What is a neck lift?

Written by Dr. Julian De Silva
One of the most frequent indicators of facial ageing are changes in the neck. The appearance of vertical bands in the neck and fullness 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.

Why have a neck lift?

Ageing of the face is characterised by three key changes, loss of volume of the fat and soft tissues in the face, gravitational descent of facial soft tissues and laxity of the skin. For some patients, the majority of the changes are in their neck as a combination of facial ageing and often genetics. A neck lift can improve your jawline, restore a youthful angle to your neck and remove loose skin and fullness. Many patients can result in a better neck than they had even in their thirties. Key to natural-looking results is an artistic and anatomical understanding of these three elements, so the elements of the facial ageing can be rejuvenated naturally.

Watch Video: Neck lift surgery, what anatomy changes with age?
Neck lift surgery, what anatomy changes with age?

Dr De Silva’s facelift techniques

With neck lift surgery, Dr De Silva’s philosophy is that there are three important aspects of facial surgery:

  1. Safety always comes first
  2. Best possible natural result and fast recovery
  3. A personalised journey where we support you during your recovery.

Each of these aspects we have refined and improved to give you a smooth experience and recovery. A great looking neck lift requires a balance of respect to a patient’s genetic makeup surgical technical excellence and the surgeon’s artistic talent. Dr De Silva has developed a signature neck lift that incorporates his artistry. Dr De Silva customises every neck lift to the patient’s facial characteristics and often will use complementary treatments to improve his patient’s results and enhance their recovery. Some patients can benefit from a smaller procedure limited to one-hour; other patients may need a combined facelift for the best result.

Common reasons why patients ask Dr. De Silva for help?

  • Look tired, lost sparkle, feel less attractive, less attention
  • Impact relationship & profession
  • Self-conscious about neck and loss of jaw line
  • Hiding your neck e.g. avoiding photos
  • Filler is okay for adding volume only, does not lift & help lose skin, unnatural when overfilled. Non-surgical machines offer minimal improvement (<10%)
  • Starting to look like your mother or father
Watch Video: What happens in a neck lift? Animation of a neck lift procedure.
What happens in a neck lift? Animation of a neck lift procedure.

Dr. De Silva also recommends

  • Deep plane face and neck lift surgery give a massive improvement in face shape, only 3% of facelift is deep plane
  • Natural shaping of jaw line (*key importance for natural look, some patients benefit from a chin implant)
  • Signature deep plane advantages in recovery over alternative surgery (SMAS facelift)
  • Patients with very full neck, need advanced shaping of salivary glands in neck, gives better neck profile than in 20s
  • Artistry, every patient’s face is unique, requires customisation with regenerative medicine, lip lifts, chin implant to give the best result
  • With Dr. De Silva sedation anaesthesia, all patients rapid recovery less than 1-hour after procedure
  • Scars must be positioned discreetly, 99% virtually invisible (meticulous technique, 3 levels stitches, never staples)
  • Enhanced recovery, Dr. De Silva has pioneered use of regenerative medicine and oxygen therapy
  • Please note absolute results cannot be guaranteed, realistic expectations are important

Common concerns with neck lift surgery?

Many patients come to see Dr De Silva, as they are concerned about looking too different and want to have a natural rejuvenation with hidden scars and a fast recovery. We have also seen media photographs of celebrities who look quite different from their youth and a natural-looking rejuvenation is important for most of my patients. Having a facelift or neck lift surgery is a “big” decision for many patients as it is a choice to undergo surgery. Dr De Silva has respect for each person’s decision and provides a personalised evaluation and treatment options to enable you to make an informed decision about undergoing surgery. This begins with a consultation to discuss the changes that you have noticed, the expectations you would like to see for improvement and a discussion regarding recovery and potential risks.

View before and after photos - Necklift

What are the different types of neck lift?

There is a large spectrum of techniques to improve the shape of the neck; the key is customisation to an individual person’s needs. Procedures include:

  • Neck liposuction
  • Neck tightening stitches
  • Neck muscle corset stitches (plastysmaplasty)
  • Combined facelift surgery
  • Deep soft tissue reshaping (salivary gland reduction

What is involved in a neck lift?

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 jawline and the neck associated with youth. Often elevation of the soft tissues of the neck results in excess skin that requires removal. Dr De Silva hides such incision behind the ear to avoid visible scars while giving the best possible 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.

Male neck, before and after treatment photos, side view

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 jawline. A common sign of facial ageing is vertical bands in the neck that result from the 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 a 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 been respected.

Woman's neck (schem muscul on neck)

So what makes a good neck or an attractive jawline?

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 jawline 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 jawline 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 jawline 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 visualisation

Woman's face (schem lines on face and neck, after surgery)

What does a neck lift surgery involve?

Dr De Silva focuses on lifting the neck to restore the natural shape of the neck and restore the definition between the jawline and the neck. The anatomy of the neck is intricate with layers of muscles, blood vessels and nerves. Elevation of the neck requires maximising 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 platysma muscle is like a sheet that extends from the collar bones (clavicle) to the jawline, 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 keyhole 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 maximise 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 jawline, 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. 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.

