Background: The turkey neck is an urban term used to describe a hanging of neck tissue that most commonly occurs as a result of aging. It may occur in younger patients but it would be due exclusively to the loose neck tissue that results from large amounts of weight loss. Regardless of the cause, the turkey neck hangs with a large midline sag as the the tissues along the sides of the face and neck fall towards the midline of the neck.
Men often appear for ‘turkey neck surgery’ because they often present at a much older age. The male trigger to undergo any type of invasive aesthetic facial surgery is usually much higher than that of women (traditionally) as they can endure facial aging changes for longer than most women. Large turkey necks are not uncommon in older men as they approach their 70s and 80s.
One of the challenges in the older male facelift patient is their medical appropriateness for surgery. They often have cardiovascular concerns and, at the least, many are being treated for hypertension. They are at higher risk for intraoperative bleeding and postoperative hematomas. And they have to have a good enough heart to tolerate a 3 to 4 hour facelift/necklift surgery. These concerns are in addition to the placement of incisions around the ears in men who have often inadequate hairlines and hair to hide them well.
Case Study: This 82 year-old male was bothered by his large turkey neck. He had ‘grown’ to the point where it was both embarrassing and problematic for shirt wear. Despite his age he was in good health with no cardiac history or exercise/walking in tolerance.
Under general anesthesia, a direct necklift was done with the removal of a large ‘candelabra’ pattern of skin excision. Once the skin is removed, the neck ‘defect’ can look very impressive as the skin on the sides of the neck falls back. Subplatysmal fat was directly removed and midline muscle plication done from under the chin down to the trachea. The neck skin was brought together and closed in the midline with a smaller horizontal component under the chin and a much larger horizontal closure line along the lower neck line below the trachea, Total surgical time was one hour.
The direct necklift always creates a significant and usually dramatic neck shape change because it is a direct excisional approach. (as opposed to skin flap relocation) For older men (greater than age 70), the direct necklift offers a shorter operative time, less risk of complications and a complete elimination of the turkey neck. There is the trade-off of a midline neck scar but it usually heals well in beard skin. Many older men would consider this a worthy trade-off .
Highlights:
1) Very senior men with turkey necks can be challenging patients for traditional facelift surgery.
2) The direct necklift avoids most of the issue relating to doing a full facelift in older men.
3) The midline neck scar from a direct necklift does well in older male beard skin.
Dr. Barry Eppley
Indianapolis, Indiana