21 January 2020 onur
Neck lift surgery is a fundamental step of the facial rejuvenation project. No facial rejuvenation surgery that does not involve the neck can offer a high level of effectiveness and naturalness. Rejuvenating only the face and leaving the neck out is one of the most common mistakes in facial rejuvenation surgeries, one which discloses at a glance that the person has had a facelift surgery.
In this blog post, I will list the key points about neck lift surgery and neck rejuvenation.
Neck aging is multidimensional
As the neck region ages, the superficial skin, the platysma muscle just below the skin, subcutaneous adipose tissue, the fat tissue under the platysma muscle, the midline muscles of the neck, and the salivary glands in the neck undergo significant changes. The optimal treatment must address all of these layers.
Neck aging patterns exhibit individual differences
While neck aging is caused only by the loosening of the skin in some people, the laxity of the platysma muscle is more prominent in some others. In some people, sagging and growth in deeper structures (salivary glands, digastric muscles, etc.) may be evident. Individual skeletal structure affects neck aging very closely.
Neck rejuvenation surgeries are tailored surgical procedures.
We prefer various neck rejuvenation approaches according to the differences in the aging pattern, the anatomy of the face and neck, the position of the person’s jawbone, gender, expectations, risks and other accompanying surgical procedures.
Neck problems may not be what they seem externally
The ideal angle between the neck and the chin is around 90 degrees. Loss of neck angle is one of the most common complaints in neck aesthetics. Another aesthetic defect is the fading of aesthetic surface contours of the neck. We call this a loss of definition in the neck. Our patients often think that the loss of angle in the neck is due to fat accumulation under the neck skin. However, almost 90% of individuals with neck angle loss have additional pathologies such as growth, relaxation, sagging, atrophy and attenuation in the deep neck structures. In other words, removing or losing a little fat in your jowl will not give you a more aesthetic neck appearance.
You should pay attention to the volume/surface relationship in the neck
One of the basic principles in aesthetic surgery is as follows:
When you gradually increase the volume in a compartment (face, abdomen, breast, buttocks, etc.), the body produces new skin and creates a leather garment fitting the increased volume. Pregnancy and gaining excess weight are the best examples to this. Even if you weigh 300 kilos, your body will create a suitable skin surface for your new body.
When you reduce the volume inside a compartment, the surface skin cannot shrink indefinitely. Therefore, the abdominal skin loosens and sags after pregnancy, just as the breast skin gets loose and sags after breastfeeding.
The same principle applies to the neck. When you reduce the fat tissue volume in the neck, the skin on it remains relatively loose and sagging. The form of fat reduction doesn’t matter. Regardless of whether it’s liposuction, mesotherapy, laser lipolysis, focused ultrasound, surgical reduction or natural weight loss, the skin becomes looser when fat loss takes place in the neck.
In young patients, in men, in cases where the jaw skeleton is strong or to be reinforced by surgery, a limited amount of fat can be removed from the neck without causing a serious deformity in individuals with a good platysma function, skin thickness and flexibility.
In advanced age, individuals with weak skin elasticity, especially if the jaw skeleton is weak, neck lift will be mostly needed to remove the loosening and sagging that occurs when you lose fat.
Neck lift is most often performed in combination with facelift.
The neck and the face are one. It is more advantageous to treat two areas together to obtain a more harmonious, more natural and more holistic result. During facelift, pulling the neck muscle and facial skin upwards automatically corrects the neck contour. Put your hands on both cheeks and pull them towards your temples. You will see how your neck improves.
In neck lift surgery, excess neck skin is removed from both sides of the neck along the inverted U-shaped incision line behind the ear. Since this behind-the-ear incision is a part of the facelift incision, it is both practical and easier to lift the neck alongside a facelift.
If the facelift surgery is performed but the neck is not done simultaneously but you want to have your neck done a couple of years later, the facelift incision will be reworked and the healing process will be rewound.
Most patients complain, saying, “If I had known that, I would have had my neck done while I had my face done. I had no idea that I had to undergo a partial facelift to get my neck done now.”
Well, you have just learned it.
Neck aging is closely related to the jaw skeleton.
In individuals with a weak jaw skeleton, symptoms reminiscent of neck aging appear very early. On the contrary, in individuals with a strong jaw skeleton, the neck maintains its youthful contour for much longer periods than the average.
