With massive weight loss comes total body changes with many areas of loose hanging skin and fat. The neck , more than any other part of the face, suffers a similar fate with the development of a loose and low hanging waddle in some weight loss patients. This neck waddle (turkey neck) is not usually on the top of most patient’s priorities and is rarely one of the first plastic surgery procedures massive weight loss patients undergo. However, it is the most visible and to those most severely afflicted, an area of concern for sure.
Neck waddles are treated through a full facelift procedure. As many patients do not understand what a facelift is, and it is somewhat of a misleading name, it should more accurately be called a neck-jowl lift. Or in the weight loss patient, a neck lift. Using well placed and often hidden incisions around the ear, the neck and loose facial skin is worked out backwards toward the ear. As the loose neck skin moves up and back (and removed and closed around the ears), a better defined shape to the neck is seen. This is what a facelift is…..a neck procedure and a neck procedure only. It does nothing for the rest of the face. More complete facial changes require other procedures often done at the same time as a facelift, which creates the common misconception that it is a full facial operation from the scalp down to the neck.
While necklifts are tremendously effective, the amount of loose neck skin and its loss of elasticity make for a realistic appreciation of what can be achieved. Most weight loss patient necklifts will not get a perfectly sharp neck angle. Many such patients never had a very chiseled neck to begin with. Only so much neck skin can be lifted and tightened. Also, because the skin has lost a lot of its elasticity, there will be some rebound relaxation in the months after surgery. Have no fear it is not going to return to where it started but the very tight feel right after a necklift will relax a little bit and it will not be quite as tight 6 months or a year later.
Necklifts (facelifts) are surprisingly easier to go through than most people think. Most of the neck and face skin is numb so there really is very little discomfort after. When the necklift is done by itself, all swelling and bruising is low in the neck area so the eyes and face continue to look the same after surgery as before. Recovery after a necklift is really social (How do I look?) rather than physical. (how do I feel?)
Dr. Barry Eppley