Background: Large amounts of weight loss from bariatric surgery or rigid adherence to a diet and exercise program cause the creation of substantial loose skin throughout the body. While much of this loose skin does occur around the abdominal and waistline areas, it does affect other body areas as well. The face and neck is one such area and it appears as a large neck wattle and extreme jowling. The greater the weight loss the more severe the loose skin that appears hanging off of the neck.
The standard treatment for a neck wattle, regardless of its cause is a lower facelift. (necklift) The fundamental principle of a lower facelift (I will call it an indirect necklift for the sake of this article) is that the loose skin in the neck is ‘chased’ back to the ears where it can be removed in a location where the incisions can be fairly well hidden in and around the ears.
The concern in many men about a lower facelift is how well the scars can be hidden based on their beard skin and hair pattern. The bigger the lower facelift that is needed the higher the risk that the incisions will need to be extended beyond the shadowing of the ears where they will be more visible. There is also the issue for some men, particularly older ones, of how extensive the surgery will be and how much recovery will be involved.
Case Study: This 65 year old male had gastric bypass surgery eight years previously with a stable weight loss of 120lbs. As a result of his massive weight loss he developed a lot of loose skin. One of the areas that bothered him considerably was his very large neck wattle. He wanted it gone but was not prepared to go through an extensive lower facelift to do it.
Under general anesthesia he had a direct necklift performed. A large candelabra pattern of skin and fat was excised down the central axis of the neck. Subplatysmal fat was removed and the split platysma muscle was sewn together from the chin down to the thyroid cartilage. The lateral neck skin flaps were then brought together in a modified H-pattern skin closure.
He had his sutures removed in one week and by three weeks after surgery had largely recovered. His large neck wattle had been removed. He did not get a completely sharp cervicomental angle but that may have never been possible with his neck anatomy.
A direct necklift is an alternative to a full lower facelift in men with large neck wattles. It offers a far simpler recovery with fewer risks of complications and at a lower cost. For the older man who can accept midline neck scars, the direct necklift may be acceptable. The neck scars in older men and their beard skin can heal remarkably well in many cases.
Highlights:
1) Large amounts of weight loss often results in excessively sagging neck and facial skin, particularly in older men.
2) The standard treatment of a large neck wattle is a lower facelift with incisional patterns around the ears.
3) A direct necklift offers a ‘simpler’ approach to large neck wattles in older men than a standard lower facelift.
Dr. Barry Eppley
Indianapolis, Indiana