Written by Dr. Julian De Silva
1. What is a neck lift?
One of the commonest indicators of facial ageing are changes in the neck. The appearance of vertical bands in the neck and soft tissue below the jaw are common signs of facial ageing. Lifting of the neck restores the sharp angle between the jawline and neck associated with youth and removes the unsightly vertical bands in the neck.
2. Dr. De Silva & Neck Lift Surgery
Dr. De Silva is highly specialised in only facial cosmetic surgery and performs no other surgery. He trained in London Teaching Hospitals in Surgical Specialities including Anatomy, Emergency Surgery, Neurosurgery, Ophthalmic Micro-Surgery before focusing entirely on Facial Cosmetic & Plastic Surgery. He worked in the cosmetic centres of Beverley Hills and New York with super-specialised Facial Plastic and Oculo-Facial Plastic Surgeons. Dr. De Silva tailors facelift and neck lift surgery to each individual patient. Different facial shapes, ethnicity and individual anatomical changes require different types of facelift, customized to the individual patient to achieve a natural looking and long lasting results.
Ageing of the face is characterised by three principal changes, loss of volume of the fat and soft tissues in the face, gravitational descent of facial soft tissues and laxity of the skin. Key to natural looking results is an artistic and anatomical understanding of these three elements so the elements of the facial ageing can be both restored to their previous appearance.
Neck lift surgery requires repair of the neck muscle in that results in vertical bands in the neck with age and restoration of the sharply defined angle between the jaw line and the neck associated with youth. Often elevation of the soft tissues of the neck results in an excess of skin that requires removal. Dr. De Silva hides such incision behind the ear to avoid visible scars while giving the best possible resulting neck profile. Elevation of the skin alone in older techniques leaves stretched scars that are the hallmarks of surgery, Dr. De Silva takes meticulous attention to elevating the tissues beneath the skin to enable scars to heal better free of tension. Dr. De Silva presented internationally on Advanced Neck Lifting Techniques at the 43rd Annual ASOPRS Scientific Symposium in Chicago, IL, USA.
3. What are the common neck changes that occur with age and how can a neck lift address this?
Immediately beneath the skin of the neck is the platysma muscle, this muscle forms a sheet in the neck that extends from the collarbones up to the jaw line. A common sign of facial ageing are vertical bands in the neck that result from separation of the platysma muscle. Ageing of the neck results in the appearance of these vertical cords and herniation of soft tissue below the jaw. Natural looking facial surgery requires restoration of the natural neck angle between the jaw and the neck and repair of the platysma muscle. Treating the neck is one of the most difficult aspects of facial plastic surgery, many revisions that we see are difficult cases where the natural planes and elevation of tissue has not be respected.
Natural Looking Neck
So what makes a good neck or an attractive jaw line? We see a number of unnaturally pulled vectors or directions in the neck so the vector or direction of elevation is very important. Dr. De Silva, a London neck lift specialist places importance in establishing a smooth jaw line as one of the most important aspects to an excellent result while avoiding the pulled tight look. The vector of elevation should be parallel to the jaw line in the front and at a slight angle towards the ear in the back to avoid puckering at the post-ear and achieve the most natural outcome.
The aim of the neck lift should be to get a distinct jaw line along the mandibular bone, with a sharp angle to the neck. The area may be filled with a layer of fat, which may be amenable to liposuction, alternatively Dr. De Silva will directly sculpt and stitch the soft tissue layer under direct visualization.
4. Who is the typical patient requesting a neck lift?
The typical patients who present for an isolated neck lift are typically in their forties or older. The majority of patients have already had fillers and anti-wrinkle injections but their neck is ageing because no non-surgical treatments are effective in proving laxity and soft tissue descent associated with facial ageing of the neck area. Some patients who have had previous facelift or neck lift surgeries have had recurrent looseness in their neck, or male patients who don’t want a facelift. Male patients are often better suited to neck lifts and conservative facelift surgery to give natural looking results. Dr. De Silva achieves a natural appearance in facelift and necklift surgery by lifting the descended soft tissue in their natural vectors and by being conservative.
5. Assessment of the Neck Area?
The pre-operative evaluation is very important to evaluate your individual facial ageing, the potential benefit from neck lift surgery and outcomes. Dr. De Silva evaluated the area beneath the chin, the jaw line and the soft tissue descent below the chin termed the sub-mental area, this area needs to be evaluated for specific anatomical characteristics including: thickness of skin, descent of the salivary glands below the jaw line, splitting of the neck platysma muscle which presents with vertical bands in the neck, the volume of soft tissues of the neck. All of these factors are taken into consideration in the surgical technique used in the neck lift.