A small and receding chin alone gives the person a “jowly” look. In such individuals, moving the chin forward can improve the neck contour dramatically.
I mentioned the relationship between volume and surface above. In order to maintain the volume-surface balance, I find it very useful to combine fat removal from the jowl area with chin prosthesis, chin advancement or chin filler procedures in patients with mild “jowl” complaints. When we put in front of the chin the amount of volume that is removed under the chin, we can achieve a beautiful neck contour without disturbing the volume-surface relationship and without causing a sagging of the skin.
In individuals over 60 years of age, the chin gets smaller in almost every patient due to bone loss. In the elderly patient group, we use chin prostheses almost as a routine step in neck aesthetics.
We do an incision under the chin to shape deep neck structures.
When we want to shape the anatomy in the center of the neck, we employ an additional 3-4 cm submandibular incision under the chin. This incision gives us access to the subcutaneous adipose tissue, platysma muscle, subplatysmal adipose tissue, deep neck muscles, salivary glands and hyoid bone. Through this incision, we reach the tip of the jaw to place chin prostheses or correct the drooping of the chin. This incision is located about 1 cm behind your original submandibular skinfold and does not draw attention at all because it is usually shadowed. After the first year of wound healing, it is very difficult to see this scar at first glance in a bright environment.
Superficial lifting without shaping deep neck structures does not always work well.
When there are problems in deep neck structures, it is necessary to correct them to achieve the ideal aesthetic result. For instance, a large and drooping salivary gland does not attract attention under the loose neck skin before surgery. After a superficial neck lift, especially if you have thinned the subcutaneous fat tissue in the neck, the camouflage on them is removed and large salivary glands appear. The patient complains of two walnut-sized glands between the chin tip and the chin angle. It is very important to recognize deep neck structures and include them in the treatment plan during the first surgery, because you have little choice but to repeat the neck lift to treat them afterwards.
On the other hand, it is not possible to treat deep neck structures in every patient.
This requires advanced surgical experience. It presents some risks. It prolongs the operation time.
For instance, in a patient with a heart disease, bleeding tendency and a habit of smoking, it would be unnecessary to waste time and take risks with such extensive neck procedures. We do not apply deep neck procedures for patients who cannot stay under the supervision of a doctor for 2-3 weeks after the operation, come from abroad and need to return early. Unfortunately, patients whose medical condition is not suitable for deep neck surgery have no choice but to settle for a suboptimal (below ideal) neck result.
Neck lift and skin wrinkles
Neck lift reduces horizontal wrinkles on the skin and helps the skin surface to gain a tauter appearance. It does not completely eliminate the vertical muscle strips that appear when you try to pull the corner of your mouth down. Regarding these strips, it is necessary to either make a horizontal incision on the muscle during the operation (platysma transection) or weaken the vertical muscle strips with Botox after the surgery. In addition, neck lift surgery cannot completely remove the wrinkles at the bottom of the neck, close to the chest wall. It does not completely eliminate the wrinkles on the neck skin and smoothen it. It does not remove the horizontal skin folds that occur when you tilt your chin forward. Neck lift surgery makes your neck better, not perfect.
Smoking sets an obstacle to neck lift surgery.
Neck lift requires separation of the neck skin from the underlying muscle structures. This maneuver changes the direction of blood supply to tissues. This procedure can be performed safely in healthy individuals. Since capillary circulation is weak in smokers, skin separation cannot be performed at this level. If done, irreversible tissue loss may occur in facial and neck skin. Similarly, superficial/extended face lift techniques cannot be applied in smoking patients.
The only reasonable option for smokers is deep plane face lift and deep plane (subplatysmal) neck lift surgery. In this surgery, a limited separation is made under the neck muscle and the blood supply of the surface skin is preserved. However, the effectiveness of this surgery is lower than that of a standard neck lift surgery. Our priority in medicine is to always keep the patient on the safe side. Therefore, smokers unfortunately have no choice but to settle for a suboptimal (below ideal) result due to limitations in the choice of technique. In addition to smokers, similar restrictions apply to other individuals having vascular diseases (scleroderma, advanced diabetes, vasculitis, etc.).
As in all aspects of facial aesthetics, customized planning is absolutely necessary in neck aesthetics. It is not possible to talk about standard surgeries or treatment strategies in neck aesthetics. Please feel free to contact us for detailed information on aesthetic surgery of the neck and neck lift surgery.
Take good care…
… of yourself and your beauty.