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Neck Lift
Overview
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| Example
of Dr. Cruise's neck suspension technique. Notice the
dramatic improvement of both neck angle and jaw line. Click to enlarge. |
The effects of aging show early within
the neck region. The skin begins to hang loosely and
the muscles underneath lose their tone. These changes produce
the characteristic look of the aging neck. If you look
at any young person who is not overweight you will see that
the skin is closely adherent to the neck creating a very sharp
angle at the level of the Adams Apple. This
angle is called the cervico-mental angle and makes a profound
impact on the appearance of the neck.
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| Notice
how the cervical-mental angle is restored from essentially
a hanging flat line to a more youthful angle. |
In youth, the cervico-mental angle is
very sharp approaching 70 degrees. As one ages or gains
weight, this angle becomes flatter and flatter for different
reasons. With aging, both the skin and the muscles become
lax. The muscles form cords that draped down from the
chin giving the characteristic "turkey neck" appearance.
With weight gain, the angle flattens
because of the excess subcutaneous fat. The treatment
for these two problems is completely different.
 |
| Notice
the characteristic banding of the plastyma muscles in
the Before. This "turkey neck" appearance is
eliminated in the After. Also notice the improved jaw
line and marked reduction of jowling. Click
to enlarge. |
In the case were the cervico-mental angle
has flattened because of fat accumulation within the subcutaneous
tissues, Dr. Cruise can normally improve the neck contour
with liposuction,
with or without a neck lift. When liposuction is performed on the neck two things happen. One, the
subcutaneous fat is removed and two, during the healing process
the skin redrapes more tightly against the neck creating a
leaner appearance with a sharper cervico-mental angle.
The process of facial aging is described
more thoroughly below and within the pages describing face
lift. Dr. Cruise has spent much time and has acquired
considerable experience with what causes the appearance of
neck aging and what needs to be done to correct it. The key
to neck lift surgery is to tighten the underlying muscles
that have become lax, re-create a sharp cervico-mental angle,
create a well-defined jaw line, and then redrape the skin
to accommodate the new contour. It is important to understand
that the majority of the work needs to be done underneath
the skin level. It is not just a skin tightening procedure.
Dr. Cruise has determined that, in his
hands, the best way to re-create the cervico-mental angle
is to resuspend the muscle as is typically done, but also
to augment this resuspension by securing the muscle in its
proper location with a technique called suture suspension. The
effects are quite dramatic and predictable as demonstated
in the above before and after pictures.
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| Above
picture demonstrates how the platysma muscle is suspended
under the jaw bone giving a well defined mandibular border
as well as creating a youthful neck angle. Midline platysma
muscle suture eliminates Turkey Neck. |
It is a very exciting time in plastic
surgery because we are just beginning to solve the puzzle of facial aging and Dr. Cruise is very much involved with
the progress. Even though facial aging affects the entire
face and neck, sometimes a patient is really only concerned
with a particular area such as the neck. In this situation,
only the neck needs to be addressed. Often the patient
will return to have their face and eyes done when they are
ready. This is an excellent way to approach facial rejuvenation. You
should only have corrected what really bothers you. You
can always come back and have other things done.
 Benefits
The benefits of neck lift surgery are
the rejuvenation of the neck and the re-creation of a sharp,
youthful cervico-mental angle. Here is a brief list of
the benefits provided by neck lifting:
- Re-creation of sharp neck (cervico-mental)
angle.
- Rejuvenation of neck.
- Dramatic reduction or elimination
of "turkey neck" banding in neck.
- Defining the jaw line like that seen
in the youthful neck.
- Dramatic improvement or elimination
of lax skin and wrinkles within the neck.
- Correction of double or triple chin.
- Creating a longer more elegant appearing
neck.
- Scar placement can be done completely
behind the ear, virtually unnoticeable.
- Incision is positioned within the
crease behind the ear making it unnoticeable even when the
hair is styled back. A second small incision is placed in
the crease below the chin. It, too, becomes almost unnoticeable
with time.
