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Dr. Barry Eppley

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Posts Tagged ‘necklift’

Plastic Surgery Case Study – Webbed Neck Correction with Otoplasties

Sunday, March 8th, 2015


Webbed Neck in Turner's SyndromeBackground: The webbed neck deformity is a congenital skin fold disorder that runs along the sides of the neck to the shoulders. Known technically as the pterygium colli deformity, it is known to occur in a large number of medical conditions but the most common are the genetic conditions of Turner’s and Noonan syndrome as well as Klippel-Feil syndrome. At birth there are smaller loose folds of skin on the sides of the neck but with growth the webs expand outward ultimately making it look like there is little to no neck.

Surgical correction of the webbed neck deformity is a very different form of a neck lift. It is challenging because of the thickened fascia that comprises the band and a low hairline that extends down along the webs. The most common surgical techniques are the use of modified Z-plasties. A Z-plasty is placed with the midline arm down the length of the web. The subcutaneous fibrous band is excised, the shortened trapezius muscle is released, and the hair-bearingskin flap is cut out. The anterior skin flap is rotated and advanced to join its mirror image flap from the opposite side of the neck at the posterior midline. Any remaining skin dog-ears near the shoulder are corrected with additional small Z-plasties.

An alternative technique is a purely posterior neck approach using a Butterfly correction technique. In this method, a butterfly-shaped portion of redundant skin is excised posteriorly and the lateral, superior and inferior flaps joined in a double Y midline suture line or even that of an X pattern closure. The Butterfly technique avoids the unnatural hairline and noticeable scars characteristic of a lateral Z-plasty method but does so with often a less than complete correction of the webs.

Case Study: This 9 year-old female who had Turner’s syndrome had large neck webs that completely obscured any visible neck. They extended from behind her ears out to her shoulders She also had protruding ears due to a lack of antihelical folds.

Webbed Neck and Otoplasty Correction resultUnder general anesthesia she underwent an initial Butterfly correction technique for her webbed neck in the prone position. At the same time, otoplasties were performed through postauricular incisions using permanent horizontal mattress sutures to create antihelical folds. Four months later she underwent a second stage webbed neck correction where a large posterior Z-plasty was performed using the previous scars from her first procedure to gain further reduction in the webs and to relocate the low hairline.

She had substantial improvement in her webbed neck and ear deformities. There remained some slight medial neck bands but there were no visible scars. All scars were in the occipital hairline and on the posterior neck.

Case Highlights:

1) Webbed neck deormities are most commonly seen in congenital conditions such as Turner’s syndrome.

2) Traditional webbed neck surgeries use z-plasties along the sides of the neck which can result in visible scarring.

3) A two-stage approach to correction of the webbed neck results in no visible scars along the sides of the neck or shoulders.

Dr. Barry Eppley

Indianapolis, Indiana

Update on the Corset Platysmaplasty Neck Lift

Sunday, November 30th, 2014


The neck is one of the primary reasons that patients present for some form of faciial rejuvenation. It is not rare that such aging patients only wants a ‘necklift’ and not a fuller ‘facelift’, even though they rarely understand the difference between these two procedures or facial rejuvenation concepts. There are a wide variety of neck remodeling procedures that are currently available with vary in their degree of invasiveness and extent of the surgery.

corset platysmaplasty indianapolisIn the December 2014 issue of the journal Plastic and Reconstructive Surgery, an article was published entitled ‘Neck Lift My Way: An Update’. In this paper, a  renowned neck lift expert provides his experience over a 38 year period with over 500 neck lifts done in the past ten years with his techniques. Such an intense experience with one procedure is always worthy of deep consideration to apply to one’s own experience. He reviews eight fundamental features of his learned neck lift techniques based on the original corset platysmaplasty.

