What to Do with Neck Laxity when General Anesthesia Isn't an Option?

I'm a 39-year-old with mild/moderate neck laxity, but I'm not after a face lift. I understand that invasive lifting has the highest guarantee of success, but for medical reasons, I prefer not to have general anesthesia (especially considering its an elective procedure).

I have consulted 7 MD's who are respected and reputable plastic surgeons in the Stanford/Palo Alto area (head and neck and general Plastic surgeons) and have had a range of responses. One suggested a "mini" facelift (which is basically a face lift) with submentoplasty and chin implant, a couple recommended an isolated submentoplasty and chin implant, 2 recommended an isolated neck lift, and one MD said I'm not a candidate for face/neck lift surgery and should get a chin implant, Botox in the platysmal bands, resurfacing, and Titan Laser. One also said Active/Deep FX all over my face and neck would be the best. I'm now frustrated and feel as if there's no hope but to live with my prematurely wrinkled neck. Any advice?

Doctor Answers 19

Neck Lift Can Be Done Under Local Anesthesia

Thank you for your question.

A Neck Lift can e done under local anesthesia if that is what you need and want.

The laser resurfacing methods you mention will not tighten neck skin.

Thermage, Ulthera, Titan, and Lux IR Deep are non surgical skin tightening methods for the neck but only achieve at best a 20% result.

I understand your frustration. If after seeing 7 surgeons you are undecided and unsure the best option is to do nothing and re assess in a year. Good luck.

There are multiple ways to rejuvenate a neck

While it's difficult to know what options you have without examining you, what I think you are seeing is that depending on the surgeon, there are multiple options for neck rejuvenation. I think you have been offered a wide range of options, some more invasive than others, and each with its advantages and shortcomings. I don't think you have to live with your neck if you're unhappy with its appearance, and I do think you can have a procedure done to improve it. The key will be to decide what risks you are willing to accept, what would you would accept as an improvement, and make a decision that works best with your current goals.

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 149 reviews

It depends on your goals: Your neck profile or skin texture

All of the proposed options can all be performed without General anesthesia.  

Some can be performed under local anesthesia alone with oral or intramuscular sedation, while other surgeons may prefer local anesthesia with IV sedation.  This helps to avoid the general anesthesia which you have your reason for avoiding.  Some people have a history or family history of Malignant hyperthermia from general anesthesia inhalational anesthetics (the anesthesia gases), which would be a contraindication for having general anesthesia.

I think a common element of all of your consultations is the necklift/submentoplasty.  

I don't think that Botox on the platysma muscle bands does enough to flatten them out, and it is not a good long term solution.  It can end up becoming a money pit, with less than optimal results.

The chin implant recommendation and necklift (submentoplasty/platysmaplasty) will both help with your neck profile.  Redraping the neck skin will help slightly with skin texture from the mere repositioning of the neck skin, but these surgeries will have a very limited affect on the true texture of the skin.  If you have significant sun damage and crepiness of the neck skin, the skin quality doesn't change with the surgical procedures.  

I have heard good things with the fractional lasers, and I have seen patients treated by dermatologists in my area using Fraxel, with impressive results.  I don't know how much of an improvement you will get on the neck skin, but it should change the texture since the laser is resurfacing the skin and not just repositioning it.

Profile versus Skin Texture

You mentioned two separate things about your neck which I consider different problems and the solutions are different.  You mentioned mild to moderate neck laxity, which should mean some kind of hanging neck skin or neck bands (platysmal bands) which is making the neck skin hang by the tenting of the platysmal bands through the skin.  In the end of your question your mention your "wrinkled neck" which suggests to me that you have more of a skin texture problem.  

The submentoplasty is a mini-necklift with an incision solely under the chin, to lipsuction fat and tie together the muscle bands (platysmal bands) and sometimes also cut the edge of the muscle.  A full necklift is the submentoplasty with additional incisions around the base of the earlobes and back of the ear into the hairline.  A lower face and necklift will have incisions both in front and behind the ear.

By sculpting the profile of the neck on a fat and muscle level allows the neck skin can be redraped or repositioned into the "crotch" of the neck where the neck and chin meet.  This angle is called the cervicomental angle (cervico- means neck; mental means chin).  If the neck skin is wrinkly, you may see a slight improvement in the wrinkles when the skin is redraped into this cervicomental angle.  When you have the "honeymoon swelling" everything will look great, but when the swelling is finally gone, you will still see some improvement, but not as much as during the "honeymoon."

The question you have to ask yourself is whether you are looking for profile improvement, or skin texture improvement.  In general, profile improvement is performed using surgery and implants while skin texture improvement is a resurfacing procedure which involves lasers or peels.  If both aren't bad, but you want improvement in both, you may opt for a combination procedure.

I hope this makes some sense.  


Dr. Yang

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

As you can see, there are multiple options!

There are a wide variety of options to rejuvenate the neck. Because you are young, some of the more conservative options might be the most reasonable but it really depends on your anatomy and your expectations.

You are hand-cuffing the doctors by placing restrictions on the anesthesia. I would suggest going back to the ones you liked most (I would recommend Ben Maser, MD at the PAMF) and ask them what they would advise if anesthesia were not an issue. Then ask them what anesthesia they use (physician anesthesiologist is best) and see if you can't get through the anesthesia issue. It would be a shame not to get the result you want because you have restricted the doctors from being able to do what they truly believe is best for you.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Neck Rejuvination Options

A lot of surgeons offer different options and prefer different methods when it comes to facial rejuvenation. Truly, there may be several options for you that would achieve the end result you desire. You also need to take into account that, if you feel you are not healthy enough to undergo general anesthesia, you may want to discuss that with the surgeons as well. If it is just a matter of an allergy, then you should be fine with the local anesthesia and a form of medication that relaxes you.