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.

Woman's neck (Necklift diagrams)

Will I look like myself?

This is a common concern for many patients. Dr De Silva’s philosophy is a natural rejuvenation, where patients look like themselves only better. For most patient’s Dr De Silva completes imaging to give patients an indication of their appearance after surgery. Any change can seem more apparent initially as all of us become used to our appearance and even small changes can take some time to get used to.

Will people be able to tell?

With good surgery, friends and family members will not be able to tell you have undergone facelift surgery. Dr De Silva customises treatments based on your individual facial characteristics, often patients that have substantial rejuvenation are surprised how friends and family have not been able to tell.

Woman's face after necklift treatment, front view

Dr De Silva and patient safety

Patient safety is of key importance for all facial plastic surgery. The intricate anatomy of the face requires precision and care. Dr De Silva is a keen advocate of patient safety and has championed the need for patient safety on Sky news and medical conferences.

Watch Video: SkyNews interviews Dr. Julian De Silva about Patient Safety in Cosmetic Surgery
Sky News interviews Dr. Julian De Silva about Patient Safety in Cosmetic Surgery

I have never had surgery and am really nervous…

Many of our patients are very nervous and have not undergone previous surgery. We take a great deal of time to ensure we provide both emotional support before and after surgery. Our aim is to provide the best possible experience and to foster a long-term relationship with our patients to provide ongoing care for years to come. Please read about some of the glowing patient experiences with us. Dr De Silva has hand-picked each and every staff member not only for their expertise but their expertise and clinical skills, also for their approach, communication and personal skills. Our proposal is to give you a choice to have surgery within a safe environment, with the care each person would like to personally receive, performed by Dr De Silva and supported by his team. We are constantly refining the model to give each patient the best experience possible

Support journey

Most patient’s recovery after neck lift is rapid, and patients return to normal activities after one to two couple of weeks, however, everyone’s journey is unique to them. Everything in life, including surgery, is an emotional experience, and for some patients, the recovery may be longer. We have a supportive and empathetic team that will continue to guide every patient through their recovery.

Watch Video: Facelift & Neck Lift Review & Testimonial
Facelift & Neck Lift Review & Testimonial

Dr De Silva books on facial surgery

Dr De Silva has published over 30 journals, and book chapters in peer-reviewed journals and several randomised control research studies, regarded as the gold standard in medical research. Dr De Silva has published several books on facial surgery and has the complete guide to facelift and neck lift surgery for publication next year

The Complete Guide to Facelift and Neck Lift Surgery

What complications can occur?

A facelift is regarded as a challenging cosmetic surgery procedure and requires in-depth knowledge of the anatomy and attention to detail. One of the most important factors responsible for the success of surgery is the surgeon. In Dr De Silva’s hand’s complications are uncommon, swelling and bruising are the most common aspects of recovery. Pain or discomfort is uncommon and resolves within 24-hours. Infection is rare, and the gold standard is prophylactic antibiotics to protect against infection. Dr De Silva avoids the side effects of general anaesthetic (deep vein thrombosis and allergies) by using safer sedation anaesthesia. Two rare and serious complications are skin necrosis (delayed healing of the skin) and stretching of a motor nerve (recovers over a 6-month period). Dr De Silva takes multiple levels of precautions to avoid these issues in the first place. Although Dr De Silva advises all patients, they must stop smoking; we have utilised advanced oxygen therapy and regenerative medicine to heal the body where this has not been possible. Although there is no surgeon completing facelift that has no revision cases, measures can be taken to make these minimal by using the most advanced techniques. Over twenty per cent of Dr De Silva’s patients have had surgery elsewhere.

During consultation: Julian De Silva M.B.B.S, M.D.

Is there anything I can do to improve my double chin and flabby neck?

There are genetic factors that can result in excessive soft tissue (including fat) beneath the jawline and laxity in the platysma muscle that is not improved by weight loss, and this can result in a poorly shaped jawline and neck appearance at a relatively young age 20s-30s.

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 loose skin below the neck. Loose skin cannot be effectively treated non-surgically and requires a surgical procedure to give a natural-looking rejuvenation.

Ageing changes in the neck including vertical bands in the neck, skin laxity and soft tissue changes below the jawline are not effectively treated with non-surgical methods and require neck lift surgery to give a natural-looking rejuvenation.

Woman's face with marker lines, before surgery

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 jawline (termed jowls). These non-surgical treatments may be effective short-term in the early stages. The limitations with non-surgical treatments are 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.

Fat-dissolving medicines have limited effect in the neck; often, they require multiple treatments and are painful. There are less effective than liposuction and neck tightening stitches in most patients.

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 jawline are not effectively treated with non-surgical methods and require neck lift surgery to give a natural-looking rejuvenation.

3d head model

Can I have an 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 are 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 are 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.

non-surgical alternative to blepharoplasty, female model

What is the recovery after a neck lift?

Most patients are able to return to social and professional activities after one to three weeks. The truth is that recovery after facelift and neck lift surgery does depend on several factors.