A submental incision with open access to the neck was used 93% of the time in his ten year series. The incision was almost always placed directly in the submental skin crease. Electrocautery was used for some of the neck skin flap elevation and all of the defatting and subplatysmal work. Hematomas and seromas were very rare (1% or less) and drains were used occasionally up to a week after surgery. Conversely injury to the marginal mandibular nerve was not rare and occurred to some degree in almost 10% of the cases. It usually resolved by four months after surgery but in some cases took longer.

The management of loose neck skin was managed primarily by lateral excision in the occipital region in most cases. The postauricular incision is extended high up behind the top of the ear and well behind the occipital hairline after being trimmed. There are still some cases in which no skin is removed but this requires a patient with good skin tone with little means to camouflage a scar behind the ear.

Subplatysmal fat extraction was performed in most patients in this series. (80%)  The anterior digastric muscles are rarely now sutured or manipulated. If a submandibular gland bulge is present, the superficial lobe of the gland is removed. A corset plastysmaplasty was performed in 90% of the patients running a suture from the chin down to the cricoid and then back up.  (2-0 PDS) A ‘tuckster suture’ is also used running from the fascia behind the ear, towards the midline and then turns back to the ear where it is tied. Its purpose is to help contour the submandibular area.

Many plastic surgeons feel that the best result of any neck lift comes when it is part of an overall facelift to get the best neck and jawline contouring results. The neck lift techniques described and shown in this paper contradict this belief. Clearly, patient education is key to clarify what an independently done neck lift can and can not do as it relates to aging issues above the jawline.

This paper provides a long-term review and technical pearls based on the original ‘corset plastymaplasty’ which was published years ago. The procedure remains somewhat ‘complex’ and time consuming to do but when carefully applied it produces veryt long-lasting and satisfying results.

Dr. Barry Eppley

Indianapolis, Indiana

Options in Contemporary Surgical Neck Rejuvenation

Sunday, December 8th, 2013


The neck, like the face, ages although it does so in a more simplistic fashion. With the neck it is only a matter of loss of the neck angle due to loose skin, fat accumulations and midline muscle separation. But with different degrees of neck aging at different times in life, the type of neck rejuvenation procedure that is needed changes. There are a variety of aesthetic neck procedures which include liposuction, submentoplasty, formal neck lifts (lower facelifts) and direct neck lifts.

Neck Liposuction Dr Barry Eppley IndianapolisThe reduction of neck fat by liposuction works best in younger people (under age 45 or so) who have good skin tone. One of the main principles of liposuction is that skin retraction is needed after fat removal to see its effects. However, in some older people with more loose neck skin that do not want a necklift, some good improvements can be seen with Smartlipo (laser liposuction) which does a good job with skin tightening. Liposuction in the neck must be aggressive (taking fat right off of the underside of the skin) to be most effective.

Submentoplasty Dr Barry Eppley IndianapolisSubmentoplasty is a less well known neck procedure for younger patients (under age 50 or so) that have both excessive neck fat and a loose or separated platysma muscle. Done through a submental incision under the chin, neck fat (above and below the platysma muscle) is done (by liposuction as well as direct fat excision) as well as muscle tightening/plication is done to create a more defined neck angle result. It can be a hard decision to determine who is best served by liposuction alone or whether the platysma muscle should be tightened after subplatysmal fat is removed by direct excision.

Facelift Dr Barry Eppley IndianapolisThe lower facelift or necklift, in the traditional sense, is for patients with more advanced loose neck skin/neck wattles/ turkeynecks (generally age 55 and older)  who need substantial neck skin tightening and resuspension. Most people aren’t that a ‘facelift’ is really a neck-jowl lift or a necklift. These are often interchangeable terms. But the concept of a facelift has changed…from the development and marketing of a limited jowl lift to a full blown extended facelift. Thus facelifts today can now be from as early as age 40 to any advanced age.

Male Direct Necklift Dr Barry Eppley IndianapolisThe most uncommonly performed neck rejuvenation procedure, a direct necklift, is done almost exclusively in older men . (65 years or older) Many older men do not want a formal facelift/necklift for either recovery or hairline concerns. It involves a direct excision of neck skin and fat as well as muscle tightening with the tradeoff of a midline scar. (which usually does quite well in the beard skin of men) Because of scar concerns, direct necklifts are not done in younger patients and rarely in even older women.

