While there are many changes that occur in the face as we age, one of the most bothersome to many patients is the changes that occur in the neck. Progessive fullness of the neck, loose sagging skin, the development of vertical banding, the numerous horizontal wrinkles that appear low in the neck and the loss of a good sharp neck angle all capture the eye of the patient and others as well. These neck changes rank right up there with aging around the eyes as the most concerning facial aging concerns to most patients.
Like the rest of medicine, it is important to determine what the anatomic problems are in the neck to match up the best operation to improve it. Younger patients often just have some beginning neck fullness and a little bit of jowling. Simple liposuction and a little jowl tuck-up may be all that is needed in these younger patients. In some of these cases, I have used LipoDissolve injections alone and have gotten a good result if the patient can tolerate the temporary swelling that comes after eacj injection session and the 3 to 4 months to get the final result. Older patients usually have more sagging and loose skin and something like a more extended facelift (neck-jowl lift) is more appropriate. This is where sitting down with your plastic surgeon and going over your concerns with the aid of a mirror is so important. The selection of which operation is best for you will depend on a good understanding on your part of what do you want to see changed and what are you willing to go through to get it.
The aging neck in the male poses some different issues. They often have more skin excess and the facelift incisions that are used in females have to be altered to account for the male beard pattern. In addition, males have a much greater tendency towards some relapse after facelift surgery due to their thicker and heavier skin. Men also have a much greater aversion to major facelift surgery and may opt for an alternative procedure known as a direct neck lift. This procedure dramatically reshapes the neck and can produce a very sharp neck angle…but at the cost of a midline neck scar from below the chin down to the adam’s apple. For some older men this may be a good trade-off and this scar usually turns out fairly well due to how better hair-bearing skin heals scars.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
In looking at the latest plastic surgery statistics listed in the Plastic Surgery News, the single procedure with the greatest area of growth was that of facelifts. The statistics show that nearly 116,200 facelifts were performed on patients age 40 or older in 2007, an increase of 14% over 2006. On the one hand, that statistic seems surprising given all of the non-invasive or minimally invasive procedures which are currehtly touted. On the other hand, I am not surprised as I have seen a similar increase in my own practice.
I think what is being ‘discovered’ is that the minimally invasive procedures have sparked more interest in facial rejuvenation for sure. But when patients come in for a consult, what they often find out is that the best value (what do I get for what I am paying) comes from a facelift-type procedure. The facelift may be combined with other things such as chemical peels, laser resurfacing, Botox, and injectable fillers, but the cornerstone of improvement comes from ‘traditional’ lifting and removing excess skin. A tightening and plumping approach if you will.
Also, what the statistics do not report is what type of facelifts are being performed. My guess would be that much of the increase is in the more limited or mini-facelifts that are so popular today. For patients in their 40s, a limited facelift can be a very quick and effective procedure that will stave off the need for a full facelift and more extensive facial rejuvenation procedures until a much later date…or maybe thet might never be needed at all if smaller procedures are done earlier and with some frequency over time.
Dr. Barry Eppley
http://www.eppleypalsticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
One of the common sequelae in the massive weight loss patient after bariatric surgery is the devlopment of a very saggy neck. What was once a very full neck for some patients becomes a hanging waddle after bariatric surgery for some. Unlike many of the body changes after bariatric surgery, the development of a sagging neck does not occur in everyone. For many, the loose skin in the neck is not a top priority over many other body areas such as the arms, abdomen, buttocks, and thighs. Often addressing the neck problem is done done until a second or third stage bariatric plastic surgery correction.
When it is important, the saggy bariatic neck can be dealt with through a very conventional approach. The typical full facelift (a facelift is a necklift….it does nothing for the face above the jowls unless other procedures are done with it), with the incisions in front and behind the ear, can lift and tighten a large amount of jowl and neck skin. When the excess is considerable, a perfectly sharp neck angle is not possible to obtain. In some rare patients, I have dealt with the neck skin by cutting it out directly (known as a direct neck lift). This is less of a procedure to go through but does leave a scar running down the middle of the neck from the chin to the adam’s apple. While many of these sscar can look quite good, you have to be prepared to bear with the scar as it goes through its maturing phases over many months. This type of scar always looks much better on men than it does in women.
Either way, a facelift or a direct neck lift are relatively easy to go through. There is virtually no pain, and much less swelling and bruising that you would think. I only keep my patients in a neck dressing for one day after surgery. Even with some swelling and bruising, the appearance is less full than before surgery. Do not confuse an isolated facelift or direct necklift with images you have seen on TV or the internet where patients are swollen and bandaged from the top of their heads to the neck. These patients are getting other facial procedures as well as perhaps including eyelifts, browlifts, nosejobs, etc. which causes a lot of mid- and upper facial swelling.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
The sagging jawline is one of the first signs of sigificant facial aging. Occurring somewhere in the early to late 40s, the development of jowling begins which may be accompanied by looser skin in the neck and loss of the once-sharp neck angle. In seeing a lot of these early aging patients, they often are initially interested in non-surgical procedures such as threadlifts or device skin tightening. Their belief is that these non-invasive procedures will produce a good result but will not involve any ‘downtime’…..and are relatively inexpensive. At the very least, they definitely want to avoid something radical such as a ‘facelift’.
While most of these early facial aging patients don’t need a full facelift, they are completely unaware of the more limited facelifts options and that significant downtime is not needed. I find most patients don’t even have a good concept of what a facelift is and are under the misconception that it is a ‘full face’ procedure going from the top of the head down to the bottom of the neck with a month for recovery. And, they certainly don’t want that ‘operated look’. These patients require a good education as to a facelift, aka neck-jowl lift, is….which makes transitioning the discussion into the limited facelift options more understandable and appealing. From both a result and value perspective, limited facelifts are definitely superior to threadlifts or any form of external, non-surgical skin tightening.
The limited facelift goes by a lot of different names such as a mini-facelift, S-lift, Quicklift, Swiftlift, EpiLift, etc. Despite the different names, the procedure is largely the same. It consists of neck liposuction in most cases combined with skin excision and tightening in front of the ear and some deeper tissue tightening. Given that the neck is not widely undermined, and often not undermined at all, the procedure is associated with less than one week of swelling and bruising. I find most of my patients truly look good in a week. Close inspection will reveal the incision into and out of the ear but it is not all that easy to see. The procedure does a beautiful job of lifting the jowl area, and when liposuction is done in the neck, some real neck changes can be seen as well. The limited facelift can be combined with many other less invasive procedures such as Botox, injectable fillers, and light laser skin resurfacing to enhance the overall effect. Much is made of being able to do this procedure under local anesthesia, but I prefer to do it under a general anesthesia. That enables the patient to be ideally comfortable and the procedure is done in a time-efficient manner.
The limited facelift was a procedure first introduced in the early 1900s and was used then because it was limited and surgery was very primtive at that time. The limited facelift is used today because it is a perfect match for early facial aging when more extensive procedures are not warranted or desired.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