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| Incision
is positioned within the crease behind the ear making
it unnoticeable even when the hair is styled back. A second
small incision is placed in the crease below the chin. It, too, becomes almost unnoticeable with time. |
Are
you a good candidate?
Anyone who has acquired a lax neck where
the skin no longer holds tightly against the Adams Apple is a good candidate for a neck lift. Despite the fact
that aging affects the entire face, it is not uncommon for
the neck to show the effects of aging earlier than that of
other areas. Therefore, depending on your situation only
a neck lift may be required to obtain the degree of facial
rejuvenation you are looking for. Here is a brief list
of good candidates for neck lift surgery.
- Lax neck skin.
- Turkey neck banding within
the neck.
- Loss of sharp neck (cervico-mental)
angle.
- Loss of jaw definition.
- Double or triple chin.
- Your neck looks shorter and older
than it used to.
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| Problems
Correctable With Neck Lift |
Dr. Cruise's philosophy regarding Neck Lift
The world of facial and neck rejuvenation
has undergone dramatic improvement over the last 10 years. In
my hands, it has become more art and fat/muscle repositioning
and less skin tightening. After reading the above sections
you will realize that facial and neck aging is actually a
very complex process. It involves primarily the descent
of facial fat and muscles and secondarily the stretching of
the skin.
When you come in for consultation, you
will have digital photographs taken of your face and neck
in multiple directions. We will review the pictures together
so that I have a clear understanding of what it is that you
would like. I will go over the process of neck lifting
and what is and what is not possible. I can then digitally
alter the pictures to see if the changes are what you are
looking for. Of course, no results can be guaranteed
but in my experience I can give you a pretty good idea of
what is likely.
The way I typically do my neck lift depends
on what is necessary. Often, it is necessary to make
a small incision just under the chin to remove neck fat and
to bring the neck muscles back together. Bringing the
neck muscles back together effectively diminishes or eliminates
the turkey neck appearance. At this point, I secure
the muscles in position by suspending it with suture. This
is markedly different than the way neck lifting was done just
10 years ago which was typically a skin pulling operation. At
this point, the skin is then gently redraped over the redefined
neck area and sutured into place without creating a tight
look. If only a neck lift is being performed, the incision
is limited to the area hidden behind the ear and a small incision
under the chin which becomes virtually unnoticeable.
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| The
skin has been removed to show suture location. The picture
demonstrates how the platysma muscle is suspended under
the jaw bone giving a well defined mandibular border as
well as creating a youthful neck angle. Midline platysma
muscle suture eliminates Turkey Neck. |
Possible
complications
The most common complication after neck
lifting is inadequate resuspension of the neck tissues. Other
risks include asymmetry, nerve injury, infection, blood and
fluid collection, and unfavorable scarring.
Prior to surgery
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Medications. Certain
medications thin your blood and should not be taken within
three weeks of surgery. The most notable is aspirin
and aspirin containing products. Vitamin E and many
herbal products also thin the blood and should not be
used within 3 weeks of surgery. Dr. Cruise will go
over this more thoroughly prior to the procedure.
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Sleep. It is important to get a good night's rest prior to the
procedure. If you think this may be a problem, please,
do not hesitate to ask Dr. Cruise for something to help
you sleep.
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Smoking. Do
not smoke within 3 weeks before and after surgery. Smoking
has a profound effect on reducing wound healing capabilities. It
significantly increases the likelihood for infection,
wound healing problems, and scar formation. It also
affects your airway, therefore, makes anesthesia much
more difficult.
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Eating. Do
not eat within 8 hours of surgery and do not drink within
6 hours of surgery. It is OK to take medications
with a sip of water. Please discuss allmedications
with Dr. Cruise and the anesthesiologist.
