What Is a Platysmaplasty:
If the eyes are the first place we begin to show our age, then the neck is arguably the second. Vertical banding, horizontal creases, fatty jowls, the dreaded “turkey-wattle,” and a crepe-y quality to the skin all work together to make us look much older before our time. A neck lift (or platysmaplasty, so named for the plastysma muscles which run along the front of the neck) tightens the skin and the underlying muscles to lift the neck as well as improve and sharpen the contour of the jawline. It is often performed in conjunction with a face lift, but may also be done as a stand-alone procedure.
Who Is a Good Candidate:
The best candidates for a neck lift are non-smokers who are in generally good health and who have a positive outlook and realistic expectations about outcome. Sagging of the neck may be due to age, but may also be a result of significant weight loss or simple heredity. Those who have sagging and/or wrinkling of the neck and a loss of separation between the neck and the chin or jaw can benefit from a neck lift procedure.
Your surgeon will almost certainly order some type of lab tests to confirm your health status before operating. He or she may also require that you adjust, cease, or begin taking certain medications in the week or two before your surgery. It is also very important that you avoid aspirin, many anti-inflammatory drugs, and herbal supplements, in the 2 weeks prior to surgery, as all of these can increase bleeding. Talk to your surgeon about everything you may be taking.
Most neck lifts are performed on an out-patient basis. After surgery, your surgeon will place a pressure dressing that will wrap around your head and underneath your chin. Your neck will feel tight and sore as the anesthesia wears off, and may show even more swelling and possible bruising over the next 3 days. Dressings may be removed after just a few days, but your sutures will remain in place for 7-10 days.
Recovery & Downtime:
Most patients can return to non-strenuous work after 5-10 days. However, for the first several weeks after surgery, you should avoid bending over, lifting heavy objects, and even turning your head from side to side. You will also have to sleep with your head elevated for one or two weeks. These guidelines can vary widely based on the patient’s personal health, the techniques used, and other variables. Always follow your surgeon’s recommendations.
Risks & Complications:
Risks and possible complications include: unfavorable scarring, excessive bleeding or hematoma, skin loss (tissue death), blood clots, numbness or other changes in sensation or intense itching, anesthesia risks, skin discoloration, persistent edema (swelling), skin contour irregularities, skin discoloration and swelling, recurrent looseness of skin, unsatisfactory aesthetic results, and the need for additional surgery.
After surgery, call your surgeon immediately if any of the following occur: chest pain, shortness of breath, unusual heartbeats, excessive bleeding.
The average total cost for a neck lift is between $3,000-$7,000, although fees can range from $2,000 to $8,000, depending in large part on the geographical area. Some surgeons automatically include the cost of submental (under the chin) liposuction with their fees for a neck lift, so be sure to ask if this is the case. Keep in mind that these estimates do not include the cost of a face lift, and it may be determined that is what is needed to give you the best result. Total costs include your surgeon’s fee, anesthesia fees, facility fees, lab fees, and medications.
Neck lift surgery is often done in conjunction with other surgeries to enhance the patient’s results. These procedures can include a face lift to correct sagging of the mid and lower face, a brow lift or eyelid lift to correct "tired" looking eyes, a chin or jaw implant or liposuction under the chin to improve the contour of the jawline, or skin resurfacing procedures (i.e., laser resurfacing or chemical peels) to improve the overall look and feel of the skin. Results may also be enhanced through the use of Botox injections, or non-surgical skin tightening using lasers or radio-frequency technology.
How It’s Done:
Anesthesia is administered. Neck lift surgery can be performed either under IV sedation or general anesthesia. For a very minimal lift, your surgeon may even determine that regional anesthesia or a combination of an oral sedative and local anesthetic[/link may be sufficient.
Incisions are made. The traditional neck lift incision begins in front of the ear lobe and loops under and behind the ear ending in the scalp towards the back of the neck. If the platysma muscles will also be tightened, there may be an additional small incision under the chin. However, newer and more specialized procedures may involve an incision only inside the hairline at the back of the neck (known as a posterior neck lift), or behind the ear only (for some suspension techniques), depending on the techniques used and the degree of lifting required.
- Platysma muscles are tightened. In an aging face, the platysma muscles often separate, creating a loss of support for the skin as well as a tendency toward a vertical “banded” appearance of the neck. Using sutures, these muscles are sewn back together in the center, using a technique that looks similar to lacing up a corset. It is also possible that a small piece of this muscle will be removed, and that some laser-assisted tightening may be used on the under-side of the deeper layers of the skin.
- Excess skin is removed. Excess skin is carefully trimmed away.
- Tissue and skin are repositioned and secured. In the case of a suspension lift, the surgeon will use some sort of sutures, mesh, or other materials in the deeper layers of the skin and muscles in order to create a sort of “hammock” to suspend and hold the tissues in their new, higher position.
- Incisions are closed and bandaged. Using a multi-layer suturing technique, the surgeon closes the incisions. If needed, drains will be placed at this time before bandaging the wounds.
Facelift (Rhytidectomy), Consumer Information Sheet, American Society of Plastic Surgeons, http://www.plasticsurgery.org/patients_consumers/procedures/Rhytidectomy.cfm?CFID=99551460&CFTOKEN=38788821
Laser Neck And Jowl Liposculpture Including Platysma Laser Resurfacing, Dermal Laser Resurfacing, And Vaporization Of Subcutaneous Fat, Dermatologic surgery, 1997, vol. 23, pp. 1143-1148, COOK W. R., Coronado Skin Medical Center, Inc., Coronado, California
The Aging Neck, Grand Rounds, Dept Of Otolaryngology UTMB, October 8, 1997 Carl Schreiner, MD, Byron Bailey, MD, Francis B. Quinn, Jr. MD