Neck lift surgery is performed by facial plastic surgeon Dr. Allan Wulc of Philadelphia’s W Cosmetic Surgery® to restore a youthful-looking neck and improve a patient’s overall aesthetics. In the same way that the face and body eventually show signs of aging, the neck also shows signs of deterioration. Over time, patients may notice significant changes in this area, like a poorly defined jawline, sagging skin below the chin, prominent vertical muscle bands, necklace lines extending horizontally around the neck and excess, wrinkled, aged, thin neck skin. The results of facial plastic surgery and cosmetic procedures, no matter how natural, often look out of place if the aging neck is ignored during the rejuvenation process. Plastic surgery of the neck is often necessary for complete facial rejuvenation.
- Why a Neck Lift?
- What’s in a neck?
- How is a Deep Neck Lift Performed?
- Neck Lift Before And After
- Female and Male Differences
- Procedures that Complement a Chin Lift
- Neck Liposuction
- Healing and Post-Operative Care Following Deep Neck Lift
- Frequently Asked Questions About Deep Neck Lift Surgery
- Why choose Dr. Allan Wulc for a Neck Lift?
Why a Neck Lift?
Signs of aging in the neck can cause a person to look older than they actually feel. There are many causes of visible aging, only some of which can be controlled. Weight gain and loss, sun damage, genetics, and gravity are the main causes of neck area deterioration. Over time, the laxity of the tissues can affect neck skin and create a “turkey wattle” appearance. The natural angles of the neck disappear as the muscle loses its attachments to the underlying bones and fat accumulates in the deep layers of the neck under the muscle.
Those who would like to improve the look of their neck by removing skin and excess fat and tightening the tissues can opt to undergo cosmetic neck lift surgery. The neck lift, or “chin lift”, addresses a sagging neck and reestablishes the sharp angles of the jawline and the neck. The procedure is designed to slim the jawline and improve facial attractiveness, eliminate the look of a double chin, and smooth bands and creases in the neck.
What’s in a neck?
A deep neck lift sounds scary. Lots of deep structures exist in the neck including the esophagus (swallowing), the trachea(breathing), the blood vessels(arteries, veins, lymphatics) and the nerves, the cervical bones, the spinal cord, and finally, the muscles that move our head.
None of these structures which are truly in the deep neck are addressed with this surgery. We don’t come remotely near them during the surgery.
The difference between a routine neck lift and a deep neck lift is that in a routine neck lift, fat is removed from the superficial tissues usually using liposuction, and the platysma muscle, the muscle that forms the cord in the neck is tightened and sometimes weakened.
In a deep neck lift, the surgery takes place under that platysma muscle. It is here that most of the changes that age the neck and make it not as aesthetically appealing occur. The midline contains deep fat that extends almost all the way to the jaws.
The muscles under the platysma muscle can hang, as can the submental salivary glands which cause a bulge that you can feel sometimes extending low and under the jawline.
With a deep neck lift, these issues can all be addressed. Looseness of the platysma muscle can also be repaired and reattached to the neck bone, the hyoid, from which it has lost its firm youthful attachments. Rarely fat above the muscle is also needed to be addressed once the underlying anatomy has been restored.
The surgery is done on an outpatient basis, usually under local anesthesia with sedation. Though it involves small incisions, it is the opposite of a minimally invasive technique in that instead of just trying to suspend and tighten, deep structures are removed to enhance the angles of the neck.
Drains are always used, and recuperation generally is on the order of one to two weeks. During your consultation, we discuss and compare the options that are open to you for restoration and rejuvenation of the neck.
How is a Deep Neck Lift Performed?
Performed usually under local anesthesia on an outpatient basis, a neck lift begins with a small incision under the chin and incisions behind the ears. The incisions are hidden in the natural curve of the back of the ears and practically not visible in the neck once healed. Localized fat deposits can be repositioned within the neck, or removed with liposuction or under direct view with excision. Excess tissue can be sculptured and jowl fat can be trimmed. The separated vertical platysma muscles of the neck are sutured together to create a sleek and slender neck. When necessary, extra skin is trimmed away from the neck from behind the ears to hug the new contours. The skin is closed with absorbable sutures.
Neck lift surgery can eliminate the look of a double chin and a turkey neck or “wattle,” which are the chief complaints that trouble most patients. At our practice in Philadelphia, neck lift surgery is one of our most requested surgical procedures.
Neck Lift Before And After
To achieve a more youthful appearance, a neck lift is often performed simultaneously with a facelift. Some typical results of both procedures are featured in our neck lift gallery.
Female and Male Differences
Women and men tend to have different facial shapes which are dictated, in part, by hormones. Often, men have squarer jaws, while women have rounded or oval-shaped lower faces. During the aging process, sagging of the facial tissues can create jowls, causing a square appearance of the jaw. Neck surgery is carefully tailored to enhance a masculine jawline in men or restore a feminine look in women while eliminating unwanted bulk and neck laxity. Contouring below the chin also helps to highlight the preferred aesthetic of the patient’s face.