Dr. Barry Eppley

Indianapolis, Indiana

The Role of the Chin in Profileplasty

Sunday, July 28th, 2013


It is very common that multiple procedures are done on the face at the same time. Whether it be for anti-aging effects or for reshaping a face, combinations of procedures produce more profound changes. This is because the face is made up of many different parts and making significant changes often requires altering more than one facial area.

The benefits of combination facial surgery are commonly seen in nose and chin surgery. Since the nose and chin make up the dominant structures of one’s facial profile, it is not surprise that the combination of rhinoplasty and chin augmentation have become known as a profileplasty. Profileplasty refers to any cosmetic procedure that would improve the appearance of the profile which is an aesthetic and proportionate relationship of the nose, chin and neck. Thus profileplasty is not just rhinoplasty and chin augmentation, although this is the most common one in the young, but also includes a facelift and chin augmentation which is most common in older patients.

It is easy to understand why rhinoplasty can be so important to profile changes as the nose sits at the center of the face. Even very subtle nose changes can be visually appreciated in the profile view. Lowering of the nasal bridge and reshaping the nasal tip in a large nose or augmenting the dorsal line and increasing tip projection in a smaller/flatter nose not only changes the shape of the nose but one’s profile as well.

Just like the nose the chin has an equal, if not greater, impact on one’s profile than even the nose. This is because the chin sits in the middle of the facial profile between the nose and the chin. Whether it is too small or too big, the chin influences the perception of both the nose and the neck. The nose, however, does not influence the appearance of the neck angle and a necklift does not alter the perception of one’s nose shape.

In many patients the best profile changes come from a change in the lower face. Chin surgery can improve facial proportion, creating a better balance between the upper face (forehead, nose and lips) and the neck. As a well known example, even a well shaped nose can seem larger if the face has a smaller chin. Even if some nose changes are done, the more important procedure might be chin augmentation on improving the appearance of the nose.

Chin surgery is often perceived as an augmentative operation but that is a limited view of the different types of available chin surgery. Chin augmentation historically is seen as an increased in horizontal projection, how much forward position of the chin is needed. While this can be done with either an implant to sit on top of the bone or to move the chin bone itself (sliding genioplasty), they change the shape of the chin differently. A chin implant can improve the horizontal projection of the chin but can do little for increasing the length or vertical height of the chin. Often more vertical height is needed when the chin is significantly short. Unlike a chin implant, a sliding genioplasty can not only bring the chin forward but can lengthen or shorten its vertical height as well.

While chin implants have historically lacked the ability for vertical elongation, new chin implants styles will soon be available that provide concurrent vertical lengthening as well. Rather than sitting completely on the bone, these newer designs sit on the ledge of the chin bone (halfway between the front and under edges of the chin bone) to create their effects.

While sliding genioplasties can lengthen the height of the chin, there are limits as to how much the bone can be moved forward. To keep the back of the moved chin bone in contact with the front edge of the fixed chin bone, the amount of bone advancement is usually limited to 10 to 12 mms. Very short chins often need much more than that to achieve an ideal chin position. In these cases a chin implant can be placed on top of the advanced chin bone (implant overlay) to achieve an additional 3mm to 5mms of further horizontal chin projection.

Chin reduction is not as commonly done for profile changes and has a checkered history. The most common chin reduction method is done as an intraoral burring or shaving of the front edge of the chin bone. While simple, it is rarely effective as no more than a few millimeters of bone is reduced and no change occurs in the soft tissue thickness. Often patients complain of seeing no change after this surgery and may even develop some soft tissue redundancy or sagging afterwards. The use of a reverse sliding genioplasty is also ill-advised as, while it does move the whole chin bone back, it pushes the attached soft tissues into the neck creating an undesired bulge.

