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, an absence of loose muscle bands, 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.
Neck bands are popularly termed as “turkey neck”. They consist of vertical bands of skin and muscle running from the lower jaw down to the collar bone. This frequently occurs at the front of the neck and is a conspicuous sign of facial and neck aging. The bands tent the neck skin and cause contour irregularities that are not seen in the youthful, aesthetic neck. Platysmal bands also obscure the normally well-defined and acute angle between the chin and the neck. This chin-neck angle becomes increasingly obtuse with age, in contrast with the acute angle observed in youth.
Platysmal bands occur due to a few concurrent processes with age: thinning and laxity of the neck skin, loss of the subcutaneous fat, and age-related separation of the two halves of the neck platysma muscle.
After the third decade of life, the skin becomes thinner and less elastic due to reduced production of elastin and collagen fibers. Changes in adipocyte (fat storage cell) netabolism results in loss of fat volume and thickness. The soft tissue layer overlying the platysma muscle and the action of the muscle becomes more prominent. The inner edges of the separated platysma muscle become prominent and manifest as neck bands.
The optimal treatment for neck bands depends on their severity, the individual anatomy and treatment goals. There are two options for the treatment of neck bands: botulinum toxin injection and neck lift. Successful neck band treatment reverses these aging changes and improves self-confidence and social functioning.
Botulinum toxin reliably reduces neck bands by partial weakening of the platysma muscle of the neck and a high degree of satisfaction is achieved in most cases. The popularity of botulinum toxin injection has grown rapidly since the 1990s, and it is now one of the most commonly administered procedures in the world. A detailed explanation of botulinum toxin treatments may be found here.
Individuals with early neck bands and with minimal skin laxity may consider botulinum toxin injection.
Botulinum toxin causes partial weakening of the platysma muscle that is involved in the formation of neck bands. The platysma muscle lies close to the muscles for speech and swallowing. Injection of neck bands is a delicate art balancing the desire to remove the creases whilst avoiding weakness of speech and swallowing.
The effects of botulinum toxin generally take 1 to 3 days to be observed, and will last for 4 to 6 months. Repeat treatments are necessary for maintenance of the result.
Individuals are advised to avoid vigorous massage to the treatment area for 2 hours following the injection. This is to prevent spread of the botulinum toxin, which may result in potential unintended adjacent muscle paralysis. Individuals may resume their usual activities immediately 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. Platysma (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, repairs the muscle separation that gives rise to the neck bands, 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. Successful outcomes are attained in most cases and individuals experience improved body image, self-confidence and social functioning.
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 neck bands are 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. The platysma muscle, which becomes gradually separated with age, is stitched together to form a strong sling. This sling corrects the neck bands and restores the acute chin-neck angle of youth. Other findings such as the double-chin deformity (excess neck fat), or enlarged salivary glands may be removed. The incision is closed meticulously to deliver optimal postoperative outcomes. The face lift and neck lift are often performed together for simultaneous and synergistic improvement.
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.