The neck after a lot of weight loss often develops a significant wattle. Affectionately called a ‘turkey neck’, it really represents a lot of loose skin. It is mainly loose skin and not much fat as can be seen by the thinness of the wattle in some patients. This neck wattle is most commonly and generally best handled by a traditional facelift approach, repositioning the loose skin up and back towards the ear. There the excess skin is trimmed off with fine scars that lie well placed around the ear.
In some patients, however, patients may not want to invest in a full facelift effort based on the magnitude of the operations or for cost reasons. There is an alternative neck waddle operation known as the direct neck lift. This is a far simpler neck operation that can actually achieve a better neck result than a facelift procedure but at a significant trade-off…visible neck scars.
In the direct neck lift, the loose hanging skin is cut out right down the middle of the neck. This leaves a straight line scar from under the chin down to below the thyroid cartilage. (adam’s apple) This is an operation that takes only an hour, has only a tight feeling after, and has very little actual recovery. This is because no skin is lift up or raised beyond the margin of the cut out. (unlike a facelift where a lot of face and neck skin is lifted up) Because more neck skin can be removed by cutting it out directly than shifting it backwards as in a facelift, the reshaped neck is actually much sharper and more defined.
The question is….how bad is this scar? Suffice it to say that if it runs down the middle of your neck, it is not completely invisible. A direct neck scar seems to blend in better in men due to their hair-bearing beard skin. (and the fact that they will perform daily microdermabrasion over it from shaving) In women, the scar may be more noticeable and the neck in women is more viewed due to clothing styles and neck lines.
The choice of a direct neck lift is a balance between what one is willing to go through vs. one’s concern about visible scarring. There is no one right answer for everyone. My experience is that older men are the most willing to have direct neck lifts and not have concerns about the neck scar. Women are understandably more guarded about neck scars and very rarely choose this solution to their neck wattle.
Dr. Barry Eppley
Indianapolis, Indiana