What procedure will tighten my neck and jowls? Platysmaplasty / Lipo / Necklift / SMAS Facelift. I'm getting confused (Photo)

Question

I thought a necklift was what I needed. Now I'm told I need lipo, platysmaplasty, Necklift and SMAS facelift then they even started on my eyes! I'm willing to accept ageing, but not my inherited jowls and turkey neck! I don't want unnecessary surgery, I just want to have my neck and chin tighter. Is a necklift a collective term for lipo and platysmaplasty or is it different? Can a necklift be done without a facelift? What results might I expect from each? Please help!

David Hansen, MD · Answer

A lower face/neck lift usually includes liposuction and a platysmaplasty and can all be done together under local with a little iv sedation for comfort. It is difficult to do just a platysmaplasty and lipo alone since you need your jawline to be more defined as well.

Jason Emer, MD · Answer

With significant neck sagging you would need a facelift / neck lift with muscle tightening (platysmaplasty). At the same time, I would recommend lasers (Fraxel, CO2, Halo, or Erbium) and microneedling RF (Fractora, Morpheus8, PiXel8, Intensif) to improve the crepey skin and wrinkles. Overall, the neck can be treated with a combination approach:

1. Microneedling and laser treatments for texture
2. Botox, Dysport, Xeomin or Jeuveau to help platysmal bands
3. Intensif, Fractora, PiXel8, or Morpheus8 microneedling RF for crepey skin and lifting
4. Injectable fillers like Belotero, Restylane Silk, Versa, and Juvederm Volbella to improve lines and folds
5. Face/neck lifting if sagging is prominent or premature, with or without platysmaplasty (muscle tightening)
6. Renuvion (J-Plasma), ThermiRF, and InMode FaceTite/AccuTite for internal tightening
7. Ultherapy and Thermage for external tightening
8. Regular Venus Legacy, Exilis Ultra, or InMode Forma treatments with facials to maintain tightness
9. PDO NovaThreads or Silhouette InstaLift cone threads for lifting and long-term collagen production

See an expert for a formal evaluation and to develop a personalized treatment plan based on your individual situation and goals. Best, Dr. Emer"

Jed H. Horowitz, MD, FACS · Answer

It's best to begin by consulting with a surgeon in-person. 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.However, if you are seeking a facelift and deemed a candidate, you may want to consider Lite-lift™. Lite-lift™ is an affordable, quick, and effective innovative facelift developed by board-certified plastic surgeons Dr. Larry Nichter and myself. The goal is to provide a less invasive natural looking option for both men and women desiring to refresh their appearance with less downtime and risks. The LiteLift® is a “real” facelift, which does address the underlying muscle, tissue and overlying skin.This is a modified facelift that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.The best candidates for #LiteLift are non-smoking patients 35-60 years old with stable skin elasticity, well-defined bone structure but showing early changes of the lower face and the neck. Older patients who cannot or do not wish to have a longer operation or general anesthetic can be improved with a Lite Lift™. All in all, Lite Lift™ surgery is individualized for each patient. A board certified plastic surgeon should evaluate both your anatomical features and aesthetic goals to suggest which procedure best suits your needs. In some cases there may be more than one option to choose from. If you are not a candidate at the time of your #consultation, your board surgeon can recommend non-surgical alternatives to address your concern.

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thank you for your question and pictures.  The necklift needs to be performed with the facelift.  The scars are the same, and the result will overall be better and not disjointed.  This will removed the little jowls you have, making a contoured jawline and removing any skin laxity.  The neck from the pictures I would suggested a little bit of liposuction under the chin and then a neck lift, to create a nice L shaped neck.  These can be performed under local anaesthetic, giving a youthful and fresh appearance.  Patients normal prefer local anaesthetic because the downtime is significantly reduced.  Patients normally returning to work after 7-10 days (if you have liposuction 10 days maybe needed as you tend to get a little more bruising).What are the benefits of a local anaesthetic 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 resultsStandard aftercare for a facelift includes, sleeping upright for the first week to minimise a collection of blood forming, showering and washing your hair every day post surgery and drying using a hairdryer on a cool settings, not allowing pets to sleep in your room or on your bed. Painkillers as prescribed by the surgeon, antibiotics if needed and prescribed by your surgeon. 
Please 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

Raymond E. Lee, MD · Answer

Thanks for sharing. In general, current neck and lower face rejuvenation treatments include
Surgical Neck lift* with a Lower Facelift would be the gold standard and gets the best overall results in the jowls and neck and indicated in middle age and older patientsSurgical Neck lift* which involves lifting and removing loose skin from behind the ears would be the next best procedureNeck Liposuction and/or Laser Lipolysis if only fat removal is required, typically in a younger patient. (A platysmaplasty can be added for further muscle tightening if needed)Ultherapy is an FDA approved non invasive tightening using ultrasound technologyKybella is a new FDA approved series of injections that melts fat under the chinCool Sculpting is FDA approved energy device to removed fat from under the chin as well. Botox to the platysma bands to decrease their activity and show*It is important the a Neck lift involves some liposuction and importantly a platysmaplasty which is a procedure that tightens the underlying loose neck muscles.  From your photos option 1 is the proper choice. Patients do not like to hear they need all this work but for an experienced surgeon this is straightforward and you will have the highest satisfaction rate.  Anything less is less results and will be less satisfaction.  Hope this helps to read this and make an informed choice. Consult with several board certified faciall platic / plastic surgeons experienced in face and neck rejuvenation to discuss your options

