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Neck Lift - Platysmaplasty Surgery

 

                                          

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The neck area is subject to a variety of conditions - including a patient being overweight.  This condition can cause the neck to appear thick or show a significant amount of fat in the jaw-line.  As we age, the skin on the neck droops and make the jaw-line hang. The skin on the neck is thinner and more delicate than on other areas of the body, making it more prone to damage. Over time, gravity takes it toll on the neck, causing wrinkles and sagging.

Some surgeons like to perform a lower face lift at the same time as the neck lift, especially if there is excess skin that needs to be excised.  Excess tissue needs to be trimmed and tailored around the ear without forming a pleat.  Excess skin can make a neck look aged  - but an early recurrence of the neck folds after a rhytidectomy or a face lift is the result of not having the platysma muscle in the neck tightened adequately.

The throat and the under the chin area is covered by the platysma muscle.  As we age - the platysma  muscle splits into two parts, one on either side of the midline.  The platysma muscle is what creates the neck contour.  As the free edge of the muscle sags - it can create the "turkey gobbler" appearance, which will contribute to an aged appearance. 

If muscle bands on the neck are visible, then this means that the platysma muscle is not connected in the middle and the bands you are seeing are the edges of the muscle.  During a platysmaplasty - excess fat is removed and the muscles are sewn together in the middle like the way a corset would be tightened.  If the skin on the neck is wrinkly and weak then the additional incisions for a full neck lift is made behind the ear to pull up - remove and tighten the skin.

A true "neck lift" will include a platysmaplasty or tightening of the strap muscles- this corrects the banding and leaves a softer and a flatter neck on profile. 

 

A neck lift may entail:

  • liposuction - this is for patients who have good elasticity - and only fat to correct

  • cervicoplasty - extreme loose skin and muscles - poor elasticity

  • platysmaplasty - remove or tighten neck muscles - process gets rid of unwanted band lines

 

Typically, a neck lift will include the removal of fat. Cervicoplasty may be included to tighten excess skin, and platysmaplasty to remove or tighten neck muscles, a process that gets rid of unwanted band lines.

 

 

 

 

Types of Neck Lifts

Liposuction is to remove excess fat in the neck area in order to give this area a neck lift.  A incision is  made below the chin to remove the excess fat depositions. This is done like a typical liposuction procedure, where a cannula is used beneath the skin in order to remove the fatty deposits. The cannula is used specifically to break up the fat and to remove it from the neck area. 

 

                                    

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A bandage and tape is applied to the areas where the incisions were made to help reduce swelling and discomfort.  Finally, a compression elastic bandage is applied to the neck and head area in which this will have to be worn for several weeks after the surgery.

 

                                                                              

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                                                        Liposuction Neck Lift

                                                                  

 

 

 

This procedure is primarily used to remove excess skin and tissue on the neck area.  A incision is made under the chin and behind the ears.  The surgeon will cut back and lift the skin which will be secured with either permanent sutures or special type of surgical tissue glue. The excess skin is trimmed away and then lift skin ends, suturing them into place near the incision point to create a firmer, more toned appearing chin and neck line.

The Cervicoplasty can be completed in about two or four hours, depending on the complexity of the procedure.

A bandage and tape is applied to the areas where the incisions were made to help reduce swelling and discomfort.  Finally, a compression elastic bandage is applied to the neck and head area in which this will have to be worn for several weeks after the surgery.

Recovery from a Cervicoplasty entails swelling and bruising in the areas of the neck, ears, and jaw for several days.

 

 

 

This procedure is performed to reduce the "banded appearance" of the neck area.  A incision is made under the chin like the cervicoplasty or behind the ears or both.  The plastic surgeon will insert an endoscope (instrument with a small camera on the end) to either remove or realign portions of specific neck muscles. This procedure tightens the middle area of the neck.  The surgeon will use permanent sutures in the areas of the muscles to position them in the proper area. 

A bandage and tape is applied to the areas where the incisions were made to help reduce swelling and discomfort.  Finally, a compression elastic bandage is applied to the neck and head area in which this will have to be worn for several weeks after the surgery.

 

 

 

Most surgeons feel that a properly performed neck lift is the foundation for an excellent rhytidetectomy (face lift) result.  Performing a corset platysmaplasty could possibly be more important than the choice of the type of face lift that will be planned.

A corset platysmaplasty sews together the free edge of platysma muscle under the chin to create a small hammock or sling which supports the flat area under the chin and creates a neck/chin angle (cervicomental angle).

