Podcast Episode 11 • 10:27
Why Can’t I Just Do a Neck Lift Instead of a Face Lift?
What are the risks and complications of neck lifts (cervicoplasty)? Do neck lifts last? What about thread lifts or barb suture lifts? How do neck lifts compare to face lifts?
Listen on for the answers to all these questions and more!
Welcome to Plain Talk About Plastic Surgery, a podcast that educates you about all things relating to plastic surgery procedures and operations, with down-to earth and honest information.
I’m your host, Dr. Elizabeth Kerner. While you listen, I hope you’ll think of me as your sister, the plastic surgeon, who will tell you like it really is.
I have been in practice in Plano TX, a northern suburb of Dallas, for over 30 years. I am an American Board of Plastic Surgery certified plastic surgeon, and have been a member of both the American Society of Plastic Surgeons and the The Aesthetic Society.
My practice is predominantly cosmetic surgery, doing about 80% cosmetic surgery and 20% reconstructive surgery.
I am a past president of the Texas Society of Plastic Surgeons. I was also the first female president of the hospital medical staff at Texas Health Presbyterian Hospital Plano, where we have 1,400 doctors.
Each episode of Plain Talk About Plastic Surgery will focus on one area of plastic surgery in depth, discussing the anatomy, the operative technique, risks, potential complications, and most importantly, who would be a good candidate and who would not be a good candidate.
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Welcome to Plain Talk About Plastic Surgery. I’m Dr. Elizabeth Kerner, your host for this podcast. If this is the first podcast you’ve tuned into, I’m here to give you practical and down to earth honest information about various plastic surgery operations and procedures.
I’ve been in practice for 32 years, and I’m hoping that this will be an informative discussion, almost as if I were your sister saying, “oh, you should do this or don’t do that.”
Today, our podcast is Why Can’t I Just Have My Neck Fixed?
This is such a common question I’m asked when women and men come in and what really bothers them is the neck. So, that is the portion below the jaw line. And I’m here to tell you why most people aren’t going to do well with just an isolated neck lift.
How the Anatomy of Your Neck Affects Whether a Neck Lift is For You (or Not)
As I always like to do, I’ll start with some anatomy. So the neck is considered the area underneath your jawline or your mandible, and it extends down to your collarbones, the clavicles. And what bothers most people is the central portion of the neck, what’s called the submental area, the mentum being your chin.
This area is created by – going from the outside to the inside – skin, and then a layer of fat, which can be substantial or in some people very little, and then below that are the platysma muscles.
Platysma muscles are little thin rhomboidal shaped muscles that go from the collarbone up to the jaw line and in most people extend into about the mid cheek. When they hit the cheek, they kind of peter out and become part of what we call this SMAS or superficial musculo aponeurotic system. And the SMAS is what is sutured, lifted, moved, vectored, in facelifts.
So if you think about it, for most people, the platysma is intimately involved with the SMAS, which means what’s happening in your cheek is also affecting what’s happening in your neck.
Well, to get back to anatomy, so when we’re young, normally the platysma muscles meet in the mid part of our neck underneath of the chin, and they cross over each other. So they form a nice little hammock there.
Underneath of the platysma muscles, there’s usually a little fat pad, the subplatysmal fat. And adjacent to the subplatysma fat will be your sub mandibular glands, which are the little round bally glands sitting about a third of the way along your jaw line.
And deep to that are the muscles that support your throat. The mylohyoid is the floor and the deep sides are the digastrics. The digastrics help for internal throat support and movement. They hook onto a little wishbone piece of cartilage called the hyoid.
So in the anatomy lottery, if your hyoid sits pretty high up towards your mandible, that means the digastrics are going to go from, let’s just say, bottom part of the mouth into the hyoid, and you’re going to have a very acute angle or a nice, sharp, crisp angle underneath of your chin. Think Audrey Hepburn. That would be a good person to think of.
If you have a low hyoid, meaning the hyoid is situated farther down along the neck, the digastrics when they join into that are going to create a more oblique angle.
So underlying all of what can be done to your neck is really your anatomy. If you have a low hyoid and you have bulky digastrics and you’ve always had an oblique angle, and then you couple that with maybe you have a bit of a weak chin, so you don’t have a very prominent chin, because that also adds to the appearance of fullness if you don’t have a chin that juts out.
Jay Leno with his big old chin will never have a problem with looking fat and full under his neck because the chin just comes out so far he’s always going to have more of an acute angle.
So that’s all the anatomy. A low hyoid, thick digastrics, a platysma muscle that never quite met in the middle or has gotten quite weak and also extends up into the cheek area; all of those are going to be factors for how you’re neck’s going to look.
The Mirror Test: What You See Isn’t Always What You Get
So if you’re like most everybody and you stand in front of the mirror and you pull the skin of your neck backwards and you say, “look, I just need my neck.”
But what I find is most people are subconsciously putting their finger along the jaw line because when you pull along the jaw and upwards a little bit, it makes the neck look a whole lot better.
