One of the main reasons to consider facial surgery is to improve your neck. I often hear a woman bemoan the fact that she now has her mother’s neck or that she wants to have surgery specifically so that she can avoid that fate! “Get rid of my turkey waddle,” patients exclaim! Men avoid neckties (they also do this because they believe that a necktie resembles a hangman’s noose) because it accentuates their aging neck.

What do necks need to have done to restore their beauty? One or more of the following is usually required:

1. Smooth the skin wrinkles.
2. Remove the excess fat.
3. Eliminate the muscle bands.
4. Tighten the loose skin.

1. Skin wrinkles are not eliminated by surgery. The analogy of a crumpled sheet of paper is helpful. It doesn’t matter how tightly the paper is pulled, the wrinkles will not go away. The same holds true of the neck. A neck lift with its pull will not remove the wrinkles. A light chemical peel, Thermage, Fraxel Laser, and the Titan Laser may all help. These can be done several months following a neck lift if wrinkles remain a problem.

2. Fat removal alone can be done by liposuction surgery and often under local anesthesia. There are several things to remember, though:

• Someone with a fat neck may have fat deep inside the neck and this may be best treated with weight loss. Although fat just beneath the muscle bands can be trimmed during a neck lift, the deeper fat cannot.
• After liposuction loose skin may be a problem. For this reason liposuction alone works best for those patients with good skin tone. If loose skin is present, it will need to be surgically tightened for the best result.
• Proponents of laser assisted liposuction of the neck claim that you can get tightening of the skin at the same time as liposuction of the fat. I have not found this skin tightening to be very impressive. In my opinion, a much better result comes with surgical lifting.

3. In many patients muscle bands appear as two cords located on one or both sides of the front of the neck. When a person tenses their neck muscles, these muscle bands will stand out. If these are noticeable, I believe the best way to handle them is to sew the bands together, a procedure called a platysmaplasty. This may even be done without a full neck lift. It is tempting to believe that this procedure is reconnecting the muscles that were once joined together in your youth. Studies have shown, though, that most patients have muscle bands that have always been separated, they just don’t show up until a person ages and the muscles begin to droop. An alternative treatment is to inject them with Botox and make them less noticeable, but this must be repeated every 3 months to maintain the look.

4. Tightening of the loose skin requires a lifting procedure. If the skin is minimally loose, a MACS-Lift may work. For looser skin, a full neck lift is required. All of these lifting operations require surgical incisions around the ears that are at times almost invisible. A 1½ – 2 week recovery is required.

In some cases, other procedures may be helpful. Please give my office a call at 800-837-7795 to make an appointment or email us to discuss your individual situation.