Lax, loose skin around the neck, often accompanied by a jowly jawline or double chin and, most famously, the vertical bands of the platysma (aka “turkey neck”) can make you look older and more tired than you actually feel. A variety of creams, brushes, gels and devices, as well as more minimally invasive methods like radiofrequency tightening and mesotherapy can sometimes provide improvement but are usually limited in their ability to address significant skin and fat laxity.
For patients who are seeking an effective solution, a neck lift (also known as lower rhytidectomy) is the most effective method to rejuvenate the neck and jawline, as it tightens the skin, corrects fatty or loose skin, and restores the well-defined angle between the chin and neck. An experienced plastic surgeon performing a neck lift using a technique that tightens the underlying tissues as well as the skin has the ability to create an aesthetic result that is significant and natural-looking.
But what causes a turkey neck in the first place, and what exactly does a neck lift do? The factors that lead to an aged neck are the same that contribute to a jowly jaw and sagging chin. As we age, our skin naturally becomes looser and less elastic. Our skin’s production of collagen and elastin, the proteins that help maintain skin elasticity, decrease over time. Additionally, the superficial muscular aponeurosis system (SMAS), a fibrous layer that provides underlying support to the facial structures and attachments in the neck, becomes looser and descends as we age. The platysma is also a key factor. The platysma is a large muscle in the neck that often splits into two at the midline as we age. This can lead to visible vertical bands in the neck and a drooping appearance. Patients may also experience fat accumulation under their chin. All of these factors can lead to the loss of the cervicomental angle, the distinct angle between the chin and neck that is seen in younger patients. Genetics, sun exposure, and weight loss are all additional factors that can play a role in the changes to the neck and jawline.
Neck lift surgery is a multi-layered process to address all of the changes that lead to an aging neck and jawline. The surgery is performed under general anesthesia or deep sedation. The incisions are carefully planned and placed, starting in the creases in front of the ear, and following the edge of the earlobe and behind the ear into the hairline. The incision in the hairline can also wrap up and around behind the ear as needed for incision camouflage. An additional small incision is often placed under the chin to allow for the best access to all the structures in the central neck. This approach is known as an endoscopic neck lift. The neck lift procedure itself involves a multistep approach. After the skin is lifted, the surgeon can remove excess fat through liposuction to refine the neck and jawline.
The most important step for long-term results is platysmaplasty. The edges of the divided platysma muscle are first identified, and then stitched together along the midline of the neck. The platysma provides an important muscular sling that forms the foundation of support for the overlying skin and subcutaneous fat. It is tightened and sutured into its final position. The next step is usually tightening the SMAS layer of tissue and suturing it to its new, more superior position as well. Manipulation of these deeper tissues with tension-free skin closure is the key to a significant, natural-looking neck lift.
The skin is then redraped over this new, tightened foundation. It is pulled supero-laterally, or up and back, to recreate the sharp cervicomental angle that patients desire under the jawline. Excess skin is trimmed, and the skin is meticulously sutured closed. A compression garment is applied to minimize swelling in the first few days after the surgery.
Recovery from a neck lift takes time and patience. Pain after surgery is mild and can be managed with medication. Patients will experience swelling and bruising in the first few days and weeks after the procedure, and should continue to keep their head elevated as much as possible, including while sleeping. Patients can usually resume most social activities within two weeks, although heavy lifting and rigorous exercise should be avoided for at least 4-6 weeks. Patients should also be aware that while they may see significant improvements within the first few weeks after surgery, the full results will continue to develop over the first few months as swelling gradually subsides and scars continue to soften and fade into their hidden positions.
As with any surgical procedure, neck lifts do have potential risks and complications. These include bleeding, infection, adverse reactions to anesthesia, and nerve injury. Nerve injury can cause temporary or, in very rare cases, permanent weakness of the lower facial muscles. Asymmetry, poor scarring, and contour irregularities are also potential risks. These risks can be minimized by choosing a board-certified plastic surgeon with extensive experience in facial anatomy and facial rejuvenation.
At the end of the recovery period, the result of the surgery is often a rejuvenated appearance and a major boost to self-confidence. As neck laxity and fat accumulation in the neck and jawline are the most tell-tale signs of aging, neck lift surgery can often provide a significant aesthetic improvement by smoothing and tightening the skin, restoring definition, and sculpting the neck and jawline to create a more youthful and well-defined profile. Neck lift results are significant, structural, and long-lasting, with patients often seeing a decade or more of natural-looking benefits.
