Overview of Neck Rejuvenation
When people come in for a cosmetic evaluation of their face, a common concern is the signs of aging appearing on their neck. This might include vertical lines on the edges of the neck muscles, known as platysmal bands, extra fat under the chin (in the submental area), and a less distinct neck-to-chin angle.
There are many ways to deal with these issues, and they can range from gentle to more aggressive treatments. These might include a neck lift with or without another procedure called a platysmaplasty, removing fat from under the chin (submental liposuction), injections to help break down fat, cold therapy (cryotherapy), injections to relax the muscles (botulinum toxin injection), and methods to restore the skin’s surface, and others.
What treatment is best for you would depend on what you want to achieve, your budget, your overall health, and the structure of your neck and face. Often, these treatments can be combined with others, like a face lift, eye lift (blepharoplasty) or injections that fill in wrinkles and lines. Doctors often work together with other healthcare professionals, like nurses who specialize in injections or skin specialists (aestheticians), to make sure you get the results you want and are happy with the outcome.
Anatomy and Physiology of Neck Rejuvenation
Understanding the surface anatomy of the neck is crucial for planning proper procedures and noting physical features. Aging changes in the neck are usually classified using the Dedo system, divided as follows:
1. Normal
2. Loose skin only
3. Excess neck fat
4. Neck muscle changes
5. Weaker jawline
6. Lower position of a neck bone (hyoid)
Each stage gets harder to treat. For example, loose skin is typically corrected with a simple neck lift. Under the skin, there is a layer of fat that can be removed through various methods such as liposuction, medication injections, or freezing; liposuction is often combined with surgical neck lifts. Below this fat lies a thin layer of muscle (platysma muscle). This muscle forms vertical bands in the neck as we age when its edges separate and move sideways. Joining the edges of the platysma back together during surgery can help reduce these bands and provide a support layer for a neck lift.
Underneath the platysma layer, there’s additional fat that can be removed if needed, but it needs careful handling due to the proximity to important bodily structures. A weaker jawline or lower position of the hyoid bone can lead to unfavourable surgical outcomes, so they’re important to note before any procedure.
However, more than just the items on the Dedo list, other factors come into play when considering neck procedures. For instance, the glands under the jaw might appear more prominent after surgery, creating an unpleasant look. In some cases, these glands might need to be reduced or removed. The quality of the skin is also important because neck skin is thinner and less capable of handling resurfacing procedures compared to facial skin.
While most of the key structures in the neck are located deeply, there are a few nerves and vessels that can be at risk during neck surgery. Injuries to these nerves can result in an inability to move the lower lip properly, which can lead to an uneven smile. More commonly injured is the nerve near the sternocleidomastoid muscle and behind the ear, the injury to which can have severe consequences. Close to this nerve is a vein, which can also be at risk during surgery.
Why do People Need Neck Rejuvenation
Just like people, our necks age differently based on a variety of factors. Sometimes, people notice physical changes and want to do something about them. This is when a doctor might recommend certain procedures. The choice of procedure will depend on the specific issues faced by the person.
For instance, if you notice your neck skin is loose, a neck lift might be suggested. This is because a neck lift can tighten the skin effectively. But if you have wrinkles without the skin being too loose, then treatments like CO2 or Er:YAG laser resurfacing might work better. These are treatments that use light energy to improve the appearance of your skin.
If you have mild neckline creases which might look like bands, known as platysmal banding, you could be advised to have an injection of onabotulinumtoxin. This is a medication that relaxes the muscles and helps to smooth out the bands. But, if you have these platysmal bands alongside loose skin, a surgery called plastymaplasty might be better. This is because plastymaplasty can deal with the bands while a simultaneous skin lifting surgery (rhytidectomy) can take care of the loose skin.
If you notice too much fat beneath your chin, you might be recommended submental liposuction, or fat removal. This can be done on its own or along with a skin lifting surgery. Other options to tackle the excess fat include cryotherapy (freezing the fat cells), radiofrequency ablation (heating the fat cells), and deoxycholic acid injections (dissolving the fat cells), generally done as separate procedures.
In all scenarios, the best course of action will be the one that addresses your specific concerns and needs.
When a Person Should Avoid Neck Rejuvenation
There are certain situations where cosmetic procedures on the neck might not be advisable. These include having health issues that could lead to heart or lung problems during anaesthesia, unrealistic expectations of the results, or other health conditions that could lead to complications after the operation.