The advantage of a corset platysmaplasty is that it helps prevent falling neck lifts, recurrence of neck muscle bands, pixie ears, and thickened scars behind the ear.  Some surgeons believe that trying to perform a neck lift by tacking the back edge of the platysma muscle behind the ear with performing a corset platysmaplasty could potentially be a contributing factor in the failure of a neck lift.
 

 

How a Corset Platysmaplasty is performed:

                 

     Image Credit:  Rejuvenation of the Aging Neck, Sykes, JM, Facial plast Surg 2001; 17: 099-108, Thieme-connect.
 

 

 

 

 

This method is slightly different that liposuction under the chin. The submentoplasty involves an incision located under the chin (similar to the liposuction method) - however, it is about 1/2" to 3/4" long in order to see the muscle bands. The plastic surgeon will sew these bands together in a corset platysmaplasty, giving the neck and nice profile and angle. The neck muscles are tightened with a combination of either liposuction and or muscle tightening.

  • A mini neck lift is a procedure that is limited to younger patients who have better elasticity of the skin, since there is no skin that is removed. This method allows the skin to shrink back to the new shape of the neck. 

  • A mini neck lift is limited to those patients approximately 45 years and younger - and the patients are normally near their ideal or target weight. 

  • Patients normally wear a compression garment during recovery for several days after the surgical procedure.

 

 

 

 

Sometimes patients who have had one neck lift might need a revision procedure because of either complications that happened with the first surgery or they need more liposuction done to get the aesthetic look they are after. A mini neck lift or submentoplasty is indicated for these patients.

A submental tuck-up or modified submentoplasty can involve one of three tissues:

  • Repeat liposuction only for re-accumulation or resettling of an asymmetrical area of fatty tissue in the sub-mandibular or submental area 

  • Skin re-draping due to rebound relaxation of the skin itself, premature loss of elasticity, or rippling in the skin texture itself. This is often caused by or aggravated if the patient has had a seroma in the early postoperative period

  • Platysma band correction that may involve repeating the procedure and undermining with re-draping of the skin 

 

 

 

  • FAST FACTS on Mini Neck Lifts

Candidates for Surgery:  a mini-neck lift or a limited incision neck lift is an excellent procedure for those whose aging is primarily isolated to the neck and have relatively good skin tone.

Procedure: Via a small incision under the chin excess fat is removed, muscles tightened, and soft tissue sculpted to improve neck contour.

Surgical Time: 1 1/2 to 2 hours

Anesthesia: Local with IV sedation, General Anesthesia

Recovery: 10 days to 2 weeks for acceptable appearance

Risks: Infection, bleeding, and contour irregularities have been reported.

 

 

 

 

A neck lift can improve the appearance of the neck area by creating more definition in the angle of the jaw line.  Patients who are candidates for a neck lift are between the ages of 18 years to 70 years of age. 

A neck lift will improve these cosmetic problems:

  • "Turkey Neck"

  • Excess fat and or skin in the neck area

  • Retrognathia - where the jaw recedes and makes it look as if the person has no chin or jaw-line.
     

Good Candidates for Neck Lift:

  • Loss of sharp neck angle

  • Loss of jaw definition

  • Double chin

  • Lax neck skin

  • Neck appears shorter and older than it used to be

 

Neck lift surgery is a good option for you if:

  • Patient is physically healthy

  • Psychologically stable

  • Patient does not smoke

  • Patient has a positive outlook and specific, but realistic goals in mind for the improvement of the appearance of the neck

 

 

 

 

The goal of having a neck lift procedure it to obtain a more attractive neck. 

The Benefits of a Neck Lift will give:

  • tighter appearance to lax skin and wrinkles within the neck

  • firmer appearance to the skin

  • younger looking skin

  • re-creation of the sharp neck (cervico-mental) angle

  • reduction or elimination of turkey neck banding in neck

  • defining the jaw line

  • correction of double or triple chin

  • creating a longer more elegant appearing neck

  • scar placement is done completely behind the ear

A neck lift is one of the most common age-erasing procedures done today - with it being able to correct sagging neck skin, muscles and excess fat.  A neck lift can restore a more youthful contour and definition.

 

In youth, the cervico-mental angle is very sharp - resembling a 90 degree angle. As one ages or gains weight, this angle becomes flatter for various reasons. With aging, both the skin and the muscles become lax. The muscle can form cords that draped down from the chin giving the characteristic "turkey neck" appearance.

 

 

 

 

 

 

 

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