A neck lift, often referred to as a as a “mini-facelift” or a “minimal or partial facelift”, corrects for a minimal amount of loose skin around the neck. This procedure concentrates solely on the neck area and, although it can yield dramatic effects to the neckline without undergoing a full facelift, it t is not for individuals who have a considerable amount of loose skin under the jaw or in front of the neck, sometimes called a “turkey waddle”. It is, however, a good option for younger patients who do not require as much correction. It is not only faster but less invasive which means reduced swelling, scarring, bruising and risk. While a neck lift may make you look younger, it cannot curb the ageing process.

Another surgical technique to improve the neckline by removing fatty deposits is sub-mental liposuction, also called neck liposuction, and is often performed in conjunction with neck lift, face lift or chin implant surgery. Although the size and shape of the neck can be significantly changed with liposuction, extra skin once the fat has been removed. Wearing a compression band will help to firm the area but, if your skin elasticity is poor, this extra skin may sag. To correct for extra skin, it may be necessary to perform a neck lift or a face lift, either concurrently or after this procedure.

What happens during the procedure?

Your surgeon will begin with a complete medical history and examination to check for conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars. Before your surgery, routine laboratory tests may be requested including blood counts and blood chemistries.

Both procedures are usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility, and take about an hour. Most patients can return home after the surgery or can stay in a nearby hotel or recovery facility for the first night. If you are having more than one procedure, however, you may chose to remain in the hospital or in a recovery facility for a few days so that medical staff can monitor the recovery process.

Neck Lift and Neck Liposuction surgery can be performed under local anesthesia mild sedation, under “twilight anesthesia” (which is local anesthesia with heavy sedation) or under general anesthesia. Usually long or multiple procedures are performed under general anesthetia.

In a Neck Lift, the surgeon can remove some of the saggy and redundant neck skin through incisions behind the ear and under the chin area. Sometimes the incisions extend in front of the ear as well. The muscle under the chin is tightened and elevated by placing a suture across the neck crease. Loose skin is tightened by pulling the skin upward and backward and removing the excess skin from behind the ear. The incisions are closed with sutures that will be removed after one to two weeks, self-dissolving sutures or, in the scalp area, removable surgical staples.

Neck Liposuction is not an alternative to weight loss but can remove stubborn fat deposits which do not respond to diet and exercise. Today, a number of new techniques, including Ultrasound Assisted Lipoplasty (UAL), Power Assisted Liposuction (PAL), the Tumescent Technique, and the Super-wet Technique are used.

During the procedure, fat is removed through a small incision usually placed in a natural skin crease under the chin or behind the ear lobes. A thin tube called a cannula is then inserted into the fatty area. The cannula is used to break up the fat deposits and sculpt the area to the desired proportions. The unwanted fat is removed with a high pressure vacuum, leaving the skin, muscles, nerves, and blood vessels intact.

In the Super-wet Technique, a saline solution containing a local anesthetic and adrenaline is injected into the area to be treated, which makes the fat deposits easier to break up and extract. This extra fluid also minimizes trauma to the surrounding tissue, reducing swelling and post-operative pain. The administration of adrenaline also decreases bleeding during surgery, further reducing risks.

The Tumescent Technique, in which even larger amounts of liquid solution are injected, has similar benefits.

A newer method, Ultrasound Assisted Liposuction (UAL), uses sound waves to liquefy the fat after the injection of fluids. UAL also minimizes trauma, causing less bruising and blood loss.

Another earlier method of liposuction is called Dry Liposuction because no liquefying agent is used but it is not in frequent use today.

The technique chosen for your operation will be determined by a combination of factors, including the precise area to be treated, the amount of fat to be removed, your surgeon’s training and experience, and your preferences. The pain during the procedure is most often minimal, although you may feel pressure, movement, or a vibrating sensation.

Are there risks or potential side effects?

As with all surgeries, there is always a possibility of complications following chin surgery, including infection, bleeding, a reaction to the anesthesia, hematoma, seroma, asymmetry, and nerve damage.

Make sure to tell your surgeon if you are a smoker. Smoking can increase the risks of this procedure because nicotine constricts the blood vessels, decreases blood flow to tissues and greatly increases the chance of scarring. Some patients who smoke can actually lose a portion of skin due to decreased oxygen flow into the skin caused by nicotine and decreased skin oxygen levels caused by carbon monoxide can cause the skin to die. These risks are significantly reduced if you stop smoking at least two weeks before surgery and wait until you are completely healed before starting again. Poor healing of the skin may also occur in people who have very thin skin. It is most likely to occur in the thin skin of the neck behind the ear.

Neck Liposuction carries specific risks, such as imperfections in final appearance. The skin surface may be irregular, wavy, asymmetric, or even “baggy”, especially in the older patient. Numbness and changes in pigmentation may occur. Often, revision surgery is performed to improve the appearance. Ultrasound Assisted Liposuction carries the risk for burns to the skin and deeper tissues. In addition, the long-term biological effects, if any, of ultrasound energy are not known.