The most effective chin reductions are done from a submental (under the chin) approach where the bone can be more dramatically reduced in all dimensions if needed and the excess soft tissues excised  and tightened. (tucked) While this does create a scar under the chin, it can remain imperceptible if its length remains curved to parallel the shape of the jawline and it stays within the confines of a vertical line dropped down from the corners of the mouth.

When considering profileplasty, or even an isolated chin augmentation or reduction procedure, the use of computer imaging is critical. It can not only confirm which procedures are beneficial but, more importantly, the magnitude of those desired changes. A plastic surgeon can never really know what ‘flavor’ of change any patient desires and such imaging helps to establish what that is. While computer imaging is never a guarantee as to how the final result will look, it provides a method of visual communication to help the surgeon not guess as to the patient’s profileplasty goals.

Dr. Barry Eppley

Indianapolis, Indiana

Necklifts for the Younger Patient

Sunday, December 2nd, 2012


While the face in theory ages evenly, one’s concerns about different facial changes is not. Besides the eyes, the neck is a frequent target of aging dissatisfaction. While the neck is composed of various tissues, one wants see is loose and hanging skin. This makes one yearn for the days when the skin between the chin and neck was firm and taut and a more defined neck angle existed. While styles and fashion have changed over the years, a sharp and clean neckline has always been a youthful image.

While the neck has always been a physical disdain of aging, what has changed is the age at which these concerns arise. Turkey necks and wattles are understandable neck concerns, but they represent older patients often in the sixth, seventh and eighth decades of life.  Ever since Nora Ephron’s book ‘I Hate My Neck’ was published, it was like a light bulb when off for many younger people.  Younger people, women and men alike, now appear in the fourth and fifth decades, to do something about their loosening neck skin. The reality is that the publication of the book was merely coincidental to this interest. The wide spread use of Botox and fillers has filled many a plastic surgeon’s office with early aging patients where the opportunity to discuss these concerns can easily happen.

The interest in addressing the earlier changes in neck aging has led to a variety of surgical and non-surgical treatments. A host of energy-driven devices exist for neck tightening, like Exilis and Ultherapy, but these are really bridging therapies until the time comes when one is ready for a more definitive surgical approach. Some fat shrinkage and skin tightening may work well for more minor neck droops, but really significant and and longer-lasting results requires tightening the muscle and skin to resist the never-ending effects of gravity.

Necklifting options today range from under the chin approaches (submental incisions) that use skin tightening caused by fat removal and/or muscle tightening and more traditional approaches (facelift) that use skin shifting and excision by incisions around the ears. Most younger aging neck patients are going to usually benefit by submental approaches and these are of the greatest interest because they are ‘less’ surgery with a quicker recovery. By definition a submental approach involves a small and inconspicuous incision right under the chin. It can be just a few millimeters when only liposuction is used. The heat created by the use of Smartlipo is a reall complement to the any fat removal done. For someone with a full neck but good thick skin, this could be all that is needed to create a better neck contour.

The most unknown necklift is that of the submentoplasty or platysmaplasty. Through a slightly larger submental incision, fat is first removed from under the skin but the cornerstone of the procedure is the muscle tightening. The sagging platysma muscles are sewn either back together or folded onto themselves in an up and down fashion creating an effect like a corset on the waistline. (which is why this procedure is also known as a corset platymaplasty) This shortens the vertical length of the muscle, pulling the neck angle upward  and with that the overlying skin as well. Other muscle innovations create slings from one side of the neck to the other using permanent sutures to create a hammock-like effect with special instrumentation for passing these sutures into the correction position.

While not as common, a few will have a neck problem that is not primarily fat but just loose skin. Skin laxity is a less frequent cause of younger patients but definitely becomes more of an issue as one crosses the half century mark. Loose skin in the neck, if not too severe, is managed by a smaller neck-jowl tuck-up or one of the many variations of short scar or limited facelifts. While less skin is removed than in a traditional facelift, the tightened on both sides of the jawline creates a hammock-like effect across the midline of the neck pulling it tighter.