If a person has blood disorders or needs continuous blood-thinning treatments, they have a higher chance of getting a bruise-like swelling (hematoma) after a facelift surgery (rhytidectomy). Furthermore, people with uncontrolled diabetes, inflammation of blood vessels (vasculitides), recent history of smoking, past experiences of poor healing or scarring after injuries or surgery or people on immune-altering treatments are more likely to have issues with wound healing. These might include a risk of infection, extra scarring, or even skin death (necrosis).
Equipment used for Neck Rejuvenation
If you’re getting a surgical neck lift, there are several tools that the surgeon uses. They need a special marker to draw on your skin, a local anesthetic (a medicine that numbs the area), or a tumescent solution (a fluid that helps to numb and shrink blood vessels to reduce bleeding). A scalpel, a small sharp knife, will be used for the cuts, followed by a medical instrument used to hold back tissue or organs (called a retractor), together with a light source. They also use special scissors designed for facelift surgeries, devices to hold and manipulate needles (needle drivers), and a tool that uses electricity to stop bleeding (electrocautery). A device that removes fluid or gas by suction will be used, as well as stitches (or sutures) to pull the skin back together. They use stronger, thicker sutures to bring together the borders of the platysma (a muscle in the neck), and smaller ones for the skin.
As for improving the look of the skin, the doctor may use a variety of systems. These might involve lasers, which come in different types like carbon dioxide, diode, and another called erbium-doped yttrium-aluminum-garnet lasers. They might also use either broadband light or intense pulsed light, which both utilize different spectrums of light to treat the skin. If these are not available, they might do a superficial chemical peel, which uses chemical solutions to ‘peel’ away the top layers of skin and reveal healthier skin underneath.
Other options exist to cut down on extra fat. These might include cryoablation, which uses cold temperatures to kill fat cells, or radiofrequency ablation, which uses heat. However, these procedures need special tools as well.
If the doctor is injecting botulinum toxin (the active ingredient in Botox) or deoxycholic acid (a medicine used to decrease the appearance of a ‘double chin’), this requires fairly simple tools – just some sterile saline (a saltwater solution), hypodermic needles (needles that can inject substances under the skin), and a syringe.
Who is needed to perform Neck Rejuvenation?
When a surgery is being conducted, many people are involved in the process. These include someone to give anesthesia (to make you sleep during the operation), a nurse who moves around the operating room assisting the surgeon, a technician who manages the medical equipment, the chief surgeon who does the actual operation, and possibly another surgical helper. This helper can be a specialized nurse or a physician assistant.
Non-surgical treatments, like injections, are a bit different. They can be done by a variety of healthcare professionals. This may include a surgeon, a doctor who isn’t a surgeon (for example, a skin doctor also known as a dermatologist), or a non-doctor such as a physician assistant or nurse.
Preparing for Neck Rejuvenation
Preparing a patient for a cosmetic procedure is very important and it starts with having a clear discussion with them. This conversation helps the doctor understand the patient’s goals and set realistic expectations for the surgery. It’s vital that both the doctor and the patient agree on what can be achieved before the operation starts.
If the patient smokes cigarettes or takes blood-thinning medications, the doctor will likely advise them to stop temporarily. Stopping these can help with the healing process after the surgery.
Things like checking the function of nerves in the face and taking pictures of the patient before the operation can also help the surgeon during the procedure. The surgeon will also make marks on the patient’s face to guide them during the operation. It’s important not to wash or rub off these marks during the pre-surgical cleaning.
To help manage pain and control bleeding during the surgery, the patient may be given a local anesthetic. This will help to numb the area during the surgery. Even if the operation is performed under general anesthesia (where the patient is fully asleep), local anesthesia can still be useful. Medications might also be given to reduce swelling and prevent nausea after the surgery, helping the patient feel better and get home sooner.
How is Neck Rejuvenation performed
A submentoplasty, or neck lift, is a medical procedure used to rejuvenate the neck area, making your skin look youthful and fresh. The procedure starts with a small cut, about 1.2 inches long, just under the chin (or ‘submental’ area). This is done using a blade that also makes two small cuts near the base of each earlobe. The surgeon then puts a small tube, called a liposuction cannula, into these cuts to remove any excess fat from these areas. The tube is always pointed away from the top layer of the skin to prevent the blood supply to the skin from being disrupted and to avoid uneven skin. The tube is handled with great care to make sure that it doesn’t harm any blood vessels or important structures in the body.
