Neck and Facelift

Neck and Facelift Image

A vast majority of people will benefit from improving their neck at the same time as improving their jawline with a facelift procedure. Occasionally, a person will have a nice contour of the neck with an aged appearance of the jowls and jawline, and in this case the neck muscles will not be tightened. This particular type of facelift is referred to as an Anterior Facelift.

Patients who desire a tight, more contoured neck and do not have significant laxity in the lower face or jowls will benefit from a necklift. There are several layers of tissue in the neck that can be addressed to create a more defined and attractive appearance. The skin of the neck can be in excess and this is a common finding in most people over 50. There is a layer of fat beneath the skin known as the subcutaneous fat layer and this layer can be in excess creating unwanted fullness in the neck. This is less of a problem in thinner people and usually an issue for heavier people. The neck musculature beneath the subcutaneous fat layer is known as the platysma. There is a platysma muscle on the left side and one on the right side. With age the platysma muscle loosens making the edge of each platysma very noticeable. This is commonly referred to as the "Turkey Gobbler" or "Turkey Neck".

Underneath the platysma muscle is a thick layer of fat known as the subplatysmal fat layer creating unwanted fullness in many people. My standard approach to the aged neck has become very aggressive over the last 10 years. I have learned through thousands of my own patients that the tighter the better in the neck. People will in no way look done or pulled by having their neck contour tight. This same principle does not apply to the sides of the face but it does apply to the neck. When people look pulled after having an old-style facelift, their cheeks, mouths, and sides of their faces look strange, not their neck. Furthermore, the neck is the most likely area to loosen quickly after a facelift if aggressive tightening techniques are not used. Short-lived surgical results lead to patient and surgeon disappointment.

Early in practice, I was very conservative in the neck as well as the face and developed a reputation as “The King of Natural”. This led to outstanding results and never a weird look for any of my patients; however, the rate of neck loosening was fairly high. I saw many of my own patients back two years later complaining that their necks had loosened even though their faces looked great. I also saw many people who had facelifts with other famous surgeons who saw their necks loosen earlier than they had hoped. Based on this experience, I honed my techniques to create a long lasting tightening of the neck while preserving a natural appearance. My technique now includes reduction of the subcutaneous fat layer if there is excess fat. By elevating platysma muscle off of the subplatysmal fat layer to gain complete exposure of the fat, this layer can be removed to whatever degree is necessary thus creating an aesthetically pleasing and sculpted appearance to the neck. People with thicker necks or those who are overweight require a complete removal of the subplatysmal fat layer. Other people may only require partial removal of the subplatysmal fat layer, depending on their anatomy.

Once the subplatysmal fat layer is removed, the platysma muscle will be closed in a very tight and sturdy way so that there is very little chance of premature loosening of the neck contour. The technique of platysma tightening is known as the corset platysmaplasty. Once these maneuvers are complete, the neck will have an angular, youthful, and attractive contour. At this point, attention will be turned to the facelift to address the loose skin. The different facelift techniques that I use are described in the other sections of this website, but they all are designed to tighten the SMAS (muscle layer) which is essentially the upper end of the platysma muscle.

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