One of the most common and among the most frustrating complaints of the natural aging process is the development of redundant, lax skin and muscle banding in the lower one-third of the face and neck (aka “turkey neck”). This concern can have a major detrimental impact on a person’s confidence and self-image as well as dramatically undermining any effort to look youthful. To be sure, some level of skin laxity and muscle banding is inevitable as we age. A certain degree of redundancy may also respond to non-surgical treatment with modalities such as radiofrequency or ultrasound therapy for modest improvement. However, once the laxity becomes more advanced, as is often the case with a “turkey neck,” non-surgical treatment is much less likely to be helpful or effective. If a permanent, dramatic change is desired and neck surgery is something that is being considered, there is no better solution than turkey neck excision (aka cervicoplasty or lower rhytidectomy/“neck lift”) for effectively and predictably restoring a defined, smooth, tight jawline and neck contour.
The presence of a turkey neck can be the result of several factors that are all anatomically related. Loss of skin elasticity and firmness with age due to a decline in collagen and elastin production, which results in excess and sagging skin. The SMAS (superficial muscular aponeurotic system), a dense fibrous tissue layer that envelops the muscles and fat of the face and neck, which also begins to lose elasticity, loosen, and descend with time. In the neck, the platysma muscle, a broad, flat muscle that stretches across the neck, which enables movement of the jaw, weakens, separates, and sags as we age, contributing to loose, sagging skin and the formation of two thick vertical cords that are easily visible when one is speaking or turning their head. Submental fat (fat under the chin) may also become more noticeable, or accumulate with the other support structures in the neck and jawline loosening and descending. A genetic predisposition, sun damage, weight gain and loss, and other environmental factors, including smoking, will all accelerate these processes, leading to the wrinkled, heavy, and droopy appearance that makes up the turkey neck.
Turkey neck excision is a multi-faceted procedure which targets each of the above described elements of anatomy, and is much more complex than it may sound. It is not a simple matter of just cutting away a flap of loose skin and tightening things up, although this is a necessary component. A true turkey neck excision (plastic surgery neck lift) is an intricate operation that involves repositioning of the deep tissues, tightening of the platysma muscle, and excision of the overlying loose skin. The procedure is performed under general anesthesia or IV sedation and can take several hours, depending on the extent of the work being done, as well as if the patient is having it done in combination with a full facelift. To start, the incisions for the procedure are created. An accomplished plastic surgeon will endeavor to place these incisions in inconspicuous places, following the natural creases and curves of the anatomy so that they are as invisible as possible, to reduce the visibility of scars. The typical incision begins in the hairline at about the height of the sideburn, and travels down and around the ear, then finishes hidden in the posterior hairline behind the ear. For work being done exclusively in the central neck area, a small incision will also be made under the chin.
With incisions created, the work begins underneath the skin. Excess submental fat is usually also an issue in this area, and is typically addressed first with liposuction, removing the fat and creating a smoother base contour. From here, the borders of the platysma muscle will be sought out and, if there is muscle banding present, the separated muscles will be sutured together in the midline, essentially creating a supportive sling that results in a firmer foundation under the skin of the neck, and helps to correct the vertical cords. This muscle repair is called platysmaplasty, and is one of the most important steps in achieving a long-lasting and natural-looking result. After this step, the overlying SMAS layer will be tightened and lifted to a more youthful position. This manipulation of the deeper structural tissues is what makes a neck lift a truly modern one, as it affords a long-term support to the skin and, since the closure of the skin requires less tension to be stretched over, results in a more natural and less prominent scar.
In the final stages of the operation, the skin will be re-draped. It will be pulled upward and to a degree posteriorly, which is important to restoring the cervicomental angle (angle between the neck and chin). Excess skin will be excised, and the remaining skin is closed with meticulous, atraumatic, and fine sutures. Drains will be placed underneath the skin to prevent fluid collection, and a compressive bandage will be applied, all of which will support the new contour and help to reduce swelling in the initial recovery period.
The recovery after a turkey neck excision procedure is one that takes time and patience, as well as following the post-operative instructions. The first week will be the most uncomfortable in terms of swelling, bruising, tightness or numbness in the neck and lower face, and pain, which can be adequately managed with medication. Patients will have to keep their head elevated at all times, even sleeping upright in a chair or with extra pillows. Exertion, bending over, and activities that will elevate blood pressure are to be avoided for the first few weeks after surgery. Most patients can return to work and even social situations after two weeks if their job is relatively sedentary. It is best to hold off on heavier exercise and more vigorous activities for four to six weeks. Swelling will begin to subside over the course of several weeks, and results will begin to be seen. The final, refined result will continue to take shape and improve over a period of three to six months, as the last of the swelling goes down and the scars mature and fade.
As with any major surgical operation, there are risks and potential complications involved with turkey neck excision surgery. These can include any potential adverse reactions to anesthesia, hematoma (accumulation of blood which may require drainage), seroma (fluid accumulation), infection, and poor wound healing. Nerve injury specific to this procedure is also a risk, and may result in weakness of the muscles of the lower lip or those that control smiling. While this may be temporary in most cases, in very rare situations it may be permanent. In very rare cases, numbness of the chin may also persist. Uneven results, skin irregularities, asymmetry, and unsatisfactory scarring can also occur, but again, are extremely rare with a qualified plastic surgeon who has extensive experience performing facial rejuvenation surgery. The risk of any such potential issue is minimized by selecting a certified and experienced plastic surgeon, following all pre-operative and post-operative instructions, and undergoing a full medical clearance before the procedure.
When successful, the results of a turkey neck excision can be nothing short of transformational. By removing the laxity and excess skin of the lower neck and restoring a defined cervicomental angle and a smooth neck contour, the procedure can eliminate years from a person’s appearance, and dramatically change the heavy, tired look of a “turkey neck” for one that is bright, rejuvenated, and youthful. This can have a highly positive impact on a patient’s sense of well-being and confidence, and is an important part of what makes this such a valuable and worthwhile procedure. It is important to have realistic expectations when undergoing this surgery. A neck lift will not stop the aging process, but it can effectively turn back the clock. When performed by an experienced plastic surgeon, results are very long-lasting, often lasting ten or more years.
