Age takes a toll on the neck. And while minimally invasive treatments might help to make an older neck look a tad younger, it’s usually not enough, according to Beverly Hills, Calif., dermatologist Ronald Moy, M.D.
“A simple neck lift without a facelift works really well,” says Dr. Moy, past president of the American Academy of Dermatology, American Society for Dermatologic Surgery and American Board of Facial Cosmetic Surgery. “It always looks natural, yet it still improves the lower face. It sort of gives you a lower facelift.”
Surgeons can perform a neck lift restricted to the area behind the ear under local anesthesia. The procedure is relatively short — about an hour and a half. Thanks to tumescent anesthesia, there’s little risk of bleeding. And it usually addresses patients’ biggest concerns, according to Dr. Moy.
“Generally, it’s the pullback posteriorly — the backward pull — that really does all the tightening. That usually tightens the platysma muscle and tightens the skin,” he says. “We usually don’t have to make the incision in the submental area, where you’d have to suture the bands together or do some type of suctioning. The posterior pull really does all of that.”
Whether he’s operating on men’s or women’s necks, Dr. Moy says he usually removes about 2 inches of skin.
“Technically it’s simple — it’s just trimming and suturing. Any dermatologist can do that procedure. And patients are really happy with the results,” he says.
The simple neck lift is relatively complication-free, but it’s important for dermatologists and others to educate patients about what they can expect.
“When you’re pulling from behind the ear and the patient leans forward a little bit, the patient still might have some looseness. I think it’s important to educate patients that they’re going to get an improved neck, but it’s not going to get rid of all the looseness,” he says.
A less invasive approach using a radiofrequency heating device to tighten neck skin or to help prevent the skin from getting too loose remains an option for some patients in their 40s — even early 50s, according to Dr. Moy.
“Bioidentical hormones can decrease some of the sagging under the neck, or some of the creams like epidermal growth factor. These and radiofrequency device treatments, however, are not for someone who has [more significant] sagging,” Dr. Moy says. “Generally, when you get patients into their late 50s, you’re most likely going to be doing the neck lift.”
The Deep Neck Lift
St. Louis, Mo., facial plastic surgeon Mike Nayak, M.D., goes to greater lengths to restore a youthful look to the neck. He says his approach, the deep neck lift, bucks conventional surgical neck lifting thinking.
Traditionally, aesthetic surgeons approach neck lifts by suctioning subcutaneous fat, tightening the platysma area, then pulling skin from the sides to create a “tighter hammock,” he says.
“The reality is that the neck is built in layers and by treating just the first few layers of skin and subcutaneous fat, there is a finite amount of change you can make,” Dr. Nayak says. “You also can get a really off-looking result by overtreating those first couple of layers and then leaving the deeper layers alone. You can get a very disjointed look that’s not pretty, but it is tight-looking.”
Dr. Nayak says in recent years he has been safely modifying all the layers of the neck. He rebuilds the neck’s deeper layers to the shape and form of not just the younger neck but a genetically gifted younger neck, he says.
“Some people even when they’re 20 don’t have a great shape to their neck because they were born with the genetics for a more oblique or obtuse neck,” Dr. Nayak says. “I actually also use these techniques in younger people in their 20s and 30s.”