The topic of neck rejuvenation requires a discussion of skin rejuvenation, liposuction, facelift surgery, and direct skin excisions. Age related changes in the neck occur simultaneously with the age related changes in the face. These changes include sun damage to the skin, accumulation of excess fat and skin, and the formation of vertical bands. There is no absolute predictable pattern to how a neck will age and is intensely affected by an individual’s anatomy, genetics, diet and exercise patterns, and sun exposure. As such, there is no single way to address a patient’s concerns and a rejuvenation plan must be tailored to a patient’s specific issues.
As with any area of skin, the neck skin accumulates sun damage over years. The skin of the neck is thinner than the skin of the face and is more prone to complications with aggressive rejuvenation procedures such as phenol peels and traditional CO2 laser resurfacing. In general, the goal of laser skin rejuvenation is to be as aggressive as the tissue allows while balancing results with safety. Although most laser companies do not recommend the use of ablative lasers on the neck, clinicians routinely use laser rejuvenation therapies with excellent outcomes. A critical element to good outcomes is to use lower settings on the resurfacing laser or less aggressive chemical peel than in the face.
Many patients believe they are good candidates for liposuction as a sole rejuvenation procedure. In fact, the opposite is true, only a select few individuals are candidates for liposuction in isolation. As we age the skin loses elasticity and subsequently its ability to contract. The ideal candidate for neck liposuction is someone in their 20’s or 30’s with minimal sun damage or excess skin. These individuals usually have skin that will contract back down following liposuction with good results. Once sun damage has occurred and excess skin has accumulated, removal of skin becomes necessary. Excellent liposuction techniques are also critical for great results.
Most patients in their 40’s and 50’s have enough sun damage and excess skin to require removal. There are two primary ways to address this issue. The first is with a facelift or neck lift. An abbreviated mini facelift incision can be used. The neck skin is removed from the portion of the incision placed behind the ear. Some surgeons may offer patients an isolated neck lift procedure using only the portion of the facelift incision behind the ear to avoid more obvious incisions in the neck. Patients must understand that in no way will this address the excess skin and jowling of the face and is performed to avoid placing incision directly in the neck skin. During the facelift or neck lift procedure the vertical bands are addressed by tightening the platysma muscle which acts as a corset for deeper neck fat that protrudes as we age. The second way to address the excess skin of the neck is with a direct neck lift using a direct skin excision technique such as the Grecian Urn or another such procedures. It is offered as a primary procedure almost exclusively in men. Sometimes residual skin following a face or neck lift will be removed with smaller direct neck excision techniques, but in general it is a bad idea in women as a primary procedure because it will leave visible scars. In men, because of their bearded skin, a direct neck excision can be a good alternative to a facelift procedure. During a direct neck excision, the vertical bands should be addressed by tightening the underlying platysma muscle during the skin excision.
Total neck rejuvenation in older patients should include removal of the excess skin by a method the patient and the physician are comfortable with, along with tightening of the platysma muscle and liposuction as indicated. A staged skin rejuvenation procedure may be performed either before or after surgery to complete the rejuvenation. Consultation with a knowledgeable and skilled facial plastic surgeon will help avoid bad outcomes and disappointing results.