That’s when we get into facelift territory.
Now, if you go to the mirror and you pull your neck skin from the center back and you really stay underneath of the mandible, so you’re not encroaching in the skin in the jaw area, sometimes what will happen is it will pull that jaw towards the ear. So you get a really unpleasant looking furrow from the corner of your mouth down towards your mandible.
Other times it will cause a lot of bunching of skin in front of the ear lobe, which you can’t leave that there. So that has to be taken out. So now essentially you’re doing a facelift.
If you pull up in your cheek area, like along your cheek bone and you pull that skin and fat up and it’s like, “wow, half of my neck just miraculously got better.” That means that your platysma muscle goes up into the SMAS and the lengthening and the falling of that tissue is really part and parcel of what’s happening in your neck.
And for most patients that’s what I find; I can’t just do the neck because it’s really the cheek fall – the mid face fall – that’s exacerbating it. And if we don’t pull the cheek back up then number one: the operation isn’t going to last very long because you haven’t attacked what the problem is of facial aging.
The second is, if you are able to just do a neck, then we run into problems again with how do we support the tissue.
The Three Operations That Can Be Done On The Neck
So for the neck, real quickly, there’s three operations that can be done.
One is just to liposuction the fat under the chin.
So if between the skin and the muscle, all you have is a little wad of fat there, that can be liposuction and that does very well.
That’s usually a late 20s to 40 kind of operation because someone has just kind of a fatty face right there. We’re not tightening the muscles. We’re not doing anything else. We’re just getting rid of that little fat blob.
The second would be an anterior cervicoplasty, cervicoplasty being the name for tightening up the neck.
In this operation a small cut is made under the chin. You take the fat out and then you just tighten the front part of the muscle where it separates. But if your platysma muscle is weak all the way along and it’s really falling from the cheek area, that’s not going to help very much.
I find that doing just an anterior cervicoplasty probably lasts about 18 months and then people will start to see that they’re getting banding back.
A full cervicoplasty is a half of a facelift.
So that’s the incision behind the ear, and then under the chin. We do all the regular stuff under the chin, take the fat out and then go underneath the skin, across the neck, and then you’re pulling that platysma muscle and suturing it in behind the ear into the mastoid.
The problem with all of this is a platysma muscle is relatively thin. It’s not a great big bulky muscle. It’s not like your tummy where we can put big stitches into the rectus muscles and they’ll stay. There’s really no fascia to speak of there.
So the biggest issue we have with necks, even with a facelift, is that oftentimes the sutures that we put into the platysma muscle just don’t hold, because if you think of it, you’re just sort of stitching up meat. And if there’s nothing to really get a good firm handle on, that muscle will pull through.
That’s why if you’ve now thought, “well, I’ll just do a thread lift or do some barb suture lift,” well, that really doesn’t last at all.
Again, you’re putting a barbed material into the meat of the muscle and it just pulls through. So unless you create a good amount of scarring, that’s not going to hold either.
In a full cervicoplasty, the correction is really from below the jaw line, so below the mandible, down towards collarbone. Again, if you have a lot of mid-cheek fullness or laxity in jowling then it’s not going to fix that. So sometimes it makes you look really weird if the lower part looks good and then your face itself has kind of a weird bagginess to it.
But those are the things that can be done for patients to know if they could potentially have just a cervicoplasty.
Am I A Candidate for a Cervicoplasty (Neck Lift)?
The only way for me to be able to tell you that is to come into the office and just basically play with your face. I can pull on the tissues and tell you pretty quickly if you’re a potential candidate for just a neck or if you just really are going to have to bite the bullet and do a facelift.
And nobody likes to hear that, but we don’t want you to have an operation that is not going to last long or is not appropriate for your condition and isn’t going to hit your expectations, or you’ll always be moderately disappointed with your results.
Because any time you have an operation, you have the risk of surgery and anesthesia, not to mention the money. We need to be really sure that what I can do, what can be done with your anatomy, is going to hit your expectations pretty solidly.
So that is all I have today on why can’t I just do my neck?
I hope this has cleared up a little bit of the confusion of why cervicoplasties are not normally done as an isolated procedure.
Feel free to visit our website, www.DrKerner.com. That’s D-R-K-E-R-N-E-R.com.
We do have more information on my web site, and before and after photographs. I have a few cervicoplasty pictures but not many because I don’t do very many in isolation. And I think you’ll find if you look across all plastic surgeons web sites, we don’t have that many facelift pre and post pictures because patients are very reluctant to let us put their faces up on the Internet. Although they tend to say before surgery, “absolutely, put my pictures up” and then afterwards they’re like, “noooo, don’t really think I want to be up there.” So it’s hard to find a lot of good facelift pictures to show you. But we do have some up there.
We also have a newsletter that you can subscribe to just by calling and giving us your email. This keeps you up to date on specials that are being offered in the office.
Thank you very much for listening. Have a great day. And don’t forget to use your sunblock.