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

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.

Face and necklifting can very, very safely be performed with local anesthesia. Most often I will use sedation with the local anesthetic, but I have had patients request no sedation, and they do very well with a procedure like a necklift. 
You will find many more modernly trained surgeons steering away from unnecessary general anesthesia. It falls in the same minimally invasive direction that all of medicine is headed.To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut
#realself500 Physician

Without photos, it's difficult to make suggestions based on your concern. There are many options; both surgical and non. However, the best option for you depends on the level of #laxity. It's best to begin consulting with an board certified plastic surgeon in-person. He or she will evaluate both your anatomical features and aesthetic goals to determine which neck lift procedure best suits your individual needs. Factors which are considered during your consultation to determine if you are a #candidate for #rejuvenating the neck include: •Visibility and amount of excess fat below the chin and along the neckline.•The presence of banding down the front of the #neck.•The amount of #excess skin and condition of your skin.•Chin Deficiency.•Presence of Prominent Digastric Muscles (a.k.a. submandibular gland fullness).
During the examination the chin will be evaluated along with the neck and jawline.  A weak #chin means there is not adequate 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.
If you are not a candidate at the time of your #consultation, your board certified plastic surgeon can recommend non-surgical #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. 

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

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 faceliftThere is minimal bruising and swelling, especially when compared to traditional faceliftsAs the procedure is performed under local anaesthetic, you can go straight home following the procedureFull recovery in a matter of days rather than monthsSignificantly less risk than Facelifts performed under general anaestheticFresh, youthful and long lasting resultsMake 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

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.

 Your situation illustrates my usual advice to patients that if you see three different surgeons about a single problem, you will usually get three different answers.  Personally, I do not understand why no one offered to do a neck lift procedure on you under local anesthesia.  This would almost certainly address your concerns.

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.  

Best,

Dr. Yang

There are several different options to improve the neck skin laxity. Without assessing a picture, it is difficult to make a recommendation. Your young age and some of the other plastic surgeon opinions lead me to believe you would benefit from a midline platysmaplasty or neck lift performed with a incision just under the chin. Using this same incision, you may also benefit from a chin implant. Both of these procedures can be performed under local anesthesia with minimal scarring and incision length. Consult  with a plastic surgeon certified by the American Board of Plastic Surgery to learn more.

With regards to your question, there are several topics to discuss.

Anesthesia: If you have some form of cardiac, pulmonary, or metabolic reason for not having anesthesia, the discussion should end here. Elective facial cosmetic surgery is for healthy people; there is no good reason to take unnecessary risks.

However, if you are healthy at age 39, the techniques available for anesthesia in a neck lift procedure do not require general anesthesia and are very safe. The technique used by a sizable portion of Facial Plastic Surgeons for face/necklift procedures is twilight sedation. This means you will have no memory of the event, no pain during the procedure, yet are still able to breathe for yourself; monitoring equipment is used to measure your pulse, blood pressure, and oxygenation level. In my practice, a Board Certified Anesthesiologist gives you sedation. Face/Neck lift without sedation? I have found that after appropriate explanation of the what is involved in the procedure and the anxiety level associated with being awake for a procedure, the overwhelming majority of my patients opt to have sedation. I have also found hat most patients who elect not to have sedation experience more anxiety than they had anticipated when they have the procedure.

Do not believe the hype of large infomercial based companies offering "no anesthesia" lifts as some sort of a healthier bonus. There are risks associated with any procedure. Take Home Point: If you are receiving a large dose of oral sedatives for a procedure and you are not monitored by a CRNA or Anesthesiologist, you will be putting yourself at higher risk than if you have sedation with an Anesthesiologist or CRNA watching you.

Neck Lift or Facelift: Pictures would be very instructive. However, one thing I note is that 2 out of 7 Surgeons you saw mentioned a chin implant. I recommend going with the Surgeon with whom you felt most comfortable.

Your surgeon can do the same surgical neck lift with just tumescent local anesthesia without general anesthesia. Many anesthesiologists now do the local anesthesia instead of the general anesthesia for face lifts and neck lifts. If you've decided on your surgeon , then the next step is for you to discuss your wishes with your surgeon so he has time to locate an anesthesiologist who can do the tumescent local for you. It is a win-win situation. There are always options. That is why this type of forum with many docs is so needed and valuable.
Good Luck,
David Hansen,MD