Swelling

Swelling is the main aspect of healing after facelift surgery, and by 2-weeks after surgery, 80% of the swelling will have resolved. Although the swelling will continue to resolve, most resolves by six weeks. The final result when all of the swelling has resolved can take as long as a year.

Bruising

Most patients have minimal bruising that resolves over 1-2 weeks. Occasionally, less than five per cent of the time, there can be a marked bruise immediately below the eyes where the skin is very thin, this bruising can take 6-weeks to go, though it can be covered with makeup 1-week.

Numbness

There is numbness around the ears and chin in the recovery period; this continues to improve over the first six weeks, although it can take 6-12 months to disappear completely.

Pain

In terms of pain, there is surprisingly little, and usually for less than 24 hours. Oral analgesia is adequate for the first day after surgery, and many of our patients never take any analgesia.

Scars

The position and shape of the scar can be camouflaged around the natural curves and lines behind the ears, and under the chin, they reach their final endpoint 6-12 months later. They are discrete and generally difficult to see after a few weeks; there are steps that can be taken to speed up their recovery and soften their appearance. One week after surgery, they can be covered with concealer makeup for social activities. Most can be restarted after 2-3 weeks; there may be some residual bruising and swelling; generally, this can be covered up with concealer. On average, at 2-weeks after surgery. With an important event such as a wedding, you should allow 6-weeks as a minimum to allow the majority of the swelling to have resolved.

Exercise

As a general rule three weeks.

Scars - female model

Fast recovery techniques with Dr De Silva

The type of surgery you have influences your healing; not all facelift is the same. Factors influencing healing included whether the surgery is principally mini-neck lift surgery, revision surgery, ethnicity, fuller neck and the use of associated techniques.

The techniques your surgeon employees to complete the surgery. Dr De Silva performs conservative surgery that limits trauma to the natural anatomy, and where appropriate innovative techniques to speed up the recovery process.

Dr De Silva has pioneered the use of regenerative medicine (utilising our own growth factors) to heal the body faster; we are committed to providing our patients with the latest advancements from scientific research.

Watch Video: What is the recovery after facelift surgery? The truth revealed…
What is the recovery after facelift surgery? The truth revealed...

Fast recovery techniques with Dr De Silva

The type of surgery you have influences your healing; not all facelift is the same. Factors influencing healing included whether the surgery is principally mini-neck lift surgery, revision surgery, ethnicity, fuller neck and the use of associated techniques.

The techniques your surgeon employees to complete the surgery. Dr De Silva performs conservative surgery that limits trauma to the natural anatomy, and where appropriate innovative techniques to speed up the recovery process.

Dr De Silva has pioneered the use of regenerative medicine (utilising our own growth factors) to heal the body faster; we are committed to providing our patients with the latest advancements from scientific research.

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 specialised 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 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.

What are things you can do to speed up recovery?

There are many prescription and herbal medications that should be avoided both before and after surgery, as they can encourage both bruising and swelling. Dr De Silva and his team give comprehensive advice to all his patients on what should be avoided before and after surgery. In addition, there are some herbal medications, such as arnica, that should be taken to reduce bleeding, Dr De Silva provides his patients with a specialist herbal medicine than enhances recovery.

Icing around your face and neck for the first three days, in the form of ice in a zip lock bag, frozen peas or gel mask all have a beneficial effect on reducing swelling when applied to the area for ten minutes regularly after surgery. There are other factors such as resting and taking things easy during the daytime that will maintain relatively low and stable blood pressure. Keeping your head elevated when sleeping will also reduce bruising and swelling.

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.

Can a facelift be combined with other techniques?

Dr De Silva frequently combines rhinoplasty with other facial procedures to give a natural-looking result and avoid the use of scars associated with conventional techniques:

Upper third of the face:

  • Blepharoplasty or eyelid surgery
  • Minimal incision brow lift (Brow & Forehead Lift)
  • Anti-wrinkle treatments for fine lines

Middle third of the face:

  • Volume augmentation of the cheeks with fillers, fat transfer or implants
  • Fat-transfer to the mid-face and cheeks (Fat Transfer)
  • Skin resurfacing for lines & deep wrinkles (Skin Resurfacing)
  • Anti-wrinkle injections for fine lines
  • Rhinoplasty (Nose reshaping)

Lower third of the face:

Male sculpture: body and face muscul schema

Dr De Silva

Dr Julian De Silva teaches facelift surgery to other international surgeons every year. Teaching has always been a passion, and Dr De Silva has been the lead course director for an international facelift course annually since 2016.

Dr Julian De Silva teaches on Advanced Facelifting Techniques at the 43rd Annual ASOPRS Scientific Symposium in Chicago, IL, USA.

Asoprs 47th Annual Fall Scientific Symposium
Face and Neck Lift Course ASOPRS/AAO Chicago 2016

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CENTRE FOR ADVANCED FACIAL COSMETIC & PLASTIC SURGERY - Julian De Silva M.B.B.S, M.D.

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