Many older male patients, as often defined as 65 years of age, or older, are most bothered by the development of central turkey neck or wattle.While a lower facelift is the definitive procedure for most forms of neck tissue sagging the older male may not prefer or be able to medically undergo the extent of the surgery or may be intolerant of the resultant scars in and around the ears. This is the role of the direct necklift which has been around for decades.
The direct necklift approach offers a more limited surgery with a quicker recovery…as well as an assured and complete elimination of the turkey neck because it is directly cut out. This approach is used selectively because of the more exposed midline neck scar. But in men with beard skin this scar can heal remarkably well as shaving is a form of microdermabrasion scar treatments. This is not to say this necklift surgery can not be done on older women but it must be done so even more selectively because of the scar.
In the February 2025 issue of Plastic and Reconstructive Surgery a paper on this topic was published entitled The 7-Step Neck-Lift Z-Plasty. In this paper the authors describe, as the title of the paper states, their seven steps for performing a direct necklift. These steps include: 1) central neck skin pinch, 2) pear-shaped skin excision, 3) pre- and subplatysmal fat removal, 4) platysma muscle plication, 5) temporary linear skin closure, 6) central z-plasty at maximal tension point of the linear closure and 7) horizontal submental and inferior neck dog ear excisions.
I have performed the direct necklift for years and in the properly selected patent it can be a very gratifying operation with an acceptable scar tradeoff. Not every patient needs the central z-plasty for tension relief and avoidance of a wide scar in the central neck area.
There have been many variations of the vertical excision in the direct necklift from larger z-plasties, lazy s-shapes and running w-plasties. It is not clear if one of these excisional patterns produces a better scar than the others. But as a general rule it is always better to keep it simple… a straight vertical line with or without a central z-plasty. But besides the geometry of the excision the width of the removed neck skin also plays a role in how well the neck scar outcome is.
Dr. Barry Eppley
World-Renowned Plastic Surgeon