Afterward, the surgeon makes a more extensive cut under the chin, which allows them to carefully work with the skin from that area all the way down to your hyoid bone which is located in your neck region. The Surgeon moves the muscles of the neck to shape this area successfully. The next step of the procedure involves the surgeon tightening your neck muscles in a way that improves your neck’s appearance. The skin is then put back in place and the wounds are stitched up carefully, ensuring there’s no undue pressure on the skin, especially near the earlobes. Lastly, the surgeon applies an antibiotic cream and wraps a dressing around your head and neck.
Once the surgery is completed, laser skin resurfacing is usually performed. This method uses a laser to reduce the appearance of wrinkles and other skin irregularities. The laser is operated with caution and is tailored to each person’s unique skin depth and condition.
Another treatment that can be used in combination with the submentoplasty is an injection of botulinum toxin. This is a toxin that, when injected into specific muscles, causes them to relax which can reduce the appearance of wrinkles. The injections usually take 1-2 weeks to fully work and last up to 4 months.
Other treatments, like deoxycholic acid injection or cryoablation, may be performed if needed. Deoxycholic acid is a man-made version of a substance your body makes that helps to absorb fats. Cryoablation is a minimally invasive treatment that uses extreme cold to freeze and destroy diseased tissue, including cancer cells. Both of these procedures are usually performed about once a month until the desired result is achieved.
All these procedures are aimed at helping you look and feel your best by enhancing the appearance of your neck. Your doctor will customize treatment based on your specific needs.
Possible Complications of Neck Rejuvenation
While the most common issue with any cosmetic procedure is patient dissatisfaction due to insufficient or unexpected results, there are several other potential complications that can be avoided. With surgery, blood clots or liquid pockets (hematomas and seromas) are common after the operation, especially in patients who have high blood pressure or are taking blood thinners. Men also have a higher risk because having more hair follicles makes the skin’s blood flow increase.
Over-removal of fat in the neck area could result in a “cobra neck” deformity, while excessive tension when closing the surgical wound can result in a “pixie ear” deformity. Both these issues can be avoided with more careful surgical procedures.
Nerve damage, either permanent or temporary, can also happen, particularly to nerves in your ear and face. Damage to the “great auricular nerve” can make the lower part of your ear feel overly sensitive, while damage to the “marginal mandibular branch” of the facial nerve can cause an uneven smile because the muscles that lower your lip become weak. This will make one side of the upper lip sit lower than the other, creating an overall lopsided appearance.
Other normal surgical risks apply as well, such as experiencing pain, bleeding, getting an infection, formation of visible scars, hair loss, and the possibility of needing more surgery.
To avoid these complications, it is essential that the surgeon deeply understands the body’s structure, carries out the operation meticulously, and thoroughly advises the patient before surgery to align their expectations. It is also recommended that the surgeon is open to revisiting the surgical area within a year to rectify any excess skin or neckbands that remain or come back after the neck lift surgery.
Non-surgical procedures can also lead to complications like patients feeling that the results did not meet their expectations. Laser resurfacing can cause burns or scars if the settings are too harsh. After this treatment, staying out of the sun for a few months can help avoid discoloration while healing. This discoloration can be temporary (hyperpigmentation) or less common but long-lasting (hypopigmentation).
Injections can also result in reactions locally. Notably, using deoxycholic acid can cause significant swelling as the fat cells break down. Injection of botulinum toxin is generally well tolerated, but if injected too high, it could weaken the muscles that lower the lower lip and result in a lopsided smile. Lastly, in rare cases, a treatment called cryotherapy can cause an unusual increase in fat cells, which will require liposuction to treat.
What Else Should I Know About Neck Rejuvenation?
Aging often affects the neck’s appearance due to skin and muscle looseness that tend to develop over time. An extra layer of fat beneath the skin can also contribute to this, making it a common concern for many. Nowadays, there are many different ways to address an aging neck, both surgical and non-surgical. These solutions are provided by professionals from various specialties, including aestheticians, nurses, physician assistants and nurse practitioners. They can offer non-surgical treatments, assist during surgeries, or even provide aftercare.
According to statistics, necklifts were performed between 160,000 and 180,000 times in 2020 alone in the U.S. This number might even reach up to 400,000 when we consider necklift as part of facelift surgeries, making it a popular option for many. Given how common this procedure is, it’s important that medical professionals outside of cosmetic practices are aware of what options might be available to their patients and know how to spot potential complications from these treatments.
