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The neck is a visible area of change as one ages. The youthful neck is characterized by a taut neck skin without creases or excess droopy skin, a distinct lower jaw border, good muscle tone, and a well-defined angle between the chin and the neck.
Neck rejuvenation is an essential complement to achieving comprehensive and harmonious facial rejuvenation. A youthful, aesthetic neck imparts the image of an individual who is energetic and in good health.
Loose neck skin and “double chin” often occur synchronously. These commonly manifest in women following childbirth, in older individuals or in individuals who have lost significant weight. The double chin manifests as an additional fat bulge that lies behind the bony chin.
Droopy neck skin presents as excess skin folds that drape downwards and obscures the natural angle between the chin and the neck, which transforms from an acute angle to an obtuse one. These changes significantly add to an individual’s perceived age and may adversely affect the individual’s body image and social functioning.
These changes often arise as a result of pregnancy, advancing age, or significant weight loss. The double chin deformity is due to the protrusion of fat, which arises from the superficial or deep fat layer that lies adjacent to the platysma muscle. With advancing age, the platysma muscle may separate leading to loss of support and protrusion of the deep fat layer. Skin thinning and loss of elasticity occurs with age and is accelerated in smokers, due to the reduced production of elastin and collagen fibres.
Attaining beautiful and bespoke results that retain an individual’s emotional expressivity is frequently possible and requires a combination of appropriate procedure selection, precise execution and an experienced practitioner. There are two possible options for the treatment of droopy neck skin: microfocused ultrasound neck lift, and neck lift surgery.
There is an increasing demand for non-surgical facial rejuvenation and microfocused ultrasound (MFU) has emerged as one of the effective and safe technologies for tightening of the skin and subcutaneous tissues. This is a popularly requested procedure for rejuvenation. The MFU neck lift is an ambulatory procedure performed under local anesethesia and intravenous sedation for optimal effect.
Individuals with early neck skin laxity and good skin quality may consider MFU neck lift. These are usually individuals in their thirties or early forties.
MFU uses microfocused sound waves that generate vibration and heat at specific points in tissue. This creates discrete areas of controlled thermal injury zones at predetermined depths, leaving the surrounding tissue undamaged. At these areas of thermal injury, the collagen contracts and is eventually absorbed by the body, and new collagen production stimulated, resulting in skin renewal. A detailed explanation of MFU treatment may be found here.
Administering effective and safe treatments are the cornerstones of our care delivery philosophy at Picasso Plastic Surgery. Effective MFU treatment requires repeated delivery of high doses of energy, which may sometimes render the treatment slightly painful. Utilizing our detailed knowledge of anatomy, MFU treatments are performed under local anesthesia, with optional intravenous sedation if individuals for maximal comfort. This allows individuals to tolerate higher doses of treatment to obtain a visible clinical effect in a safe and comfortable manner. Individuals who do not receive optimal analgesia often receive suboptimal treatment doses and may attain less satisfactory results. Our clinic uses the Ulthera (Ultherapy) system, which is the most extensively studied MFU device and was approved by the United States Food and Drug Administration in 2009 for non-surgical skin tightening.
The effects of MFU may be observed almost immediately following the procedure. The treated areas undergo recovery, remodeling, continued collagen production, and tightening even after conclusion of the procedure. There is continued improvement up to 3 months post-procedure. In most cases, the effects are sustained for 6 to 9 months, and repeat treatment is required to maintain the result.
There are no wounds and no special post-procedural care is required. Individuals may resume their usual activities following the procedure.
The neck lift is the most comprehensive method of neck rejuvenation. It addresses the multiple causes of neck aging and delivers effective, elegant, and long-lasting results. It addresses many of the processes involved in facial aging that cannot be achieved by non-surgical methods. The scar is well-sited to permit good exposure of the underlying platysma muscle for its tightening and elevation and is well-concealed when healed. SMAS (muscle) tightening is the most important step in achieving natural and long-lasting results seen with this procedure. There is often more significant improvement and long-term expense reduction with neck lift as compared with recurrent treatment with non-surgical therapies. Neck lift is often performed as an ambulatory procedure under intravenous sedation or a short general anesthesia.
The following are good candidates for neck lift:
The neck lift tightens the neck skin and muscle, restores the angle between the neck and the chin, removes excess double-chin fat and restores the appearance of a youthful neck. Depending on the anatomy and the individual’s wishes, neck lift surgery may be performed through an incision behind the chin, or at the posterior hairline, or a combination of both. The scars are well-concealed when healed. The result is elegant and harmonious improvement of the individual’s neck appearance and reduction of the perceived age.
Individuals are advised to stop herbal supplements and traditional medicine and start special medications 7 days prior to surgery to minimize bruising and swelling. Hypertension, if present, should be well-controlled, and smoking needs to be stopped for at least 2 to 4 weeks prior to surgery to minimize the occurrence of complications.
In cases where the double chin is the predominant problem, an incision is performed just behind the chin. The skin and subcutaneous fat is lifted off the underlying platysma muscle after the incision. Excess superficial or deep fat and salivary glands are excised to recreate a smooth chin and neck contour. The platysma muscle, which becomes separated with age, is mobilized and stitched together to form a strong sling. This sling corrects neck bands if present and restores the acute chin-neck angle of youth. The incision is closed meticulously to deliver optimal postoperative outcomes.
In cases where excess neck skin is the predominant problem, an incision is made at the posterior hairline behind the ear and at the neck. This is the continuation of the face lift incision. The face lift and neck lift are often performed together for simultaneous and synergistic improvement. The posterior portion of the platysma muscle is exposed and is tightened, and the excess skin trimmed away. The wounds are closed meticulously for optimal postoperative outcomes.
Stitches are removed on the 5th postoperative day. Mild swelling and bruising is expected, which will mostly resolve by the 14th postoperative day. Most individuals are able to return to work after 1 week.
Neck swelling is improved by lying supine on a neck pillow only (without a head pillow) when sleeping at night for the first 2 to 3 days. Gentle face washing is possible from the second postoperative day onwards. Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed when asleep at night. Strenuous activity should be avoided for the first two weeks to minimize bruising.