Procedures that Complement a Chin Lift
The neck typically ages at a rate similar to the rest of the face and should be considered when planning an anti-aging makeover. A neck lift can be performed on its own or alongside additional facial plastic surgeries. Because the neck is positioned between the face and décolleté in women, and the chest in men, the area below the neck—the chest may also require treatment with peels, IPL or dilute fillers.
In patients where the chin is recessed or weak, the aging process and changes in the neck appear more rapidly and at a younger age because the face lacks the support it needs. Much like a tent pole that isn’t long enough, the fabric tends to hang, and this is similar to an unsupported neck that lacks the strong definition created by a prominent chin.
A neck lift is commonly performed as a natural extension of a facelift. While the facelift and mini facelift address the upper neck, the jowls, the jawline and the chin, a facelift does not address the entirety of the neck, specifically loose hanging skin and muscle particularly in the central part of the neck where the turkey wattle resides.
Buccal fat extraction
This procedure is particularly useful in patients with full faces. Fat is removed from a fat pad near the side of the mouth using an approach inside the mouth. The face appears slimmer after this procedure.
Eyelid Lift (Blepharoplasty)
The eyelids are the first areas to betray the signs of aging. They can appear tired or hooded with crêpey upper eyelid skin, there may be visible fat pads creating bags below the eyes, or the patient may have wrinkles surrounding them. Upper and lower eyelid surgery can be performed to address these issues.
Vertical expression lines often span the forehead in aging individuals, or the brows may sag over time. A brow lift surgery treats both of these issues by lifting the skin and eliminating extra tissue. In some cases, a brow lift may also create minor changes in the upper eyelids.
Collagen Remodeling and Skin Smoothing Treatments
Along with the aging skin of the face and neck, the décolleté or chest can have wrinkles and age spots. In this area, non-surgical treatments are favored. Laser skin resurfacing, intense pulsed light therapy, microdermabrasion, micro-needling, and even some chemical peels can smooth the skin and lighten pigmented areas. These treatments change the makeup of the skin at the cellular level. By stimulating collagen production, patients can enjoy the benefit of long term results and better skin health.
Candidates for Neck Lift
Both men and women alike can benefit from neck lift surgery. The procedure can be tailored to enhance either a feminine or masculine jawline. Patients who are best suited for this a deep neck lift surgery are those with poor neck definition who are in good overall health and who have realistic expectations of the surgical outcome. Extra bulk under the chin can lead to the perceived look of weight gain. By eliminating unwanted fat and skin and tightening the neck muscles, a patient’s face can appear slimmer after the procedure. During the planning phase, we will discuss any recommended complementary procedures to enhance the results of a neck lift.
The best way for you to find out if this procedure would be of benefit to you is to schedule a consultation with us. During your initial office visit, the doctor will review your health history, perform a thorough examination of the neck, and ask you to define the change in your neck you would like to see.
Using this process, Dr. Wulc can determine if neck surgery is the best cosmetic procedure for your needs. In some cases, we may recommend other treatment options or suggest a combination of procedures to help you achieve your aesthetic goals. While in our office, you can also ask questions and review the cost of a neck lift or any other recommended surgical procedure with our staff.
Patients interested in neck contouring who have good skin elasticity may be candidates for liposuction without neck muscle tightening or neck skin removal. This procedure is most ideal for patients 50 and younger. After the fat has been suctioned away, the skin will retract on its own and the neck appears trimmer. Neck liposuction removes excess fat to help recontour a double chin. This cosmetic procedure is usually performed using tumescent liposuction, which involves the use of dilute local anesthesia below the skin to cause a firming of the fatty tissue decreasing blood loss, assuring patient comfort, and billowing the skin and fat away from more vital anatomic structures in the neck.
Patients with minimal excess skin may be good candidates for less invasive skin-tightening options, rather than a full surgical procedure with skin excision. Using Renuvion helium plasma energy, heat is delivered under the skin to remove fat excesses, to tighten the skin and the fibrous network that holds the skin tightly in place. The ideal candidate for this procedure does not have the laxity of tissues in the deep neck and only has a bit of fat excess and skin laxity above the muscles of the neck. We discover which of these procedures might be optimum for you only at the time of your consultation.
Healing and Post-Operative Care Following Deep Neck Lift
The recovery period is generally 10-12 days. Patients may notice area bruises and swelling in the days following the neck lift, which should subside within one to two weeks. Any discoloration or surgical incisions in the neck area can be covered with approved cosmetics after we deem it to be safe, usually 7 to 10 days postoperatively. The neck may feel tight and slightly stiff for the next few weeks, but the sensations will gradually fade as your results emerge, and ultrasonic techniques that we employ in our office can help soften this stiffness.
Frequently Asked Questions About Deep Neck Lift Surgery
Neck lift surgery addresses the area of the neck from below the chin to the clavicles. During the procedure, Dr. Wulc can remove extra fat and skin and tighten the neck muscles. Facelift surgery is performed to restore youth to the lower and middle areas of the face, spanning from the upper cheeks to the jawline. It can rejuvenate the upper neck area with fat and skin removal, but will only partially improve muscle laxity—the turkey wattle.