Dr. De Silva a London facelift and neck lift surgeon, after evaluation of your neck sometimes advocates additional techniques or procedures to give the best result. Descent of the salivary glands should be managed with elevation of the glands to restore them to their previous position. Marked laxity of the skin with minimal elasticity will require tightening of the skin with hidden incisions in order to provide a smooth and natural looking neck contour. In addition the position of the chin in relation to the lips in profile view is an important consideration. A small chin weakens the lower third of the face and is best treated with chin augmentation, often with the use of a high-grade silicone implant at the same time as the neck lift surgery.
6. What does a neck lift surgery involve?
Dr. De Silva London neck lift surgeon focuses his techniques in lifting the neck to restore the natural curvature of the neck and angle between the jaw line and the neck, hiding incisions to enable tightening of the skin. The anatomy of the neck is intricate with layers of muscles, blood vessels and nerves. Elevation of the neck requires maximizing the lifting of the neck that has descended with facial ageing and gravity. The vessels in the neck are important as they provide the blood supply to the head and neck.
The images below are taken from Dr. Julian De Silva’s forthcoming book on Facial Cosmetic & Plastic Surgery, the sequence of figures show the principles of neck lift surgery only, no two people have identical changes, Dr. De Silva tailors the neck surgery to the individual person depending on factors including gender, age, skin & soft tissue laxity.
The platysma muscle is like a sheet that extends from the collar bones (clavicle) to the jaw line, with facial ageing this muscle often becomes floppy with bands. The platysma can be seen in the figure below:
Dr. De Silva infiltrates the neck areas with a highly diluted local anaesthetic solution to reduce bleeding and numb all areas of the neck. Incisions are hidden under the chin and immediately behind the ear. Key to the surgery is addressing the thin platysma muscle that becomes lax in the neck often resulting in vertical bands running down the anterior part of the neck. The edges of the platysma muscle are identified through a key-hole incision in the neck, the muscle is sculpted and stitched together to smoothen the neck contour. The soft tissue under the chin requires elevation with a combination of sculpting and refining the soft tissues and liposuction to accumulated fat. The neck lift requires suturing of the platysma muscle in the midline of the neck to restore and support the neck. Dr. De Silva uses a specialised double imbrication technique to maximize the tightness of the neck, to give the best support possible against gravity and the longest possible result.
Dr. De Silva tailors the neck lift to the individual and their facial anatomy. Heavy neck and subsequent tissues require additional techniques and sutures to lift the neck and support the neck against gravity.
Patients who are not good candidates for an isolated neck lift are those with extreme skin laxity and with soft tissue that is present over the jaw line, termed jowls. These signs of facial ageing are suited to a combined technique that includes both face and neck lift surgery.
Dr. De Silva utilises the latest innovations in surgical techniques to improve the results of neck lift surgery. These include the use of fibrin tissue adhesives in patients that have increased risk of bleeding this works to reduce bleeding by triggering the clotting cascade. Dr. De Silva may suggest the use of additional procedures to enhance the result of a neck lift. The position of the chin in relation to the jaw and lips is an important consideration. A small chin results in weakness of the lower third of the face and chin augmentation at the same time as the neck lift surgery will enhance the result.
7. What type of anaesthesia is required for a neck lift?
Dr. Julian De Silva teaches
on Advanced Face-Lifting Techniques at the 43rd Annual ASOPRS Scientific Symposium in Chicago, IL, USA.
Neck lift surgery does require some form of anaesthesia, there are three principal types of anaesthesia – local, sedative anaesthesia and general anaesthesia.
Local anaesthesia involves injecting numbing medicine at the area to be operated on. The face is a sensitive are of the face, and local anaesthesia along is not usually sufficient for neck lift surgery.
Sedative anaesthesia also known as twilight anaesthesia means an anaesthesiologist gives you some medications that make you sleep during the surgery. Dr. De Silva offers sedation anaesthesia for neck lift surgery, which ensures a comfortable experience, as patients have a rapid recovery and go home approximately thirty minutes after the surgery with an escort or chaperone. Patients generally prefer sedation to general anaesthesia as there is less nausea, sickness and tiredness after sedation anaesthesia
General anaesthesia means that the patient is completely unconscious, requires a breathing tube and the recovery is slower taking a minimum of 4-6 hours. For neck lift surgery, general anaesthesia is safe, effective and commonly used. In some patients general anaesthesia may not be the best option if you have existing medical conditions.
Neck lift surgery is completed is under general anaesthesia and sedation anaesthesia. General anaesthesia means that your body is completely unconscious, the medications used in general anaesthesia are given by an anaesthesiologist. The normal protective mechanisms of the body are subdued and a breathing tube is used to protect the airway and maintain breathing. The advantages of general anaesthesia include protection of the airway for breathing and complete anaesthesia and unconsciousness. The disadvantages of general anaesthesia include a longer recovery that with other forms of anaesthesia, common side effects of the medication are drowsiness and nausea and increased resources. The ideal choice of anaesthesia for neck lift surgery does differ for each patient, as depending on your medical history, previous experiences of anaesthesia and allergies, different types of anaesthesia are best suited.