The revolution in sagging necks is that more and more younger patients are turning to necklifts as stand alone procedures…changing for some the title of their own book ‘I Love My Neck!’

Dr. Barry Eppley

Indianapolis, Indiana

The Scar of the Direct Necklift

Tuesday, March 23rd, 2010

The neck wattle is a common sign of facial aging and often one of the most bothersome. Even in the presence of many other facial changes that occur with time, some patients find the sagging neck to be the first and, sometimes only, area they want addressed. This is particularly seen in older men.

While a facelift is the traditional approach to the neck wattle, there are numerous reasons why some patients do not want to undergo that operation. Cost, recovery, and lack of hair or a good hairline in and around the ear are the most common.

An alternative approach to neck wattle reduction is the direct necklift. While uncommonly done, this operation removes the neck wattle by cutting it out right down the middle of the neck. A small but powerful operation, excess skin and fat are removed and the platysmal separation sewed together…directly. While there are a lot of advantages to the direct neck lift (minimal recovery, short operative time, little to no bruising or swelling), it comes with the trade-off of an unnatural location for the resultant scar. Patients must balance that disadvantage with its other advantages.

To help with that determination, an appreciation of the scar in the direct necklift is critical. The ultimate question is…how does the scar look and is it a bad scar? The scar pattern is really an H-shape that is turned on its side. A small horizontal limb is right under the chin (hidden and is inconsequential), a longer vertical limb that runs between the underside of the chin and a low horizontal skin crease (the scar concern) and a low horizontal scar just under the thyroid cartilage. (adam’s apple, that usually heals imperceptibly in older thin skin)

I have used three types of direct necklift incisional approaches. They differ in how the vertical scar line is placed. The vertical scar can be a straight line, a straight line with a central Z in it (z-plasty), and a running W-pattern. The purpose of the breaking up the straight line with a Z or a lot of W cuts is to prevent scar contracture and tightening at the cervicomental angle. I have seen good scar results with all of them and this probably has a lot to do with patient selection. (older male patients 60 years and up) Currently, I favor the straight line approach for the vertical scar and will usually defer the need for a central z-plasty until later. In some cases, but not all, a hypertrophic scar will develop in the tightest part of the closure (cervicomental angle) with the straight line closure. Depending upon how the closure feels during surgery, a z-plasty may be placed if it is felt to be advantageous and this is usually done in women as opposed to men.

For the well-informed patient, a direct necklift can be a better operation for their neck wattle. The scar does particularly well in men because of their beard skin, daily microdermabrasion treatments that they do (shaving) and the value of a re-established sharp cervicomental angle when wearing shirts. Its value in women lies in its simplicity and minimal recovery, particularly in the face of older age and comproming medical conditions.

Dr. Barry Eppley

Indianapolis, Indiana

The Sternal Notch Tuck-Up: A Low Horizontal Neck Lift

Sunday, February 28th, 2010

As one’s face ages, there is a gradual downward shifting of tissues from the cheek down into the neck area. The combination of time, gravity, and loss of skin’s elasticity and its underlying anchoring ligaments accounts for this inferior movement. Because the jaw (mandible) acts like a ‘fixed fence line’, the falling over of aging tissues creates the appearance of jowling and loss of a once sharp neck-jaw line angle.

But beyond the jawline, other well seen areas are also affected by this tissue migration. Down at the ‘bottom of the well’, the lowest area of the neck can also accumulate excess or rolls of loose skin. These can become particularly evident in patients over 60 years of age and are one of the late signs of facial aging. Just above the sternal notch at the levels of the low end of the thyroid cartilage and across the level of the cricoid cartilages, loose aged skin folds up onto itself extending outward into the sides of the neck. Folds may often hang over into the concave sternal notch area.