During your consultation, we can advise you as to which neck rejuvenation option is best for your needs. Generally, younger patients or those with good skin quality will be better suited radiofrequency energy treatments with Renuvion. Patients with excess skin that will not retract to its original shape against the neck will usually need a more aggressive procedure. Patients with deep strucutral changes in the neck will benefit much more from a deep neck lifting procedure.
Fat can accumulate in the neck for different reasons. When the platysma muscles separate, the underlying fat layer is no longer covered by a tightly-woven structure. This causes the fat to appear in deposits below the skin. After weight gain, fat accumulates throughout the face and body, including the neck. Other conditions or factors may also contribute to a bulky appearance of the neck.
Your surgery will be accomplished with a combination of sedation and local anesthesia, so you should not feel pain during the surgery. After the procedure, any unwanted post-operative sensations can be kept at bay with pain medication that we prescribe and in general, little pain medication is required other than Tylenol. The neck may feel tight and stiff for a time after surgery. We educate you in exactly what to expect after your surgery well in advance of your surgical date.
What are the best treatments for a sagging neck?
The best treatment for a saggy neck is surgerical. There are multiple layers in the neck —skin, muscle, and fat. Each of these areas should be addressed for an optimum result. Other treatments are compromises, but may be appropriate if only one or two of these issues need to be addressed. If the skin is loose, it can be tightened in reasonable amounts with a variety of skin tightening modalities we utilize such as laser, peels, or with radiofrequency energy with micro-needling or with Thermitight, Facetite or Renuvion helium plasma energy (JZPlasty). If the skin sagging is greater, the skin actually may require removal. This removal is done through incisions behind the neck which are concealed. If the issue is fat, the fat can be addressed either with liposuction, Kybella, or by removal with sculpturing. If the muscle is the cause, the best treatments for minimal degrees of muscle laxity issues are Botox or other neurotoxins which work in select patients to resculpt the neck temporarily. None of these procedures accomplish as much as a direct deep neck lift which can address all the layers of the neck under direct surgical view.
Our preferred treatment, the deep neck lift involves sculpturing all deep fibrous tissues and excess redundant muscle and restoring lax ligamentous attachments in the neck. This procedure generally provides a long-lasting improvement dramatic aesthetic benefit.
What causes jowls?
Jowls are caused by the laxity of the ligaments that suspend the cheeks and the face. When the cheek starts to sag, the fat compartments, superficial and deep that lie under the skin weigh down the face and gravity takes over, producing jowls at the base of the sagging cheek. A ligament—the mandibular ligament, tethers this fat in place and prevents the jowls from sagging further. Fat accumulates right behind the ligament. Without this ligament, called the mandibular ligament, the face would sag all the way down into the neck. If your jowls appear to diminish when you lift your cheek, one of the most beneficial and anatomically correct procedures to treat this is a midfacelift.
We utilize multiple procedures for the treatment of sagging jowls including Kybella injection, liposuction, laser liposuction, and external laser skin tightening or radiofrequency skin tightening or skin tightening with plasma resurfacing—the so-called Renuvion J-Z plasty. How do you choose which is appropriate for you?
How to prevent jowl formation and how to reduce jowls naturally:
We have seen jowls diminish with weight loss. Otherwise, the fat in this location needs to be addressed—either diminished with treatment modalities designed to eliminate fat such as Radiofrequency or elevated surgically through a small incision. Some physicians have experience injecting Kybella as a means of addressing the jowls—we have not seen great changes with this technique which has been described to cause temporary partial facial paralysis.
W Cosmetic Surgery® of Philadelphia for your Neck Lift
Philadelphia facial plastic surgeon, Dr. Allan Wulc, MD, FACS, has unique credentials. Dr. Wulc is board certified by the ABMS board in Ophthalmology. He fellowship trained in eye and facial plastic surgery and is a diplomate of the American Society of Ophthalmic Plastic and Reconstructive Surgery. He is board certified in Facial Cosmetic Surgery by the American Board of Cosmetic Surgery, where he served as a trustee for six years. He is fellow of the American College of Surgeons. Dr. Wulc has been recognized by Castle- Connolly and Philadelphia magazine as a Top Doc for more than 25 years consecutively.
Dr. Wulc is passionate about all asepcts of facial cosmetic surgery, regenerative and anti-aging medicine and specializes in minimally invasive treatments that result in maximum aesthetic improvements. With over 25 years of experience, Dr. Wulc has made his mark in the field of facial plastics by developing new surgical techniques, educating fellow surgeons, and publishing numerous papers and chapters in authoritative journals and textbooks.
W Cosmetic Surgery® boasts an extensive menu of cosmetic treatments, including various ways to improve the look of the neck. Call the clinic to book your neck lift consultation at (610) 828-8880, or fill out the Contact Us form to request a staff member to reach out to you. Serving customers from Plymouth, Philadelphia, Main Line, PA and surrounding areas.
Why choose Dr. Allan Wulc for a Neck Lift?
He is board-certified in:
- Ophthalmology by the American Board of Ophthalmology
- Cosmetic Surgery, Facial by the American Board of Cosmetic Surgery
- Plastic Surgery by the American Board of Physican Specialties
- a diplomate of the American Society of Ophthalmic Plastic and Reconstructive Surgeons.