Deep contouring neck lift

Four elements can detract from the aesthetic balance of the neck:

• volume

• hyperactive platysma bands

• laxity

• skin texture

The first three fall into the scope of surgery. The fourth is a mixture of surgical and non-surgical treatment. Addressing laxity in the surgical approach helps the skin texture to a degree, because spare, poorly supported skin is no longer being asked to drape over an unchanged deeper shape. Preserving some fatty tissue under the skin is also important: that thin layer helps the skin keep a smoother appearance.

Deep neck contouring is able, to a significant degree, to capture those first three elements and treat them selectively. Volume excess is taken from the deeper layers; some of the fat immediately under the skin is left in place to protect texture. That is the difference between tightening the surface and changing the architecture that the surface sits on.

An anterior neck lift is the volume-only version of this work, used when bands and spare skin are not the problem. This page is the operation used when they are.

Management of volume reduction is focused below the platysma muscles. It includes reduction of deep-seated fatty tissue, of the digastric muscles where they blunt the contour, and of the lower part of the submandibular glands. These deeper features are frequently hereditary. They are not always a matter of age or of weight fluctuation, which is why diet and exercise so often leave the upper neck looking much as it did.

There is also a more superficial layer of fat, under the skin and above the platysma. Preserving some of that layer is very important. It helps the skin keep a smoother appearance and protects texture. Deep contouring addresses the volume excess from the deeper layers and maintains some superficial fat to protect texture. Reducing only what sits on the surface, and leaving the deeper structures untouched, is a common reason a neck still looks full after a more limited procedure — and over-thinning the fat under the skin is a common reason the surface then looks uneven.

Management of the platysma bands is primarily through platysmaplasty and lateral platysma elevation and tensioning. The bands are a muscular problem. Stretching the skin over them does not make them behave; it only hides them for a while, and sometimes not even that.

Treating one of these elements by exaggerating another is a poor plan. Volume, bands and laxity have to be identified separately in the consultation, and the operation has to be allowed to treat each of them. That is why a neck that is only emptied of fat can still look banded, and why a neck that is only tightened can still look full.

Lateral platysma tension, in the context of a preservation neck lift technique, also produces control of the neck skin laxity. The platysma is used as the vehicle that carries and settles the skin, rather than the skin being asked to hold the result by its own tightness.

When the neck skin laxity is severe, I prefer to address it separately from the platysma. The muscle and the skin are then planned as two related but distinct tasks, so that one is not exaggerated at the expense of the other. Spare skin is not a substitute for the deeper work, and the deeper work is not a substitute for spare skin.

The deeper tissues are accessed and treated as required: reducing the deep fat, reducing or tightening the digastric muscles where they contribute to girth, and reducing the lower part of the submandibular glands when they blunt the line under the jaw. Some fatty tissue under the skin is deliberately kept.

Platysmaplasty and lateral platysma elevation and tensioning manage the bands. In a preservation neck lift, that lateral tension is also what controls a useful amount of skin laxity. When spare skin is severe, it is dealt with as its own step.

A formal or typical neck lift of this kind also includes skin tightening with scars in front of the ears, and a scar behind the ear that is more extensive than the short scar used when the neck is not being lifted with the face. The exact pattern follows the starting anatomy, not a template.

The same three elements present in different proportions. That is why we do not treat every neck with the same incision or the same depth of work. The main categories of neck contouring through neck lift remain:

• Anterior neck lift, with no skin reduction. Volume is reduced through a 3–3.5 cm incision under the chin. Skin elasticity is reasonably good and the contour is already smooth. Bands and spare skin are not treated.

• Isolated neck lift, primarily involving skin tightening behind the ears. Used when the face does not need to be lifted at the same time, but the neck still needs shape control and a modest management of spare skin.

• Formal or typical neck lift — this page. In our practice this is a deep contouring neck lift: the deeper structures are treated, the platysma is managed, and the skin is settled once that work is done.

If the face is lifted and a full or banded neck is left behind, the junction at the jawline can look unfinished. If the neck is refined and the jowls are left heavy, the same thing happens in the other direction. When brow, face and neck laxity are all significant, the combination of a deep plane facelift, a deep contouring neck lift and a brow lift provides a unified reshaping. That is less likely to leave artefacts in the contours than treating each region as an isolated problem.