While facelift surgery can produce remarkable changes in the central and upper portions of the neck across the jaw line, it does not usually provide significant improvement in the low central neck. This is a simple function of the mechanics of how a facelift works. The greatest impact of tissue movement from a facelift comes from areas closest to where the upward pull is coming from…the ear. As you move further away from the ear, the influence of the pull becomes less. The lowest portions of the central neck are as far as you can get from the ear area and are affected by a facelift little if any at all.

The most powerful procedure to change the bothersome loose rolls of skin in the lower neck is a sternal notch tuck-up or a low horizontal neck lift. Removing skin directly can make a dramatic difference. Using a visible low horizontal neck skin crease that commonly runs across this area, the skin excision uses that line to orient the placement of the final scar. This is a very simple skin excision procedure that often can be done under local anesthesia. There is no swelling, pain and usually little to no bruising afterwards. Dissolveable sutures are placed under the skin so suture removal is not needed.

The sternal notch tuck-up can remove as much as one to two inches of skin which is overlying the low central neck area. This gets rid of that telltale sign of aging which is hard to hide. Even after an excellent facelift result, this area can still not be substantially changed when all the swelling has subsided. Like the appearance of the back of the hands, loose and sagging low neck skin can give away one’s age regardless of how well the jawline and upper face looks.

When should a sternal notch tuck-up be considered? It is a procedure that should not be done at the same time as a facelift. This is not only for vascular and healing considerations but also because a full facelift may well provide enough improvement in this area that the need for it may be unnecessary. It could, however, be done at the same time as a limited or mini-facelift (aka Lifestyle Lift) because neck skin flaps are not raised to any significant degree in this procedure. Liposuction is usually  the only procedure done in the central neck area with this type of facelifting.

Ideally, a sternal notch tuckup is done after a facelift has demonstrated that this area is not adequately improved. The thin aged skin of the lower neck typically heals so well that the scar that is created is negligible.  

Dr. Barry Eppley

Indianapolis, Indiana

The Anatomy of the Aging Neck

Tuesday, April 14th, 2009

When seeing someone considering having a facelift (necklift), I frequently get asked in my Indianapolis plastic surgery practice,  ‘How did my neck get like this?’ They often say it looked just fine until a few years ago and then suddenly it looks like it does now. That question is a good one and understanding why and how a loose and low hanging neck developed helps one appreciate what plastic surgery approaches may or may not work for its improvement.

Three specific anatomic factors contribute to a change in one’s neck profile or angle, skin, fat, and muscle. The skin of our face and neck is held up into place through ligaments that run from the underside of the skin down to the bone. (osteocutaneous ligaments) With aging and gravity, these ligaments loosen and the skin and fat from the side of the face and neck begins to fall. This process is accentuated by a loss of elasticity of the skin due to chronic moisture loss and UV irradiation. Together, loose skin develops in the neck and one begins to see the appearance of jowling.

The muscle component of the problem comes from the midline separation of the platysmal muscle. Running from the collarbones up to the lower edge of the jaw, this large sheet of fairly superficial neck muscle keeps fat and other structures tucked up underneath or close to the jaw. As one ages, this thin muscle separates in the midline from the chin down past the adam’s apple in an inverted V fashion. As the muscle splits, the fat in the center of the neck falls furthering contributing to a lowering of the neck angle. In thick-skinned neck with more fat, the neck angle simply becomes more obtuse. In thin-skinned necks, the edges of the muscle can be seen as commonly observed neck bands.

Understanding how the neck ages helps one understand what to do about it.  The most successful neck treatment strategies (e.g., facelift) deal with all three anatomic problems, removing fat, tightening skin, and putting the muscle back together. This is why more simple, less invasive procedures such as liposuction alone, skin tightening devices, or small tuck-up operations are not very successful at major neck aging issues. Although they can be useful if they are done when the signs of neck aging are just beginning.

