How do you avoid that sharp unnatural angular look after face lift with neck lift?

I don't know if this is possible, but is there a way to avoid that sharp angular look to the neck after a face lift. To me it looks like the head of a puppet on a stick. I have seen this look with some of the top plastic surgeons. To me it's a dead giveaway that someone had a face lift and it does not look feminine or natural to me. It just looks like it the neck was pulled way too tight.

Doctor Answers 19

Facelift and Necklift results: how to avoid a sharp angular look?

If you look at two classic beauties from the ages, certain things become clearer:

Athena, one of the three beauties in Greek mythology (Aphrodite and Hera being the other “fairest of them all”) is often shown as a classically beautiful face. She has a fullness to the face with gentle angles along the jawline and a blending in of the face into the neck: not the “puppet on a stick” you note.

Nefertiti from more than 3000 years ago, one of the two famous queens of ancient Egypt (Cleopatra, of course, being the other), is regarded in cosmetic surgery as being “well-good” as the saying goes. She is put up as an example, not only of perfect proportions (of the face), but also desirable angles and sharpness of the neck (cervico-mental angle). I am afraid, she may, rather, unfortunately, to you, look like a puppet on the proverbial string!

If you were going to gather all the cosmetic surgeons you know who do facelifts and neck lifts, you will find that most will find both these faces pleasing and desirable.

Depending upon the wishes of the patient and the aims of the surgeon, by using techniques and modifications, one can endeavor to achieve an Athena-like or a Nefertiti-like result. Preoperative discussions and expressions of likes-and-dislikes are vital.

I have put these two beautiful ladies in a brief video for you to digest. At the end of the video is an example of the Duchenne smile, which is where we smile with our eyes but people call them crow’s feet. However, preserving them gives one a much more approachable and genial facial appearance. Another example of how variable tastes and perceptions can be.

In other words, horses for courses, each unto him or herself, or there is no accounting for taste! Take your pick.

A very useful and astute observation on your part: gives many of us in the teaching and operating profession an opportunity to discuss and learn. Thanks.

Best wishes,

Prof. Bhupendra C. K. Patel MD, FRCS


Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 15 reviews

Facelift contour

Contour following a facelift should be improved along the neck and jawline, but you're correct that an overly angulated neck and jawline loses the smooth softness of youth.  One important factor in creating this smooth contour is to avoid over-aggressive fat removal in the submental and neck area.  A common mistake is to remove this fat too aggressively in a well-intentioned but misguided attempt at creating a more defined jawline.  This fat is important to maintaining a smooth and soft appearing neck and jawline.  An individual consultation with a facelift specialist should help to clarify and distill these issues for you personally.  A link with more information and pictures is included.  Good luck!

Scott K. Thompson, MD
Salt Lake City Facial Plastic Surgeon
4.9 out of 5 stars 99 reviews

It's all in the surgeon's aesthetics

Some surgeons pull as much as they can during a facelift.  That's never a good idea because it distorts the face and results in widened scars.  But in particular it is bad to pull too much behind the ears because it gives that sharp unnatural angular look across the neck which I think you are referring to.  That problem is made worse because during a facelift the patients shoulders drift upwards, so that what seems ok on the table causes a tension band across the neck as the shoulders relax.
I promise this is avoidable by finding a surgeon who can describe to you the things that he/she find troublesome in facelifts and how they avoid those looks.  Don't just tell them what you don't want; listen to them describe their aesthetics and you are sure to interview a plastic surgeon who has your taste.

Steven Teitelbaum, MD
Los Angeles Plastic Surgeon
4.8 out of 5 stars 44 reviews

The two secrets for a natural look of the neck after a facelift

Secret N°1: is being conservative with the liposuction of the neck. A two aggressive neck liposuction leads to an unnatural stick-like neck devoid of the natural fatty layer under the skin.

Secret N°2: is not cutting the platysma muscles (the large muscles under the skin of the neck). Cutting these muscles gives an unnatural angular look to the upper neck.

