How to Tell When It’s Time to Consider a Neck Lift

Your neck can age at a completely different rate than the rest of your face. The jawline can soften, the angle under the chin can become less defined, and two vertical cords can appear when you speak, even though your cheeks and eyes are still pretty much in good shape. To simply refer to all of that as "loose skin" is to ignore the anatomy that dictates your treatment plan.

Dr Passaretti looks at your skin, your fat, your platysma muscle, your jawline and your lower face all in conjunction. A neck lift may be indicated when the deeper structures have moved beyond what can be reasonably addressed with non-surgical means.

Sagging Skin Is Only One Possible Cause

The contour under your chin is determined by a number of tissue layers. You have the skin on the surface, the fat which will affect the fullness, and then the platysma which is a thin muscular sheet running across the front and sides of the neck. A change in any of those layers can mean the distinction between your jaw and your neck becomes blurred. Sagging skin can lead to a hanging fold under the chin (often referred to as 'turkey neck').

Skin laxity can lead to fine creases or a hanging pocket, while wrinkles are a reflection of the reduced collagen production that occurs with age. Platysma laxity will give you vertical bands, particularly when you're tensing your neck or speaking. Fat gives fullness under the chin, and the descending lower face tissue gives you the jowls. Many patients will have a combination of these signs of ageing.

Read the Shape, Not Just the Skin

A heavy neck is a completely different proposition to a thin banded or crepey neck. A soft fullness under the chin may well be stable in weight. Cords are indicative of platysma and bunching under the jaw is a sign of reduced skin elasticity. A softening of the jawline can also be a feature of the lower face.

An assessment will tell you how much of the change is above the platysma and how much is down to deeper support. Photos can mask muscle movement, skin quality and the actual location of the fat.

When Neck Liposuction May Be Enough

If your primary concern is localised fat and your skin still has a good degree of contractility then double chin removal via submental liposuction or neck liposuction may be the procedure you're after. It's the removal of accessible excess fat via small incisions and again it's down to your skin to contract and settle over the more defined contour.

This is often the best approach for an ideal candidate with minimal skin laxity and can also be of benefit in flattening out quite a bit of jowling when volume is the problem. Liposuction has its limits when you have skin that's already hanging or when the platysma has separated. If you're removing volume under skin of poor elasticity you may actually end up with more laxity and suction alone won't fix the neck bands.

When a Neck Lift Plastic Surgery Becomes More Appropriate

A persistent fold under the chin, visible platysma bands, loose skin and a receding neck angle are some of the specific signs that would indicate a neck lift may be appropriate. The neck lift can be used to remove excess skin, contour excess fat, tighten the underlying muscle and reposition the remaining skin to produce a smoother neck and more youthful contours. Incisions are typically placed around the ears and may include one under the chin. The scars are generally placed in a discreet position to minimise scarring although they will still be visible in the early stages of healing.

There is no such thing as the "perfect" age for surgery. The timing is going to be dictated by when the changes become apparent and significant enough to want to address rather than by some arbitrary age. In many patients the initial signs do start to appear in the 40s. The majority of people having a neck lift are in their 30s and over, with the bulk of the candidates falling between 40 and 70. Some younger patients in their 20s may be suitable in certain circumstances depending on their individual anatomy. Good candidates will be in good general health (ideally non-smokers), have realistic expectations, be able to discuss any relevant medical conditions and be able to articulate clearly why they feel the procedure is appropriate in the context of their own individual goals. The recovery is generally five to seven days of early downtime with a temporary drain in the area of the incision and most people are back to all their normal physical activities within three weeks. The results can last 5 to 10 years and can leave you looking many years younger even as you continue to age.

The Jawline Can Change the Recommendation

The face and neck have a common supporting layer. If you have jowls and laxity in the lower face in addition to changes in the neck, treating just below the jaw is likely to leave a very distinct difference between the two areas. This is a very common complaint of older patients who are looking for a more balanced result. The ideal candidate is generally an older individual looking for neck rejuvenation.

Dr Passaretti may recommend a facelift that includes the neck in such cases. A mini facelift may be appropriate for younger patients with very early signs of ageing and only a very mild amount of lower face sagging. A full facelift is generally the better option when there is more widespread descent or heavier jowling. His Dual Plane Plication Lift® allows the skin and the deeper supporting layers to be addressed separately on the jawline and neck. More widespread facial descent may require a deep plane facelift.

For more complete rejuvenation a neck lift can also be combined with other procedures (including eyelid surgery) for overall rejuvenation and a more balanced youthful appearance.

Where Nonsurgical Treatments Fit

Non surgical options can address some of the early signs of ageing. Neuromodulators can temporarily soften active platysma bands, resurfacing or energy based treatments can improve the texture and mild laxity. These options do not move the excess skin and do not reposition the separated muscle.

Repeated treatments with no real improvement under the chin could point to a structural issue. A consultation would be the way to establish whether a neck lift, liposuction, a combined facelift or indeed further non-surgical treatment is the right thing to do. The recommendation in that respect would be the same as for any cosmetic procedure really, that it may well be appropriate to pursue a less invasive route to achieve the desired result. That of course would be in line with your own appearance goals as well as the amount of recovery time you can actually afford.

When to Get a Neck Lift

The right time for a neck lift is when the cause of the change and the extent of the surgery are in line. Dr Passaretti looks at your neck in both motion and at rest, assessing skin elasticity, muscle banding, fat distribution, jawline support and lower face ageing to determine the specific signs of change and thus tailor the treatment to the degree of sagging skin and lower face ageing.

Dr. David Passaretti is a board certified plastic surgeon with over 20 years of experience and brings that experience to facial rejuvenation at The Aesthetic Center in Darien, CT. His approach is to individualise the treatment recommendations based on the patient's candidacy, their anatomy and the result they ultimately achieve. To determine if you are a candidate for a neck lift with or without other procedures to achieve a smooth, youthful neck, please request a private consultation.