Dr. Barry Eppley

Indianapolis, Indiana

The Longevity of Facelift Surgery

Thursday, April 2nd, 2009

Facelift surgery is a considerable investment of emotion and money which usually produces a return that is well worth it. A common question that I frequently hear in my Indianapolis plastic surgery practice is….how long will my facelift results last? This is a very understandable question and one that deserves a good answer.

A facelift operation treats the symptoms of the problem not the actual root cause of aging.  (which no one knows how to stop) As a result, every patient will outlive the results of the surgery. I would argue that is the goal of every facelift patient…to live long enough to outlast the benefits of the surgery. While somewhat humorous, this speaks to the fact that facial aging is a continuous and ongoing process that can not be stopped. Therefore, no one should expect facelift results to be permanent or continue unaffected in the years ahead.

The classic facelift longevity answer is that it may last up to ten years. In many cases, the benefits of a tighter neck and jowls may well still be present this far out from the initial surgery. But there will be changes, a gradual relaxation of the neck and jowl skin. A gradual return of some sagging and loose neck and jowl skin will happen in all patients. This relaxation rate differs amongst patients and it can not be predicted whom will sag faster or slower. Thick heavy skin tends to sag quicker, while thin skin tends to hold up better.

The concept of skin relaxation is important to understand. Often referred to as ‘rebound relaxation’, the very tight neck and jowl area that one has right after surgery will relax somewhat over the first year. This is distressing to some, but it is an inevitable reality. One should not expect the neck skin to remain as tight as it was initially. As the final remnants of swelling goes away months later, small little areas of loose skin or wrinkles may develop in the neck. This is not a failure of the operation, but a manifestation of skin creep and relaxation.

Because of this ongoing relaxation, I advise  my patients to consider intermittent ‘tuck-ups’ of the facelift years later. These miniature facelift procedures help freshen up the neck and jowl areas and make the result continue to look fresh and new. Often done just under IV sedation or local anesthetic, these limited facelifts are limited in scope with very minimal downtime. 

Facelifts are a little like your lawn. They require maintenance and intermittent care to remain looking their best. Think of such facial rejuvenation as a long-term program, not just a one-time surgical procedure.

Dr. Barry Eppley

Indianapolis, Indiana     

Necklifting in the Older Patient

Thursday, March 26th, 2009

As one gets older, the development of a significant neck waddle or turkey neck is inevitable for most. At age 70 and beyond, the sagging neck is often one of the most bothersome cosmetic issues for men and women alike. While there may be numerous physical affirmities that are troubling, the loose hanging neck is a visible reminder of advancing years.

While many older people have overiding medical issues that make dealing with a neck waddle insignificant, some would if the procedure was not unduly extensive and expensive. While a traditional facelift is the gold standard for aging neck issues, this may be more than the elderly person wants to undergo. They would like a procedure that is effective, quick and easy to perform, involves no significant recovery, and has very few risks….an operation that fits better with the needs of their age.

This is why the direct necklift for the older patient may be a good choice. It is a one hour procedure that can be performed under local or IV sedation. It involves no dressings or drains. The risks of infection, hematoma, or any other significant postoperative problems is as close to zero as any operation can conceivably get. There are no restrictions or physical limitations after surgery. One can shower the next day and go on with life. Ironically, it also produces a neck result in large neck waddles that is unmatched by even a traditional facelift. I have done patients as old as 88 with this neck method and they have been very appreciative.

The direct necklift is not perfect however. The tradeoff is a midline scar that runs from under the chin down to the adam’s apple. While this scar generally looks very acceptable and I have yet to find a patient that has complained about it, thorough presurgical education about it is important. Showing pictures of the scar is the best way to determine one’s potential acceptance of it. You either find it no problem or are uncertain about it. Any uncertainty makes you a non-candidate for the procedure. The straight line scar will also tend to contract and get a little tight in the first few months afetr surgery. This may require some steroid injections to soften it as it heals or a minor in-office z-plasty can ultimately be done in the central portion of the scar where it is tightest if this issue continues to be bothersome.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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