The risks increase if a greater number and size of areas are treated at one time. Removal of large volumes of fat and fluid may require sizable volumes of pre-injection fluid and longer operating times than in smaller operations. The combination of these factors can create greater hazards for infection, delays in healing, improper fluid balance, injury (especially perforation) to vital organs, shock, and unfavorable drug reactions. As with any surgical procedure, blood clots may form in the veins with risk of migration to the lungs, which can be fatal.

Another risk of liposuction is Pulmonary Thromboemboli, blood clots that can break free and travel to the lungs resulting in pulmonary Thromboemboli. This can put a patient into adult breathing distress and subsequently into cardiac arrest or coma that can result in a vegetative state from loss of oxygen to the brain. Although rare, this can happen within three weeks of the surgery but will most likely show symptoms of shortness of breath and fatigue within the first 72 hours. There is also a risk of Pulmonary Edema (or fluid in the lungs) from over hydration. This can occur when extreme amounts of saline are intravenously supplied with the purpose of replenishing fluids that were taken out. Some surgeons try for “twice the amount in as is removed, just to be safe”. This is most seen with tumescent and super-wet techniques. Ask your surgeon how much fluid he returns to the patient’s body.

Be sure to ask your surgeon about all of the risks associated with the procedure your considering before you make any decision.

What to expect post-procedure?

After a Neck Lift, mild to moderate swelling and bruising can be expected. The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Keep your head elevated, above heart level when lying down. Your surgeon will prescribe medication to alleviate the pain but, after a few days, an over-the-counter pain reliever should be sufficient to alleviate any discomfort. Your surgeon may recommend that you wear a chin strap for the first one to two weeks after surgery to minimize the swelling and bruising. Initially, the strap is worn day and night.

Following Neck Liposuction, your neck may be stiff and sore for a few days, and you may experience some pain, burning, swelling, bleeding or temporary numbness. Again, your surgeon will prescribe medication to alleviate the pain and initial discomfort.

An antibiotic ointment may also be prescribed to prevent infection at the incision sites. Non-dissolving sutures will be removed in a week to 10 days and you will be fitted with a compression band to reduce the swelling and hold your neck in its new shape until the tissues have adjusted. This must be worn for several weeks after your surgery to ensure that your neck stays firmly shaped.

How soon does normal life resume?

For the first week following neck lift surgery you can to resume light activity but avoid any bending or heavy lifting. You can usually return to work in seven to ten days provided the work is not physically demanding and makeup can be used to conceal bruising.

After Neck Liposuction, most of the bruising and swelling should subside within three weeks and you can return to work within a week, or even within a few days provided the work is fairly sedentary. Remember that you will be wearing the compression band for several weeks after your surgery to ensure that your neck stays firmly shaped.

Most of the visible signs of surgery should fade completely within about three weeks. Minor bruising can be concealed with special camouflage makeup. You may feel a bit tired and let down at first. As with any surgery, it is also sometimes normal to feel anxious or depressed in the days or weeks following the operation. If there is heavy bleeding or increased pain, be sure to inform your surgeon.

Who performs it?

A face lift is usually performed by a plastic surgeon or an otolaryngologist (ENT).

Are you a good candidate?

As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to tighten the skin around your neck or remove excess fat, then a neck lift or neck liposuction may be appropriate, especially if:

• Your surgeon is aware of any and all medical conditions and any allergies you may have and whether you are a smoker. Also, tell your surgeon about any medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription).
• You are not prone to scarring problems such as keloids.
• You do not smoke.
• You have specific fat pockets that are resistant to diet and exercise and desire reshaping, not weight loss.
• You do not have frequent fluctuations in weight.
• You have had no previous surgery in the area where liposuction is desired.
• You have good facial skin elasticity.
• You have a good understanding of the limitations of the procedure.

How to prepare for surgery?

Your doctor will give you specific instructions to prepare for surgery. In addition, you will be given specific instructions about taking or avoiding certain vitamins and medications but here are some general guidelines:

• Avoid aspirin, any aspirin containing medication or any other non-steroidal anti-inflammatories (NSAID), such as Motrin® or Advil®, for two weeks prior to treatment. Because aspirin thins the blood, it can interfere with normal blood clotting and increase the risk of bleeding and bruising.
• Smoking inhibits the healing process, so stop smoking before your procedure and if you start again, make sure it is after you are completely healed.
• Avoid drinking alcohol a few days before your surgery.
• Make sure to follow any fasting instructions the night before and morning of your surgery. Your doctor may insist on an empty stomach depending on the type of anesthesia.
• Make sure that you arrange for someone to bring you home and to help you out for 24 hours after surgery.

Are there alternatives to this procedure?

Less invasive procedures may be alternatives but they cannot produce the same results as a neck surgery. To correct deep lines and wrinkles, BOTOX® or collagen injections can be administered. Laser skin resurfacing, dermabrasion and chemical peels can smooth fine lines, while a full facelift can correct for excess skin around the jaw line.