I Hate my Neck

Lots of things on my face bother me but I absolutely can't stand my neck for a moment longer ....its a bad mixture of genetics and sun and I'm really wanting to fix it. I just had Total FX on my face a couple of weeks ago and healed very quickly. Is a face and neck lift the only thing that will help me? I'm terrified of going under general anesthesia because I have young children and although its safe, there's always a risk. I also don't know any surgeons who specialize in neck rejuvenation. Help!

Doctor Answers 19

A neck lift is most effective, but nonsurgical skin tightening and Botox will improve your neck

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Dear Johnjana,

Your face looks excellent after your fractional ablative laser skin resurfacing.

You have an excellent jawline and no fat on your neck, so you are very fortunate.

There is no question that a neck lift, with well hidden scars behind the ear would give you an excellent result, and the best result.

However, I understand your reluctance to have surgery and there are non-surgical neck and facial rejuvenation options available to you-the results will just not be as good.

There are 2 components to what I see in your neck.

First, the little cords or bands are caused by the platysma muscle bands beneath the neck skin. Tiny amounts of Botox can reduce the contraction of the platysma muscle and lessen the appearanc of these bands. Injections will have to be repeated every 6-8 months.

The second component is a small amount of loose skin. New skin tightening techjnologies like the LuxIR Deep, Thermage, Titan, and Refirme can tigthten neck skin about 20-30%.

You will need 4 skin tightening treatments scheduled 4 weeks apart, and you will not see your final results until 6 months aqfter your last treatment.

If you only do skin tightening and not Botox, the cords or bands will still show.

I use the LuxIR Deep made by Palomar and have had very good results.

However, the MOST IMPOTANT thing is the person who uses the machine, not the machine per se. You need to do your homework and find a doctor who is experienced at skin tightening. It is OK if a nurse or medical aesthetician does your treatment-just make sure they have a lot of experience. The higher energies used by the operator, the better the skin tightening. The LuxIR Deep has excellent skin cooling which allows more aggresssive treatments.

Laser liposuction of a double chin also tightens skin, but since you do not have fat, I would not us the laser lipo fiber on you.

A surgical neck lift will offer you the best, longest lasting result

See before and after pictures of the surgical neck lift below( April photo # 1)

Neck laxity often needs surgery

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As you have already discovered, the minimally invasive procedures to tighten the neck are often disappointing. There are two excellent ways of reducing neck looseness.

First, a lower facelift can be done. This involves incisions behind the ear and underneath the earlobe. It tightens the neck and the neck skin nicely.

In some patients, the shape of your jawline contributes to the neck skin appearing loose. If the chin is receding, a small chin implant along with the lower facelift may be just the ticket.

A face lift that includes the upper and lower face can also redistribute volume, reducing it from the jowls and adding to the cheekbone area. This increases the power of the lift even more.

If cleverly done, performed by a oard certified plastic surgeon with a special interest and great experience in facelifts, facelift incisions should be minimally detectable or nondetectable. The ear and hairline should appear normal and unoperated.

For anesthesia, almost all modern facelifts use local anesthesia. Most patients in addition receive IV sedation or a light general anesthetic to make the procedure more pleasant. A properly selected patient should have a medical clearance and normal laboratory tests. If in addition the surgery is performed in an accredited surgical center with a board certified MD anesthesiologist, this will give the highest possible safety. We have all our facelift patients stay in an aftercare facility with a registered nurse at least one night after surgery, to monitor vital signs and keep the patient comfortable.

I have small children myself and many of my patients are very concerned with the safety of their surgery, especially if they have small children. Following all the guidelines above will not get you the best price, but will lead you to the safest surgery performed by the most competent surgeon.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

Surgical treatment for sagging neck skin

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I would not recommend a facelift but if anything a necklift only. You have such a minor issue as viewed by your photos but unfortunately it is enough loose skin that non invasive things such as thermage or other skin tightening devices will not help.

Hope that helps.

Surgical treatment will work better for the neck area

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You will need surgical treatment to get the best result. Lasers, fiiler,threads and botox will not work for you because of the skin condition and loss of elasticity. Find a board certified plastic surgeon and in the consultation listen to the recomendation before bringing up your concerns about general anesthesia. This way you will get the best recomendations , then ask your doctor if he or she can do this with local anesthesia.

Neck improvement under sedation

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Based on your photograph, an extended necklift or minifacelift may give you a great result.  These procedures can be performed under sedation or twilight anesthesia which is safer.  If you're not comfortable with that, a nonsurgical necklift is also a common procedure using fillers into the face to improve extra skin in the neck. 

Neck lift can be performed with local anesthesia and twilight sedation

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You do not need to go under general anesthesia for a mini face and neck lift. This procedure cab easily performed with local anesthesia and twilight sedation. Laser surgery will not improve you neck laxity.

Weekend Necklift

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It is possible that you may be a candidate for what is termed, "The Laser Assisted Weekend Necklift:" It is a minimally invasive procedure.

Cervicofacial Liposculpture is first employed to contour the unfavorable fatty changes seen in the face and neck as time passes by, such as the ‘Turkey neck’ and ‘double chin’.

Careful attention is then turned to tightening the neck muscles and eliminating neck bands. Finally, I employ laser technology to ‘resurface’ the underside of the neck skin, thereby ‘shrinkwrapping’ the skin of the neck restoring a youthful contour.

A consultation with a board certified facial plastic surgeon or board certified plastic surgeon will help determine which procedures will provide the best results for you.

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 123 reviews

Neck Lift without Face Lift

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From the picture you have shown, it appears that a straightforward neck lift concentrating on bringing your neck muscles back together can achieve the appearance you desire. This can be done under local anesthesia and you would eliminate the risks of undergoing general anesthesia. A midline plastysmaplasty or re-approximation of the neck muscles is performed with a small incision under the skin. 

Ankit Desai, MD
Jacksonville Plastic Surgeon

Neck lift or face lift may give the results you want

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A neck lift is an excellent operation for somebody less than 50 years of age who just has excess fat above and below the platysmal muscle. Traditional liposuction is an older but simpler procedure that can help as well. Women usually over 50 will require a face/neck lift because of the excess skin that needs to be removed, in addition to addressing facial and neck muscles. The photos shows there is no fat in the neck, just inelastic skin. A lower face neck lift with tightening of the excess skin is required. For many examples, please see the link below

There are many ways to improve neck banding

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You didn't mention what was most bothersome but I'm assuming its the banding in your neck. Botox can help improve this banding and will last 3-6 months. Another way of doing this is by doing a minimally invasive facelift concentrating in the neck area along with doing some work under the chin to release the bands. This approach is more invasive and another way of improving the way your neck looks is by grafting fat throughout your neck. You have to have enough fat to graft into the area. Usually the abdomen or stomach area is the best area to get this fat.

Philip Young, MD
Bellevue Facial Plastic Surgeon

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.