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Washing. It
is a good idea to wash the surgical area thoroughly the
night before and the morning of surgery. Do not forget
to wash inside your ears just like your mother told you. Please
wash your hair the morning of surgery, comb it straight
back, and hold it in place. Do not apply any make
up
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Arrival. It
is best to arrive on time so things go smoothly. Please
be sure to have someone else drive you. The surgery can
not take place unless someone is there to drive you home
before the procedure starts.
- State of mind. Remember,
this should be a happy and exciting time. A certain
amount of nervousness is normal but you should not be overly
concerned. Dr.Cruise and ICRS are both well trained
and experienced. Excessive worrying can actually be
detrimental and you should discuss this with Dr. Cruise
prior to surgery so that something can be prescribed to
make sure you remain calm.
Anesthesia
ICRS uses only board certified anesthesiologists
to make sure you have the best anesthesia possible. The anesthesiologist
will discuss with you what type of anesthesia is best for
you. He/she will take into consideration your medical history,
the procedure, and your personal wishes.
The type of anesthesia is up to you. Dr. Cruise prefers a general anesthesia and so do most patients,
but local anesthesia with sedation is possible. You will
discuss this with Dr. Cruise and the anesthesia team.
After
the procedure
The procedure itself will take about
2 to 3 hours.
Immediately. Right
after the operation you will be watched for 1 or 2 hours and
encouraged to walk. Dr. Cruise is a strong advocate of
good pain relief so you will be given as much pain medication
as necessary for the entire postoperative period. Of course,
there will be swelling and bruising but there is surprisingly
little pain. You will have a head dressing on as well as ice
packs to help keep the swelling down. When you lay down
you must keep your head elevated usually on 3 pillows to prevent
swelling.
That evening. It
is recommended that you take it easy. You can walk around,
eat, but not too much more. You must sit and lay with
your head up on at least 3 pillows. You will have a lightly
compressive dressing around your neck. This should be worn
continuously for 1 week and then at night for 6 weeks. This
will help keep the swelling down as well with helping the
skin contract up against the underlying muscle. You should
take as much pain medication as necessary and try to go to
sleep early. Apply ice packs every 2 hours for the first
24 hours. You will be given medication to help keep the
swelling down as well as to prevent infection.
First
48 hours. You will be walking around easily. You should
take a shower the day after and gently wash your hair. Use
a lot of shampoo so that your hair lathers easily and then
apply a generous amount of conditioner. Just be gentle. The
incisions will continue to ooze for about 4 days. You will
see Dr. Cruise in his office 7 days after the procedure to
make sure everything is healing well. For one week you should
wear the lightly compressive head wrap at all times except,
or course, when you shower.
First
week. One week after the operation you will have
your first post-operative visit. The majority of the
bruising and swelling will be gone by this time but complete
resolution of swelling takes 3-6 months. Finish the antibiotics
prescribed. Begin wearing your compression wrap just at night
and do so until 6 weeks after the operation. Begin applying
SCARGUARD to the incisions twice a day. This can be ordered
on the internet. SCARGUARD is a combination of steroid, vitamin
E, and silicone. It does a great job of decreasing redness
and scarring. Continue to apply until the redness is gone.
Beyond. Swelling
will not completely resolve for about 6 months but, as mentioned
above, the majority of it will be gone by 1 week. Skin
contraction will not start until about 4 weeks after the procedure
and will continue to contract until about 6 months. The
final result will not be evident until 6 months when all the
swelling has resolved and skin contraction is complete but
you will certainly notice a significant improvement right
away.
Recovery
time
The swelling and bruising will resolve
in about 1-2 weeks. It is not unusual for people who
work at home to start working 1 or 2 days after surgery. People
with sedentary jobs go back to work after 5 days. If
your job, however, requires strenuous activity then it may
take as long as 3 to 4 weeks to return to work. Most
people return to work in about 1-2 weeks.
Consultation
We have outlined below what you can
expect from your neck lift consultation. Read carefully,
as there are many suggestions that will save you time, clear
up questions, and help you convey to your plastic surgeon
what you want to accomplish.
