoplasty is a procedure which reshapes and tightens the area under the chin.  The term submentoplasty, essentially means plastic surgery (-plasty) under (Sub-) the chin (mento or mentum).  The work that is performed in a submentoplasty is a combination of tightening the muscles under the chin (the platysma muscles) with or without liposuction.  If  the patient has a very thin neck to begin with, I will not liposuction the patient's neck at all.  Keeping a healthy thickness of fat immediately under the skin will help maintain the texture and prevent the "crepey" skin on the neck which we often see on older sundamaged people.  The tightening of the muscle band (platysma bands) will help to prevent them from hanging down.  If the patient doesn't have excess skin and the skin still has decent elasticity, then a submentoplasty is potentially a good option for them.  The best part of the procedure is that it can be performed under local anesthesia with minimal sedation, and requires a 1/2" to 3/4" incision under the chin typically hidden in a wrinkle under the chin.  Some surgeons may opt to make a longer incision, but I find that using a headlight and small instruments, that the small incision is wide enough to perform the procedure.

The general cut off point that I use in my practice is the age 45.  This means that in general, once a patient is older than 45, potentially they would benefit more from a regular necklift than a submentoplasty, because their skin may be more sun damaged and have less elasticity.  Patients under the age of 45, generally have good enough skin elasticity and less sun damage, so the skin will contract and shrink down without needing to make additional incision to remove the excess skin.  The concept is similar to liposuction versus a tummy tuck.  Some patients can have liposuction to reshape the "foundation" under the skin and the skin with contract and hug the new shape.  Other times, liposuction will make the skin saggy and actually look worse, in which case, a longer incision to remove the excess skin is required.

Having given the cut off at 45 year old, there are obviously exceptions.  The oldest patient I performed a submentoplasty was a 64 year old Asian woman with excellent skin elasticity and minimal sun damage to the skin.  The youngest patient I've performed a regular necklift for is 36 years old.  So I look at each patient as an individual and make a recommendation based on that particular patient.

A regular necklift is essentially the same as a submentoplasty, except there are additional incision that start around the base of the earlobe and continue in the crease behind the ear, and then transitions into the hairline behind the top of the ear.  The submentoplasty portion of the procedure creates firm foundation with the muscle and reduction of any "excess fat" for the skin to redrape or lay over.  The excess skin under the chin can then be pushed backwards behind the ear, and the incision allow for the surgeon to trim off the excess skin in a well hidden location.  If the surgeon does not make an incision there is no place to remove the excess skin, and the healing would need to depend purely on the skin contraction.

I hope this helps.  Please post any follow up questions.  I would be happy to answer them.


Dr. Yang

George Yang, MD
New York Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Surgical Advice for Sagging Neck Muscle

Thin skin with "sagging muscle" is a challenge since tightening of the skin may not be sustained and surgery of the muscle may not completely improve your appearance. I suggest you meet with an experienced surgeon with extensive experience with face and neck lift surgery to learn what your best options are.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Tightening sagging neck muscle

Based on what you are describing it appears that you would benefit from a surgical neck lift - this will address all 3 layers, skin, fat, and muscle.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Sagging skin under the neck is best addressed by a facelift

Facelift procedures are best to address excess skin under the chin and neck. The muscles via SMAS and platysma procedures as well as the excess skin will be addressed with a facelift procedure. See a reputable surgeon in your area and look at their before and after pictures, speak with their patients who have gone through the same procedure, and discuss your objectives and desires with your surgeon so a good surgical plan may be addressed. Best regards!

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 208 reviews

Sagging neck muscles

Sagging muscles need to be addressed through a platysmaplasty whereby the 2 anterior platysmal cords are sewn together through a small submental incision.  This is done at the time of a neck lift or a face/neck lift.  If there is excess and loose skin in the neck, a face/neck lift must be performed to tighten excess skin.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Tightening loose neck muscles

It's hard to say what precise surgery would be best in your case without seeing your neck. In general, the neck muscles can be tightened with a platysma-plasty. If you also have loose neck skin a facelift may be indicated as well to help with tightening the area appropriately.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 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.