The sagging neck as one ages is bothersome to both men and women. As one ages over 65, a hanging neck (aka turkey neck) is likely to develop. As one gets into the 70 s and 80s, it can be quite pronounced. While a facelift is the traditional method of managing neck problems, there are exceptions to this standard approach. Many older folks simply do not want to, can not afford to, or medically can not undergo a more extensive neck procedure. This is where the role of the direct neck lift comes into play.
The direct neck lift is a simple, and reverse, modification of a facelift. Rather than working the skin out back towards the ears (and placing the scars around the ears as in a traditional facelift), the excess skin and fat is cut out directly down the middle of the neck. This does leave a midline scar from under the chin down to the adam’s apple. But its benefits are that is a very simple procedure that can be done under local anesthesia (if necessary), causes virtually no swelling or bruising, requires no after care, and does not require any restrictions in any form of activity at all. Also, it actually produces a more significant change and tightening in the neck angle than does the standard facelift. In just one hour of plastic surgery, that neck waddle is completely gone.
Because it does result in a scar right down the middle of the neck, one must educate and select the patient very carefully. The direct neck lift is not a procedure for every neck problem. For the older male, the scar is rarely an issue and scars in bearded skin do really well anyway. In women, however, the scar concern is of much higher priority as the neck area is more of an aesthetic focus and concern for women.
For these reasons, I find that a direct neck lift is good for older women that are usually over 65, have a very heavy and low hanging neck waddle, and have medical or personal reasons that they do not want the typical facelift approach. They must be shown pictures of, not only the results, but the location and appearance of the scar. I have a simple emotional test to know if the neck scar is a concern or not, and it is based on their initial reaction to the pictures. If they show express signs of concern or uncertainty about the scar, then don’t do it. If, however, they look at the scar and go…’who cares about that when you have this’….then the resulting neck scar will not be a problem after surgery.
Dr. Barry Eppley
Indianapolis, Indiana