 Health History
All cosmetic surgery consultations
begin with a thorough health history. This is especially
true if general anesthesia is being used, but also applies
to local anesthesia. Neck Lifts are usually done
under general anesthesia. Prior to meeting with Dr. Cruise you will be given a health history questionnaire
to fill out in the waiting area. There are five areas
of your health you will be asked about. Be sure to
answer it with detail so that your surgery and anesthesia
can be optimized for you.
1) General Health
General health problems are important
to discuss so that your surgery is as safe as possible. Be
sure to mention any chronic illness. Of particular
concern are: high blood pressure, diabetes, heart problems,
liver and kidney disease, stroke, cancer, bleeding problems,
and wound healing problems.
What will Dr. Cruise do if I
have medical problems?
In short, he will make sure your
health is optimized as much as possible to ensure your
safety. This may mean referring you to your private
physician.
If you have a health problem
or are over 50 years of age you can often save yourself
time by getting a letter from your private physician prior
to your cosmetic consultation stating what the health
problem is, how it is being treated, and whether or not
you are able to tolerate general anesthesia safely.
If you are seeing any specialist
(i.e. cardiologist, kidney doctor, psychiatrist, etc.)
be sure to bring a letter from them stating that you are
able to tolerate surgery.
If you are not able to tolerate general
anesthesia it may be possible for your neck lift to be
done under local anesthesia. This must be discussed
with Dr. Cruise.
Be sure to let Dr. Cruise know
if you have ever had a blood clot.
2) Past Surgical History
On your questionnaire you will be
asked about previous surgeries. Be
sure to identify any problems you may have had with anesthesia. Of
particular concern are previous cosmetic surgeries especially
if you do not like the result and are interested in revision.
3) Medications
Be sure to list all medications you
take including aspirin and over-the-counter medications. These
are important as they may increase bleeding and affect
your surgery. It is extremely important to stop taking
aspirin and aspirin containing products at least 10 days
before surgery. Tylenol is a good alternative. Here
is a partial list of aspirin containing products and
other products to be avoided prior to surgery.
4) Allergies to Medications
Information about medications that
cause allergies is very important so that these medications
can be avoided. Of particular importance is the reaction
you had, especially if you had trouble breathing. Be
sure to include this information! Nausea is not an
allergy but it is important to mention as well.
5) Smoking, Drinking and
Drug Use
These three will certainly affect
your surgery and MUST be mentioned so that your surgery
can be optimized. Smoking causes a profound decrease
in wound healing and will lead to worse scarring and a
less favorable result. With
large procedures such as a face lift, neck lift, tummy
tuck, and breast lift smoking must be stopped at least
3 weeks before and after surgery. Otherwise, the
results could be disastrous leading to non-healing wounds,
poor scarring, and/or infection. With smaller
procedures such as eyelid surgery, nose surgery, breast
augmentation, and liposuction smoking will hurt the overall
result but this may or may not be noticeable. In
this case smoking cessation is strongly advised but is
not mandatory.
Neck lifting involves elevating the
neck skin. This puts a strain on the blood supply
to the skin. Normally, this is not a problem but
it may be in smokers. Smoking significantly decreases
blood supply to the skin and can cause skin slough. The
last thing you want after going through a neck lift is
a large scar from poor healing caused by smoking.
What Do You Want To Change?
It is important that you have a clear
idea of what you want changed when you go for consultation. The
least favorite thing a plastic surgeon wants to hear is: What do you think I need done?
Look in a mirror and identify what
bothers you. Be specific. It is helpful to break
up the neck region into three parts.
Evaluate each one of these areas individually
as this is what the plastic surgeon does during his exam.
Common complaints
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Chin: Too small, too droopy (witch's chin).
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Neck: Loose skin, too much fat, neck platysmal bands (turkey
neck).
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Jaw: Jowling.
