The aging neck is one of the most bothersome features of facial aging, whether it be a man or a woman. This is very evident as patients get older (greater than 55 or 60) and often is the sole focus regardless how the rest of the face is aging. For many men, the sagging neck is often their only facial aging concern.
Often a surprise to many patients is that the traditional facelift is the primary surgery to improve the sagging neck. While many perceive that a facelift is a total facial rejuvenation, they erroneously believe that the neck is treated differently with a ‘necklift’. Understanding that a facelift and a necklift is the same operation is a revelation for many.
For some older patients with severe neck sagging or a ‘turkey neck’, they simply do not want to go through a facelift. In most men in particular, the facelift concept and the lack of significant hair around their ears motivates them to pursue a different option. Rather than try and persuade patients to go through a procedure they don’t really want or can’t afford, I have used in my Indianapolis plastic surgery practice an uncommon option.
The direct neck lift is one limited form of facelift that just deals with the neck only. By cutting out the neck wattle directly, a dramatic change in one’s neck contour is achieved. It would be fair to say that the direct necklift produces a more dramatic neck profile change that is strongly resistant to future aging concerns caused by skin relaxation. Rather than shifting skin back in a traditional facelift, inches of skin and fat are permanently removed and platysmal muscles strongly tightened in the direct neck lift. It is simpler, faster, has next to no pain, and involves very little recovery of any significance.
But the beauty of the direct necklift is marred by one potential concern, which is why it is rarely done, that of neck scarring. That is the price that is to be paid for its simplicity and effectiveness. But how bad is this scarring? Is it slight or is it significant? Many who have never actually performed the procedure believe that the risk of poor scarring makes the direct necklift not a viable treatment option. That has not been my experience.
When speaking about necklift scarring, it is important to point out that the vast majority of patients I have treated are older men, age 65 or older. That is an important point for two reasons. The bearded skin of men allows for the most favorable s exposed scar location. Between the thickness of the skin, the healing potential of hair follicles and sweat and oil glands and the daily shaving (microdermabrasion scar treatment) that most men do, scars are set up to heal favorably. Secondly, this male population is very motivated as the other alternative (facelift) is even less appealing.
The scar pattern from a direct necklift is not a straight line. Vertical excision alone will leave redundant tissue under the chin above and along the thyroid cartilage below. Rather it is a vertical excision pattern that is combined with horizontal ellipses at either end, forming a ‘candlestick’ or ‘fishtail’ pattern. The very center of the closure in the middle of the neck will bear the zone of greatest tension. This is often relieved with a z-plasty to prevent central scar hypertrophy or widening. This is done in about half of the cases. Such an excision pattern has shown to produce remarkable neck changes in profile.
The scars from a direct necklift usually settle quite quickly and the typical early redness of scars fades by three months or so. While a very fine line vertical neck scar can be seen on very close inspection, it is largely inconspicuous in all men. The horizontal submental and low neck line scars become invisible. The redness of the scar persists longer in women and may be more visible which is why it is usually a gender-biased procedure.
While the potential scarring is an appropriate concern in the direct necklift, careful patient selection can make for a very satisfied patient. I have yet to formally revise any neck scars but have injected several raised scars of a cm or so in the tight central neck zone.
Dr. Barry Eppley
Indianapolis, Indiana