Who is suitable for necklift Surgery (Platysmaplasty)?
Neck lift surgery is suitable for middle aged and older individuals who have begun to notice that the skin is sagging and there is loss of the pleasing angle between the chin and the neck . There may also be loose muscle bands and quite commonly there may also be excess fat in the region under the chin.
Individuals who achieve the best results from surgery are generally those who are not too overweight and who have once had a good definition of the angle between the chin and the neck. There are some body types who even when they were younger have always had a short chin which blends into the neck and these individuals will have limited results from surgery. Individuals who are overweight may have ‘chubby’ faces and a ‘chubby’ neck and in these cases improvements may also be limited from necklift procedures.
What happens during the operation ?
During neck lift surgery the skin is elevated using an incision which is similar to a facelift incision which is hidden in the natural curves in around the ear but mainly in the groove behind the ear which then extends into the hairline behind the ear. The extension into the hairline behind the ear may be longer depending on how much loose skin there is in the neck. No hair is shaved during the operation but it is simply parted. The skin is elevated to provide access to the deeper tissues.
A tightening of the deeper tissues is performed by pulling the neck muscles ( the platysma muscle) from the side via the opening which is made around the ear. This is known as the lateral approach to correcting the neck and is very conveniently performed simultaneously with a facelift. If the neck muscles are very loose and cause vertical bands then an anterior approach is also needed which involves a further small incision under the chin to sew the platysma muscle bands together. This is called a platysmaplasty . If necessary some liposuction can be carried out at the same time to improve the contour of the neck and occasionally a deeper layer of fat beneath the platysma muscle is also removed before the platysmaplasty is performed since this sharpens the angle between the neck and the chin.
There is a space under the skin which can sometimes accumulate fluid and hence a drain is sometimes needed. This is a tube which lies under the skin and comes out from under the skin to be connected to a small plastic bottle. This is removed the next day after surgery.
After the deeper tissues have been tightened, the excess loose skin is trimmed away and the skin is sutured very carefully around the ear with very delicate stitches. If an incision has been made under the chin this is also closed with delicate stitches. A dressing will be applied to produce some gentle compression in the few hours after surgery.
What additional procedures can be carried out at the same time as the neck lift ?
Since the incision for a necklift is similar to a facelift, the procedure is usually carried out with some degree of work to the jawline by way of a facelift to improve the facial contour. You can read more about facelift surgery in the facelift sections of this website. In addition some patients may decide to undergo any combination of procedures which can include an upper and lower blepharoplasty and a browlift.
What anaesthetic is required ?
A necklift is usually performed under general anaesthetic. There will be some clinics heavily promoting local anaesthetic procedures but this is usually due to the fact that they have no facility for general anaesthetic, no access to larger fully equipped hospitals and the surgery is routinely being carried out in a very limited manner which will of course limit the results of the rejuvenation. Furthermore there are many minimally invasive procedures which are promoted by many clinics using threadlift techniques which are performed under local anaesthetic. These are not as effective as a surgical necklift, the results may be shortlived and the other benefits of removing fat and improving the jawline will not be achieved.
The recovery following a necklift
It is advisable to stay the night in our London hospital. A dressing which is applied around the face and neck is removed the next morning. Your hair will then be carefully washed by the nurses. When you return home it is important to sleep upright for the first few days and to be careful not to lift heavy objects and to avoid stooping. Taking it gently will reduce the swelling and bruising. The degree of bruising is variable. If liposuction has been required under the chin the bruising tends to be more noticeable. Any visible bruising subsides by the end of two weeks. You can cover with make up provided you keep away from any stitch lines.
The stitches are removed at 5 – 7 days after which you should generally feel quite comfortable. Many patients experience a tight feeling across the neck but usually there is very little or no pain from this operation. Any mild discomfort is easily controlled with painkillers.
After 2 weeks it is acceptable to return to work but there will still be some very minor swelling which takes another 3 to 4 weeks to completely settle. However, during this stage it should not be overtly visible that you have had surgery. It is best to refrain from heavy exercise for approximately six weeks post surgery.
There can be some minor thickenings in the neck which can temporarily feel like minor bumps under the skin . These areas will gradually soften over a period of a few weeks.
The best results are seen at approximately 3 months by which time the tissues have settled. However, the skin can feel somewhat numb and it can take a few months for the full sensation to return.
The risks of necklift surgery?
There is generally a low incidence of risks following necklift surgery.
The risks of this operation are higher in smokers and if you smoke it is important to completely stop several weeks prior to surgery. If you are a heavy smoker and you cannot stop smoking you will be unsuitable for surgery.
Infection is a risk but you will be given prophylactic antibiotics which means that this situation is very rare.
Bleeding is a risk which can result in a situation called a haematoma . This is a swelling under the skin which will mean a return to the operating room to remove the swelling and stop any bleeding point. It is not life threatening and will not compromise the result of the surgery. However, there can be a little more bruising during the recovery phase. This situation occurs in about 2 – 3% pf patients and if it occurs it will be identified during the first night in hospital.
The skin will lose its sensation but this gradually returns over a period of a few months. During this recovery phase there may be some minor symptoms like pins and needles or some itching. This is nothing to be worried about and is part of the normal recovery.
Delayed healing of the skin can rarely occur adjacent to the scars. This results in a thick leathery scab which will take some time to separate and heal. It can mean the scar may be thicker than usual and may need further minor intervention to improve the quality of scar. This is more common in smokers and therefore it is imperative you do not smoke prior to surgery.
Damage to the facial nerve is extremely rare during facelift and necklift surgery but needs to be mentioned.
Minor hair loss can occur around the scars which cross into the hairline but usually this is temporary with permanent hairloss being very rare indeed.