Sedation anaesthesia is also known as “twilight anaesthesia” or MAC (Monitored anaesthesia care) means that your body is sleepy and relaxed, you are still conscious and able to respond to questions and instructions. Sedation is generally regarded as safer than general anaesthesia, patients breath on their own, have rapid recovery after sedation and are able to home quicker without symptoms of nausea or the hang over of general anaesthesia. Typically you won’t remember the procedure or the short period of time following it, though you will feel a little euphoric.
Dr. De Silva tailors the type of anaesthesia to the individual patient and their needs. When suitable Dr. De Silva prefers the use of sedative anaesthesia as the technique is safer, enables rapid recovery and avoids side effects of general anaesthesia with no nausea or sickness. Dr. De Silva only performs surgery in private hospital and treatment centres that have full accreditation by the Care Quality Commission.
8. What is the recovery time for a neck lift?
Most patients will go home on the day of surgery or spend one day in hospital. There is a support bandage that applies pressure to the face and neck for the first day. There is usually only mild discomfort that is relieved by oral analgesia, neck lift surgery usually results in feelings of tightness after the surgery. Dr. De Silva advises his patients to apply ice packs to their face for the first 3-days as this speeds up recovery and reduces swelling. Patients often feel good after a few days, and the lower third of the face is usually swollen and bruised for 2 weeks. Occasionally patients can feel really drained for the first couple of weeks. After 1-week patients may return to most normal activities, although strenuous activity should be avoided for 4 weeks. Most of the stitches are removed between 1-2 weeks. Dr. De Silva follows his patients very carefully after their surgery and is readily accessible 24-7, he also advises patients on minimizing scarring and may use medications that facilitate hidden incisions with the use of creams or local treatments. For a detailed video on recovery after facelift and neck lift surgery follow this link.
9. What are the neck firming options?
A neck lift procedure rejuvenates the face by lifting soft tissues of the face that have descended with facial ageing as a consequence of descent of soft tissues, laxity in soft tissues of face and skin, volume loss. A neck lift is effective to treat characteristics of the face including:
- Soft tissue beneath the jaw often includes fat that can be removed with a combination of liposuction under the chin and surgical removal.
- Vertical bands in the neck, are bands that are formed from laxity in a sheet of muscle that extends from the collar bones to the jaw (termed the platysma)
- Excess skin in the neck (secondary to laxity)
- Other consideration include local anatomy, for example a low position of an individual’s natural salivary glands can require attention in neck lift surgery to give an optimal result
The facial ageing changes occur usually present from forties, however are dependent on environmental factors (including smoking, sun exposure, poor nutrition and stress) and genetic factors.
With neck lift surgery the sharp angle between the jaw line and neck can be restored. There are a variety of surgical techniques that can be used to rejuvenate the neck, Dr. De Silva tailors the surgery to the individual’s ageing and commonly includes a double imbrication technique to the neck to restore the neck appearance.
Often to give the best result from a neck lift, the surgery needs to be combined with additional procedures including liposuction of the neck and facelift surgery.
Non-surgical treatments including the use of wrinkle injection and hyaluronic acid fillers have been substantial innovations in the past decade that have advance cosmetic surgery. Patients with early signs and symptoms of facial ageing including dynamic wrinkles (wrinkles on facial expression) and early soft tissue changes along the jaw line (termed jowls) may be effectively treated short-term with non-surgical treatments. The changes described above including vertical bands in the neck, skin laxity and soft tissue changes below the jaw line are not effectively treated with non-surgical methods and require neck lift surgery to give a natural looking rejuvenation.
10. Does a neck lift procedure improve the jawline?
A neck lift procedure rejuvenates the face by lifting soft tissues of the face that have descended with facial ageing as a consequence of descent of soft tissues, laxity in soft tissues of face and skin, volume loss. A neck lift is effective to treat characteristics of the face including soft tissue and fat beneath the jaw line, vertical bands in the neck and excess skin in the neck.
With neck lift surgery the sharp angle between the jaw line and neck can be restored. There are a variety of surgical techniques that can be used to rejuvenate the neck, Dr. De Silva tailors the surgery to the individual’s ageing and commonly includes a double imbrication technique to the neck to restore the neck appearance.Often to give the best result from a neck lift, the surgery needs to be combined with additional procedures including liposuction of the neck and facelift surgery.
11. Is there anything I can do to improve my double chin and flabby neck?
Weight loss will have an effect on improving the condition of your neck as there is fat that can accumulate under the neck. However with increasing age (over 40) there is reduced natural elasticity in the skin and weight loss can result in lose skin below the neck. Lose skin cannot be effectively treated non-surgically and requires a surgical procedure to give a natural looking rejuvenation.
