Background: Facelifting in men is less commonly done than in women. This is for a variety of reasons including better quality of bearded facial skin that is more resistant to sagging, more tolerance for the profile of an aging neck, and concerns about having the procedure. Many men wait until their sagging necks and jowls are more severe and thus have older average ages when undergoing the male facelift.
The one non-aging male neck concern that changes these considerations is in the extreme weight loss patient. Weight loss of 75 lbs or greater, whether through bariatric surgery or diet and lifestyle changes, creates a sagging neck that will develop in a much younger man. While a lot of loose body skin can be hidden by clothes, this is not the case in the neck.
Case Study: This 38 year-old male lost over 100lbs through his own lifestyle change efforts. While he had concerns about loose abdominal skin, he was most bothered by his extreme amount of hanging neck skin. He wanted a lower facelift for improvement and was prepared to accept the scars around the ears to get any amount of improvement. It was discussed with him before surgery that, even with the best result, he would not have a perfectly shaped neck. (meaning a 90 to 110 degree neck angle)
He underwent an extended open facelift procedure. A combination of pre- and postauriuclar and submental incisions was used. The neck was initially defatted with liposuction and a subplatysmal fat mass was removed by direct excision with midline platysmal muscle suturing. A preauricular incision was used and carried up into the temporal hairline. The postauricular incision went back from the crease of the ear into the occipital hairline from a high ear position to keep the scar fairly hidden. Drains were used for 48 hours after surgery.
After surgery, his one complication was a submental fluid build-up which required multiple aspirations for resolution.
His incisions went on to heal without any problems. He did develop some mild skin relaxation but the procedure still gave him about a 75% improvement. We discussed the possibility of doing a secondary neck-jowl tuck-up to get an even better result if he so desired. He currently feels that he is content with his current result.
Case Highlights:
1) The most common reason that a younger man would undergo a facelift is when he undergoes a large amount of weight loss. While male neck skin snaps back better (has more elasticity) than that of a female, they can still have a significant neck wattle.
2) An extended facelift is the only possible treatment for the male weight loss neck problem.
3) The results of the male weight loss facelift will be considerable improvement but not a perfectly sculpted neck. Some rebound skin relaxation can be expected.
Dr. Barry Eppley
Indianapolis, Indiana