Vaishali B. Doolabh, MD, FACS · Answer

Hi AlyBallyb.  Yes a necklift is a collective term for all techniques that rejuvenate the neck-lipo and platysmaplasty is addressing the different tissues that are contributing to neck fullness (lipo removes excess fat, platysmaplasty tightens sagging muscle).  Usually, the lower face tissues fall into the upper neck; with your photos, you are not a good candidate for a necklift without a facelift.  The term SMAS facelift refers to the longer lasting technique of tightening underlying tissue, rather than just pulling on skin (can give an overstretched appearance).  You would get full correction of the lower face & neck with the proposed procedure (SMAS facelift, lipo, platysmaplasty) with softening of the nasolabial and marionette folds, more midface volumization, correction of jowling, removal of excess neck fat and laxity from loose platysma muscle.  Best wishes,

Robert M. Freund, MD · Answer

In my practice, I divide the face into Zones that can be treated separately. Zones can be combined as well.The neck and lower part of the jawline can be treated by a neck lift.The neck and jowl that extends up onto the mouth can be treated by a Lower facelift.The neck, jowl and sagging cheek can be treated with a facelift.The sagging cheek and jowl can be treated by a mid face lift, otherwise called a cheek lift.The sagging brow can be treated by a multitude of different Browlifts ) lateral Browlift, Coronal brow lift, endoscopic brow lift, pretricial brow lift).A necklift is tailored the each individual. It includes removal of fat in both the area right below the skin as well as fat that is deep to the platysma muscle (you have that). The fat is removed by direct excision and liposuction. The platysmaplasty is performed in most neck lifts. So a good plastic surgeon can perform a neck lift and will include those things procedures that were described to you.If you have any further questions please read my book, "A More Beautiful You - Reverse Aging through Skincare, Plastic Surgery and Lifestyle Solutions".

William Portuese, MD · Answer

In our practice, we perform a high-SMAS lower face and neck lift procedure.  This is a comprehensive lower face and neck lift which accomplishes tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the jowls, and removing fatty deposits in the neck.  For more information, many before and after examples, please see the link and the video below

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

Hi, I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  From the photos your cheeks are flat in the front, there is excess fat in the mid face, jowls are present as well as excess fat and skin below the chin in the neck.  These factors combine to create a rectangular shaped face. 
 Following my facial beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 "Jowls” are sagging facial tissues and the primary indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face. Along with the minimally, invasive SMAS facelift described above, some of the excess skin below the chin can be removed using a small, curved incision under the chin.  This along with skin removed in front and behind the ear will tend to reduce the skin excess by around 70% or more.
 If anterior platysmal bands are present or the maximal amount of neck skin is to be removed, a "formal" neck lift can be done.  In this procedure, the face and neck tissues are elevated using a curved incision around the front (explained later) of the ear that continues in the crease behind the ear and then 3 inches into the posterior hairline.  The tissue is dissected from that point all the way across the entire neck to the same position on the other side of the head in a dissection that is as long vertically as the entire neck.  The Platysma muscles are tightened using a curved incision under the chin and each side is pulled upward and back again being tightened at a line behind each ear (under the tissues).  Since the skin flap pull is up and back, this will pick up any tissue laxity along the jaw line or "jowls" which must be dissected and flattened out using a lower facelift (incision around the front of the ears).  If this isn't done, pleats of excess skin will appear below each ear.
This is an extensive surgery taking 4 1/2 to 5 hours under a general anesthetic using larger incisions, pressure dressing, post op drains, longer recovery and possible hair loss.  
Hope this helps

Jon Ver Halen, MD, FACS (license suspended) · Answer

Hello and thank you for your excellent question. You are a great candidate for each of the procedures you have lifted. However, if you only want to address your neck, to the exclusion of the other procedures, then you should discuss this with your surgeon. Of course, you will need an in-person consultation to evaluate you for this procedure. Preoperative visualization and surgical simulation with the Crisalix system may help with your decision. Any treatment plan should be based on a detailed discussion with equal input from both you and your surgeon.    Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation in person with a qualified board-certified plastic surgeon. Good luck!
 
 Best,
  
Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

What procedure will tighten my neck and jowls? Platysmaplasty / Lipo / Necklift / SMAS Facelift. I'm getting confused (Photo)

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