There are genetic factors that can result in excessive soft tissue (including fat) beneath the jaw line and laxity in the platysma muscle that are not improved by weight loss, this can result in a poorly shaped jaw line and neck appearance at a relatively young age 20s-30s.
Ageing changes in the neck including vertical bands in the neck, skin laxity and soft tissue changes below the jaw line are not effectively treated with non-surgical methods and require neck lift surgery to give a natural looking rejuvenation.
12. Neck lift without surgery, what works?
Non-surgical treatments including the use of hyaluronic acid fillers can be used to treat early soft tissue changes along the jaw line (termed jowls). These non-surgical treatments may be effective short-term in the early stages. The limitations with non-surgical treatments is with increased laxity of the skin, excess soft tissue below the neck and vertical bands in the neck (laxity in underlying platysma muscle).
Wrinkle injection has been used to treat platysma bands in the neck, it does have limitation in that it is only effective for early bands, relatively short duration of 4-6months and ineffective to treat skin laxity.
Radiofrequency or ultrasound devices (Ultherapy) to tighten the neck tissues have some effect, however usually a modest improvement and relatively short duration.
The changes described above including vertical bands in the neck, skin laxity and soft tissue changes below the jaw line are not effectively treated with non-surgical methods and require neck lift surgery to give a natural looking rejuvenation.
13. Can I have a anti-wrinkle injections neck lift?
Wrinkle injection is a muscle relaxant that can be used to reduce the neck platysma muscle contracting. The platysma muscle is a thin sheet-like muscle under the neck skin that with facial ageing becomes lax and results in vertical bands. Anti-wrinkle injections is a neurotoxin that weakens the platysma muscle from contracting.
Non-surgical treatments including the use of Wrinkle injection have been used to treat platysma bands in the neck, it does have limitation in that it is only effective for early bands, relatively short duration of 4-6months and ineffective to treat skin laxity.
The limitations with non-surgical treatments is with increased laxity of the skin, excess soft tissue below the neck and vertical bands in the neck (laxity in underlying platysma muscle). With these characteristics a surgical neck lift procedure is required to give a natural looking and long-term rejuvenation.
14. How can I remove of excess skin in my neck?
A neck lift procedure rejuvenates the face by lifting soft tissues of the face that have descended with facial ageing as a consequence of descent of soft tissues, laxity in soft tissues of face and skin, volume loss. The appearance of excess skin in the neck (secondary to skin laxity) is common with facial ageing as there is a loss of natural skin elasticity. In addition there are genetic factors that can result in excessive skin beneath the jaw line and laxity in the platysma muscle that are apparent in the neck at a relatively young age 20s-30s.
With neck lift surgery the sharp angle between the jaw line and neck can be restored. There are a variety of surgical techniques that can be used to rejuvenate the neck, Dr. De Silva tailors the surgery to the individual’s ageing and commonly includes a double imbrication technique to the neck to restore the neck appearance. There is no good non-surgical treatment that is able to remove skin from the neck, Dr. De Silva hides incisions for neck lift surgery so that there are no visible incisions after surgery.
Often to give the best result from a neck lift, the surgery needs to be combined with additional procedures including liposuction of the neck and facelift surgery.
15. What is neck Liposuction?
Some people have ‘sagging’ necks primarily due to fat accumulation under the chin and jawbone. In some people, with good skin elasticity, controlled removal of this fat (termed neck or double chin liposuction) can be used to improve the neck appearance, by reducing the soft tissue beneath the chin. Dr. De Silva carefully assesses his patients’ neck for suitability for liposuction, as there are specific shapes of neck and skin quality that will benefit from this procedure. Dr. De Silva does not use body liposuction techniques (including traditional liposuction and ultrasound-assisted Vaser techniques), and uses a specialized micro-cannulae (fine) technique that enables finer control and natural shaping of the neck contours. The benefits of this technique over a neck lift is a surgery with hidden-incisions avoiding visible scars and relatively short downtime and recovery. In most individuals the benefit of liposuction can be seen in a few weeks though the final result will be after a 6-12 month period.
16. Lumpiness after neck liposuction
There can often be some lumpy-bumpy changes soon after liposuction as part of the healing process there is often some uneven swelling that settles down with time. In the majority of people the unevenness improves over a period of weeks although it may take as long as 6-months. In the period soon after surgery, MLD, manual lymphatic drainage by a professionally trained specialist may be beneficial in helping the process.
The earliest time to consider any further surgery is 6 to 12 months after surgery, although assessing the healing after the surgery will give information on how the area is healing. Although all of us like to get to the final endpoint faster, early intervention with further surgery is generally not recommended as this can lead to further lumpy bumpy changes. The body will naturally heal bumpy areas and early intervention will not necessarily improve the final result.
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