Computer simulation in 2D or 3D can be used effectively for planning the intervention and for assessing a potential outcome. 3D analysis of shape and surface remains an ideal platform: it lets us evaluate the contour corrections that are actually required, and to assess how a change in volume, bands or laxity would alter the surface of the neck.

There are always some differences between computer simulations and the surgical outcome. The software does not bleed, swell or heal. It does not know how a particular gland, muscle or skin envelope will sit once it has been treated. It is a planning tool. It does not promise a particular picture, and it does not replace the conversation about what you like and dislike in your own neck and jawline.

Surgery changes contour. Fine creasing, sun damage and the quality of the skin are a different problem. Addressing laxity surgically helps the texture to a degree, because the skin is no longer hanging in folds. Keeping some fat under the skin helps in the same direction: the surface has a thin, even layer to sit on, rather than being stuck down onto a hollowed plane. Neither of those steps resurfaces the skin.

Non-surgical options that already sit alongside this page on the site include Profhilo® micro necklift, mesotherapy skin boosters, Fraxel® resurfacing and peels. They are not a substitute for deep contouring when the problem is volume, bands or established laxity. They are the right tool when the surface is the complaint, or when they are used to finish a surgical change.

Naturally there will be questions, and you will want to meet the surgeon who would operate. Trust in that relationship is not a small part of the decision. Surgery is unique to each person; a detailed discussion and assessment are what allow advice to be personal rather than general.

We look at your medical history, medicines, previous facial or neck procedures and history of smoking. We look at the neck in motion as well as at rest — speaking and the resting platysma are different examinations. 2D or 3D imaging is used where it helps.

Two points need particular weight when neck lift surgery is being considered. Blood thinners increase the risk of bleeding and have to be managed specifically around the operation. Raised blood pressure also increases the risk of bleeding, and needs the same special attention. Neither is a footnote to the medical history; both influence whether surgery can be planned safely, and how it is planned.

If a deep contouring neck lift is not the better course — because an anterior neck lift would be enough, because the face or the chin is the real issue, or because the safer option is to wait — that should be said directly.

No operation is planned from a website enquiry. Surgery requires assessment and discussion in person, often more than once. The written information after the consultation allows you to consider it in detail. Fees depend on the combination of procedures and the setting in which they are carried out; they are confirmed in writing for the plan that has actually been agreed.

Post-operative care is crucial for a safe and more comfortable recovery. In our practice we provide manual lymphatic drainage to help the early swelling settle. The first days are the most restricted: tightness under the chin, bruising and a sense that the neck is not yet your own are expected. A supportive garment is often part of that period. Help at home is wise.

How soon you feel able to be seen at work depends on the extent of surgery, whether a facelift or eyelids were included, and on how you bruise. The neck continues to settle for months. Early photographs are not the result. Some firmness in the scars and some unevenness of swelling are part of that course and usually soften. Exercise, hair colouring and travel are timed individually rather than by a single calendar that suits everyone.

A deep contouring neck lift is still an operation, and it carries the risks of one. Bleeding or a haematoma, infection, delayed healing, visible or thickened scars, asymmetry, a change in the hairline or the shape of the ear when those incisions are used, prolonged swelling or numbness, weakness of a nerve branch supplying the lower lip or the platysma (usually temporary; lasting weakness is uncommon but possible), contour irregularity, and, rarely, an area of skin loss can all occur. Salivary leak or a change related to the submandibular glands is part of the discussion when those glands are reduced. The appearance may not match what was hoped for, and it will not match the simulation exactly. Further surgery is sometimes needed. Anaesthetic complications, though uncommon in healthy patients, are part of the same discussion.

The risk of bleeding is higher if you take blood-thinning medicines or if the blood pressure is raised. Those two factors need honest discussion and specific management before a date is set. Smoking, vaping and some other medicines increase the chance of a wound problem and belong in the same conversation. Ageing does not stop after surgery. How long a result remains pleasing depends on the starting anatomy, the skin, changes in weight and time. Hereditary deep volume that has been reduced does not simply grow back in the way a diet-related fat pad can; the skin and the rest of the neck still change.