Nabil Fanous, MD
Montreal Facial Plastic Surgeon
4.0 out of 5 stars 5 reviews

Natural looking facelift results

Of course it is possible to avoid the facelift results you described above! First and foremost, when deciding to have a facelift and neck lift, it is vital you find a board certified facial plastic surgeon with extensive experience in these procedures to help avoid undesirable results. When you are consulting with a facial plastic surgeon, ask for the surgeon's credentials, review before and after pictures of his/her patients, and spend time talking about your goals and make sure that the surgeon is listening to and understanding what your expectations are so you can achieve the results you want. On the surgical side, it should be your surgeon's goal to give you naturally beautiful results so that you simply look like a younger version of yourself. Today, we know that volume in the face is an important component of a youthful face. When surgeons just remove excess skin and tighten the face, you see that unnatural angular look you mentioned. But when fat grafting is used to add volume to the face, we see much more natural looking results. When I perform facelifts and neck lifts, I create a heart-shaped face that looks balanced and youthful. The jawline, neck and chin areas create the bottom portion of the heart-shaped appearance and high-arched cheeks and a full mid face and temples are the top portion. A facelift and neck lift should make you look and feel like the best version of yourself, so make sure you do your homework to find a surgeon that can deliver these results to you; you deserve to look great!

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
4.0 out of 5 stars 7 reviews

How to get soft neck lift result

Thank you for asking about your face and neck lift.

  • The sharp look of a neck lift is from removing all the fat under the skin and removing tissues at the angle of the neck, under the jaw, down to the hyoid bone.
  • This gives a long lasting result but definitely a sharp and angular one.
  • To avoid this look - and not every one does want to avoid it - more fat is left under the skin and the natural angle under the chin is preserved.
  • But the more angular ones hold up very well over time - which not all neck lifts will do.
  • Discuss the look you want with your surgeon to be sure the surgical plan fits what you have in mind.


Always consult a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Newest techniques avoid this result

This has been one of the topics more treated in the last 5 years among Plastic surgeons, and there are new techniques created to avoid this outcome. This techniques focus the treatment in the lift, trim or re-position of the SMAS not the skin. 

I, like a few other colleagues offer online consultations where you send us your photos and we can estimate the cost. Find a Board Certified Plastic Surgeon and discuss what will be the proper treatment to achieve the result you desires.

Regards,

Dr. Luis Redondo

Luis Eduardo Redondo, MD
Dominican Republic Plastic Surgeon
5.0 out of 5 stars 17 reviews

Avoiding the "operated, pull look"

Facial Plastic Surgery is an art. There are many details that will make a patient happy and others that will not make them happy. One of the details that I avoid on my patients is the exaggerated pull that some physicians try to do to their patients and sometimes this look is requested by the patients themselves. Some patients believe that if they get a surgery with the maximum amount of pulling that makes their face look tight and hard, that is the only way to make the surgery to be worth it.

I believe on what I call "natural give of the tissues" that every person at different stages of their life have up to some extent. When this normal "give" or "excess" increases and starts to look as excess skin and droopiness, that is when we as surgeons need to address the problem. By returning the patients to a "normal state of appearance" with no unnatural tightness around the cheeks and neck is only when the look of a patient will have a natural un-operated flow and look. The structure of the face/cheeks/neck are not solid structures, they are dynamic, they must move, glide, and have a natural hang. When facial structures are tight, stressed or pulled, that is when an un-natural operated look originates.

The eye is very unforgiving, it is able to detect very easily both edges of the spectrum, To much sagginess and you look old, to much stretched/tight look and you look odd. You want to be in between.

Hope this helps,
Dr. Gus Diaz
Double Board Certified in Facial Plastic Surgery.

Gustavo A. Diaz, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 15 reviews

How to avoid an unnatural outcome from facelift surgery

There are many details and fine points that can be reviewed with your surgeon at the time of consultation. I would recommend that you write down these points as each reasonable question can be addressed at the time of your surgery by an experienced facial specialist. The most important factors responsible for your future success are directly related to your surgeon’s training, board certification, surgical specialization, and observed outcomes. Your initial consultation provides you with the opportunity to review each of these elements and to make the right decision for you. I would also recommend bringing photos of faces you like and older photos of yourself to such consultations.
Be healthy and be well,
James M. Ridgway, MD, FACS

James M. Ridgway, MD, FACS
Bellevue Facial Plastic Surgeon
5.0 out of 5 stars 78 reviews

Natural neck contour after face and neck lift

Thank you for the great question. The overly angular or "puppet" look you are describing can be related to aggressive removal of fat from the under-chin area. This maneuver, preferred by some patients, can lead to the "surgical" look that you fear. The way to avoid this is to leave some fat on the skin flap in the neck, and to lift the face and neck superiorly, rather than pull back.

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 98 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.