Without seeing a picture it is difficult to give any real advice as to what I would personally recommend, however, most of those are valid options; it just depends on the exact laxity of your neck. If your neck laxity is verging on the edge of mild to moderate I would recommend a surgical procedure, such as a neck lift or mini lift, with local anesthesia and the oral medication for relaxation during the procedure. “Dr. D”

Edward E. Dickerson, IV, MD
Fayetteville Facial Plastic Surgeon
4.7 out of 5 stars 120 reviews

The Best Necklift

The best way to lift a sagging neck is to have surgery. Necklifting can be performed under local anesthesia quite comfortably.  All necklifts require removal of the submental fat.  If there are platysmal bands, these must also be corrected.  Lasers cannot address sagging skin no matter what they advertise. There are two different necklift procedures to address sagging skin.  Depending on how much sagging skin is present will determine which incisions are required to acheive your desired result.  One necklift involves one incision underneath the chin and the other involves more involved incisions hidden around the ear. 

Paul S. Howard, MD, FACS
Hoover Plastic Surgeon
5.0 out of 5 stars 7 reviews

Restore the triangle of youth.

Many women identify the first signs of aging in the central lower third of the face (around the mouth and neckline).  The development of mandibular jowls and neck skin laxity, neck muscle splaying and subcutaneous fat accumulation in the neck all contribute to making the face a "pyramid of age".  In your consultations with local experts, you have discovered that there isn't one "solution" to a so called problem, as evidenced by the variety of approaches offered.  I agree with the other consultants that a lower face (concentrating on the tissues below the corner of the lips) and necklift provide a very satisfactory and long lasting solution.  Assuming that health and weight issues remain constant, you can expect 10-15 years "grace time". 

If a patient is a surgical candidate for face and necklifts, there are alternative anesthetic techniques, which are more comfortable than straight local or tumescent anesthesia +/- oral meds.  Monitored Anesthesia Care (MAC) also known as Total Intravenous Anesthesia (TIVA) should be considered.  The experience and skill of the anesthesiologist is critical here.  My patients and I have both benefitted from this technique over the last 7 years.  Personally, I prefer not to struggle with an endotracheal tube, when addressing the neck.  Our anesthesiologists use the BIS (brain wave) monitor to dose the medications precisely.  The patient's experience no pain or anxiety and fast emergence, without the usual narcotic "hangover" or potential for nausea and vomiting.  It's not for everyone, but you might consider asking your consultants their views on this technique.  Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Consider Sedation Anesthesia

I frequently perform facial surgery including face and neck lift surgery sedation, or “twilight” anesthesia. Both of these options are common and both have equal implications on the results of your procedure. Under sedation anesthesia, you will literally sleep through the surgery. It is considered to be among the safest methods of anesthesia and involves a quicker recovery then general anesthetic. Speak with your surgeon about this option to see if sedation anesthesia is feasible for you given your medical concerns

Julian De Silva, MD
London Oculoplastic Surgeon
5.0 out of 5 stars 149 reviews

Facelift and Necklift Under Local Anaesthetic

Thank you for your question.

I have pioneered my Concept™ Facelift which is suitable for men and women who wish to reduce sagging in the lower face (jowls) and neck and regain a more natural, rejuvenated appearance. The procedure is less invasive than a traditional facelift and there is less scarring, bruising and swelling for a significantly quicker recovery period. This innovative procedure combines the latest surgical techniques with the use of local anaesthetic to dramatically reduce the risks associated with traditional facelifts, while significantly reducing the bruising and downtime of your recovery, from months to a matter of days.

What are the benefits of the local anaesthetic Concept™ Facelift?

  • Minimally invasive as it is a short scar facelift
  • There is minimal bruising and swelling, especially when compared to traditional facelifts
  • As the procedure is performed under local anaesthetic, you can go straight home following the procedure
  • Full recovery in a matter of days rather than months
  • Significantly less risk than Facelifts performed under general anaesthetic
  • Fresh, youthful and long lasting results

Make sure you find a reputable and qualified plastic surgeon who can assess you properly to give you a realistic idea of what outcome you can achieve.

All The Best

Non-Surgical Options for Neck Rejuvination

I'm sure it's difficult to get conflicting advice from so many surgeons. With that being said, there is no substitute for surgery in terms of getting a comparable result. There are however, other options that might be worth considering. I often recommend Ulthera for patients who are not interested in or ready for surgery. Ulthera can be very effective for treating wrinkles in the neck area. It uses ultrasound to re-stimulate collagen at a very deep level under the skin, leaving the top layers of skin completely in tact. It is a very non-invasive procedure with virtually no down-time. It is fantastic for people in your age range, and something that I recommend for patients on a regular basis. Most importantly, think about all of the options that have been presented to you, and narrow them down according to what you feel the most comfortable with. I would suggest scheduling follow up appointments with the 1 or 2 doctors whose opinion you trust most, and ask more questions about the recommended procedures so that you can learn more about the options available to you.

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
4.1 out of 5 stars 9 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.