Vertical Scar on Neck to Remove Loose Skin

Question

I am a 58 year old female with history of weight loss of 135 pounds. I had a very successful abdominoplasty (removal of 10 pounds of skin) and breast reduction with lift. I am scheduled for an arm lift soon and would like to have my loose skin removed from under my neck. My PS tells me there is so much skin there that I would end up with big wrinkles behind my ears so he suggests an incision down the front of my neck. I will be a long incision. Is this normal? I am concerned.

Jed H. Horowitz, MD, FACS · Answer

It's best to begin by consulting with a surgeon in-person to discuss your options. The presence of banding down the front of the #neck, and, amount of excess skin and condition of your skin are among some factors which determine what treatments will best rejuvenate your neck . During your initial examination, your chin will be evaluated along with the neck and jawline. A weak #chin implies a lack of chin support for the skin along the neck line. In younger individuals a chin implant alone is usually all that is needed to improve the appearance of the neck. Subsequently, it will also improve the overall #balance of the face and can create the illusion of a smaller nose. As a stand-alone procedure, chin augmentation can be performed in the office under local #anesthesia. For individuals with signs of #aging in the neck, a chin implant added to one of the recommended procedures above, will provide optimal results.It is usually recommended that patients who have recently experienced weight loss and massive weight loss (#MWL) remain consistent at their weight for at least six to twelve months prior any cosmetic surgery. Such will better ensure longer lasting results of the procedure without risking the fluctuation and stretching of the skin tissue. If you are not a candidate at the time of your #consultation, your board certified plastic surgeon can recommend alternatives to address your concern. Consulting with a board-certified plastic surgeon who specializes in #neck lift procedures is important to ensure you are receiving the best advice, care, and surgical experience possible.

Sam Naficy, MD, FACS · Answer

I have performed a number of neck lifts on patients after massive weight loss and have not needed to make a vertical neck incision.  Your situation may be different - a profile view would be helpful.

Steven L. Ringler, MD, FACS · Answer

From your photo, you appear to be a good candidate for a lower-face and neck lift. I rarely, if ever, perform a vertical scar reduction of the neck skin because a scar along the front of your neck is typically quite visible and therefore undesirable for most patients.The goal of cosmetic surgery is to improve the appearance with minimal scarring whenever possible. Concealing the scars behind your ears along the hairline usually achieves this goal. Make sure you visit a board certified plastic surgeon with extensive experience in Facelift and Neck-lifts for an optimal outcome. Good luck to you.

Theda C. Kontis, MD · Answer

Your photo shows a typical aging neck that is generally treated with a lower face and neck lift ("facelift"). I have performed the vertical scar you are describing, but generally on much older women who do not want to undergo a long facelift surgery. These procedures are performed under local anesthesia. I have also taken a small amount of skin after a facelift surgery on some women with very thin skin with no elasticity, who experience a recurrence of the excess skin in their neck. I recommend that you obtain a few other opinions before choosing your procedure. The physician may have a concern about your health or your ability to undergo general anesthesia, and may have recommended a simple procedure for you. Nevertheless, seek additional opinions before making your decision.

Kimberly Lee, MD · Answer

I have performed necklifts where the incision is hidden behind the ears as well as the surgery you describe with the incision down the neck--however, that is usually for women who are much older who cannot have general anesthesia.

	If you are able to undergo general anesthesia and depending on the profile of your neck, it sounds like you would be a great candidate for the traditional necklift with the incision hidden behind the ears.

Edwin Ishoo, MD · Answer

A lateral / profile picture would be most helpful to evaluate the extent of your neck skin excess. Also, you wear your hair short which is much less forgiving of the post-auricular skin bunching that clearly your surgeon is worried about. A T-neck or anterior Z plasty is not performed commonly in women but it is a valid option especially in your case. If there is extensive skin excess, I would not recommend a tight corset or Feldman midline platysmoplasty as these techniques would exagerate the neck skin excess and would lead to an extended incision behind the ear extending far down the neck. I would recommend the incision be placed in front of the hair behind the skin as I am concerned that there would be a significant step-off due to the extent of skin requiring re-draping. If you are opposed to the midline neck scar, then I would recommend growing your hair longer and allowing the surgeon to extend the incisions as far as necessary behind the ears. I believe that realistically, you want to achieve improvement of the neck and lower face but not perfection with a tight neck and sharp cervicomental angle. I also do not believe that just a neck lift will be cosmetically adequate as the lower face and neck skin needs to be redraped as a unit so that it looks more natural.

David Q. Santos, MD · Answer

It is quite common to have moderate turkey gobbler deformity or significant loose skin in the neck area after losing weight.  Today frequently, patients who have undergone lap band surgery or gastric bypass surgery and have lost a good deal of weight, 50 to 100 pounds, have resultant moderate laxity to the neck skin area.

	Remedy for this particular problem is somewhat complex.  Some surgeons will approach the solution differently.  One good answer is to simply perform a standard neck lift/facelift to significantly improve the neck issues.  This can be performed at the same time as a platysmaplasty which requires an incision in the submental crease which is just behind the chin area and minimally visible.  A large percentage of patients who undergo this procedure in an expert fashion will have resolution of concerns to the neck area, but there is always a possibility of persistent laxity in the neck area.  Staging of the procedure is also a consideration.  Many patients undergo standard facelift/neck lift with submental approach platysmaplasty will not require further treatment of the neck area, but some do and when they do a vertical scar in the neck area, also known as a t-neck, can be utilized and decided upon at that time which is essentially at a later time.  So in essence, a vertical scar is not essentially required or necessary but indeed might be depending on the particular anatomy and circumstance.

Robert M. Freund, MD · Answer

I have performed the corset platysmaplasty on many patients with skin excess far greater than yours. You would do fine and avoid the vertical scar down the middle of your neck.

	The vertical scar platysmaplasty is a quick easy technique that I will perform on older male patients that do not care about a vertical scar running down the middle of their neck (not very pleasing - also can scar badly in some). This technique can be performed in about 30 minutes under local anesthesia, so it has some benefits.

	However, in most healthy patients, the corset rules the OR!

	Good Luck! Don't settle for second best!

Francis R. Palmer, III, MD (retired) · Answer

I have performed Face Lifts for over 20 years and have never used a vertical scar down the center of the neck for skin removal.  This is an older technique that was used in the 60's and 70's.  Typically, the incisions are just under the chin and behind the ears into the hairbearing posterior scalp.  If you are at all concerned about the midline scar...and IMHO, you certainly should be...just say no and understand that you may not be abl;e to remove all of the skin from your neck.

	From your photos, you also have excess skin of the upper face as well as loose muscle that would require some form of upper face lift along with your Neck Lift.  The midline scar is the least invasive way to remove skin but the scar is unacceptable for patients and so it's not often performed.

Vertical Scar on Neck to Remove Loose Skin

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