Ideal Neck
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| Example
of Dr. Cruise's neck suspension technique. Notice how
the entire face is affected by the neck lift even though
nothing was done to the face. Notice the square, boxy
look of the jaw in the before. Compare this to the youthful
triangular look in the after. Click to enlarge. |
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Chin
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Gives triangular shape to face.
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Projects as far forward as the
lower lip in women and slightly further in men.
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The undersurface is flat, not
droopy.
|
| Example
of Dr. Cruise's neck suspension technique. Notice the
dramatic improvement of both neck angle and jaw line. Click to enlarge. |
Physical
Exam
The key to the neck physical exam is
to determine exactly what is causing the problem. Below
is a typical sequence that an experienced plastic surgeon
such as Dr. Cruise uses to evaluate the neck and what can
be done to correct problems.
The importance of the chin in relation
to the neck has already been outlined. See the section
on chin augmentation for more information. With aging, some people develop
a droopy chin otherwise know as witch's chin. This
can be corrected or markedly improved during neck lifting. There
are several ways to address the problem but they all involve
removing the hanging fibro/fatty tissue that hangs below the
ideal chin level. This can be done through a small incision
just below the chin. Notice in the above Before and After
pictures the improvement of the droopy chin. The addition
of a chin implant greatly helps improve droopiness. Usually,
as is the case above, this is not necessary. Fat removal in
combination with a properly performed neck lift will obtain
the desired improvement.
Neck
Hanging skin below the neck is probably the most common
complaint. During your consultation, your plastic surgeon
will palpate the tissue to determine if the cause is excess
skin, fat, or muscle. Most commonly, it is a combination
of all 3, therefore, all 3 must be addressed.
This muscle is called the platysma and extends from above
the jaw line to the clavicle. It is responsible for
skin tightening. Men flex this muscle to tighten their
skin when they shave. This is the deepest layer, therefore,
during a neck lift it must be addressed first. With
aging, this muscle becomes lax and separates into bands
under the chin. Thess bands are excised through a small
incision just under the chin. They are sutured together
in the midline to create a smooth, continuous neckline. If necessary, the muscle is then tightened laterally through
an incision behind the ears. Alternatively, the platysma
muscle can be suspended into proper position by a suture
that extends from one ear to the other.
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Tight
platysma causes jaw line to be well defined and neck
angle to be sharp.
|
Loose
platysma and descended facial fat cause jowling and
a poorly defined jaw line. In addition, neck bands
form causing the typical turkey neck appearance. |
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| With
Dr. Cruise's suture suspension neck lift, the platysma
muscle is suspended under the jaw bone giving a well
defined mandibular border as well as creating a youthful
neck angle. Midline platysma muscle suture eliminates Turkey Neck. |
2. Fat
Excess fat under your chin can be palpated
by pinching it between your thumb and index finger. This
fat can be removed either by excision or liposuction. Fat
excision is performed through the same incision under the
chin that platysmal tightening is accomplished.
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| Example
of patient with a signifacant amount of fat and jowling. Also notic prominent chin (witches chin) and its correction
in the After picture. |
Loose, hanging skin is tightening laterally through an
incision behind the ears. The excess skin is removed. The
length of incision behind the ear depends on how much redundant
skin is present. With minimal or moderate amounts,
the excision may be completely hidden behind the ear. With
a large amount of skin excess, the incision may extend posteriorly
into the hair-bearing scalp. See picture of typical incisions
below.
Jaw line
Jowls are fat deposits that have sunk below the jaw line. In
youth, this fat was positioned up in the cheek where it
belongs. With age, like all facial fat, it descends. It
hides the jaw line and gives an unattractive square shape
to the jaw instead of a more attractive triangular shape. It is best addressed by elevating it back into its cheek
position via a face
lift. Significant improvement, however, can be accomplished
with liposuction performed at the same time as a neck lift.
Typical Neck Lift Incisions
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| Incision
is positioned within the crease behind the ear making
it unnoticeable even when the hair is styled back. A
second small incision is placed in the crease below
the chin. It too becomes almost unnoticeable with time. |
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