Sometimes you’re so focused on keeping a youthful complexion, a saggy neck sneaks up on you. And unfortunately, once you notice that droopy skin underneath your chin, it’s hard not to zero in on it every time you look in the mirror. While treating the area with elastin- and collagen-boosting creams may help a little, the best solution is cosmetic one.
Thanks to the latest technological innovations, there’s a plethora of different treatment options available — both surgical and nonsurgical. NewBeauty called up Encino, CA plastic surgeon George Sanders, MD to hear about the various procedures that let you put your best neck forward, so you never have to hide behind a turtleneck again.
NewBeauty: If you’re looking to improve the appearance of your neck, what different types of cosmetic procedures are available?
Dr. Sanders: Good question. There are different things that can be done depending upon what the individual brings to the table. The younger patient who has reasonably tight skin is not going to have a lot of problems with the muscle—they may be having issues with fat beneath the skin or need a little bit more jawline definition. In most cases, those things can be taken care of with nonsurgical techniques. You can go with fillers if you’re trying to define a jawline or correct a chin that’s a bit recessed; you can do things like neurotoxins, Botox and Dysport if you’re trying to slim down the muscle in the cheek and give the lower part of the face more of a V-shape, or you can opt for Kybella, an injectable that targets the fat beneath the chin if you’re trying to get rid of that fullness. Other options include surgical threads or radio frequency devices that tighten loose skin. These are all good treatments for someone who doesn’t need a lot done or wants to start with something nonsurgical.
NB: What are the surgical options available?
Dr. Sanders: The first is liposuction. It’s performed under local anesthesia, so many patients are opting for something like this, because it’s permanent as well. Part of its appeal is that you can see the result you’re getting on the operating table, and then you’re good to go because the fat doesn’t grow back unless you gain a tremendous amount of weight. Unlike the nonsurgical radio frequency devices I mentioned before, there are also ones that make little incisions beneath the chin. It’s like a little wand, almost like a liposuction device,that emits radio frequency energy. You move it back and forth in the area, and then after the treatment (over a period of weeks to months) the skin tightens up.
Then, there are certain times that call for surgical lifting—like if you have loose skin or muscle bands, if you have fat in the neck that’s both in front of and behind the muscle, or if you have prominent glands beneath the neck. There are limited neck lifts if you don’t want anything major as well as full ones. Limited neck lifts are great for people between forty and fifty.
NB: How do you decide between a limited or a full lift?
Dr. Sanders: First of all, if someone has a lot of loose skin in the neck, they’re going to do better with a full neck lift since what you’re doing is lifting the skin all the way off of the neck. You make an incision under the chin as well as incisions in front of and behind the ear. These incisions allow you to lift the skin completely, so you can do things like bring the muscle bands together in front of the neck. You can also go underneath the muscle to take out extra fat or remove more loose skin.
On the other hand, if you don’t have a lot of loose skin or if you don’t have muscle bands in front of the neck, you’re an ideal candidate for a limited neck lift. With a limited neck lift, you’re not lifting the skin all the way off the front of the neck. You lift it most of the way, but not completely. You don’t need the incision under the chin; you also don’t need to drainage tubes and you don’t need to do it under anesthesia—the treatment is performed with some oral sedation.
NB: Are there any other aesthetic procedures out there that improve the neck area?
Dr. Sanders: Sometimes people will say, I don’t really want that much done to my neck, I’m more concerned with the jawline area. I’m hearing that a lot nowadays, so if they want something that’s more permanent, they could do a jawline lift. It’s even more limited than a limited neck lift. You go underneath the jaw area and tighten the deeper tissues and the muscle, because some of the jowl that you have is muscle or fat that’s falling down from the cheek. Therefore, if you tighten the area above the jowl, you can pull that loose muscle and loose fat up and get a very nice jawline. Then, you’ll do a little liposuction too. Simply put, a jawline lift is part of a neck lift.
NB: How should you prep for a lifting procedure?
Dr. Sanders: To ensure you have the best results, avoid things that cause bleeding afterwards. So for the two weeks prior, avoid aspirin, Advil, Motrin, and Aleve. Also steer clear of herbal supplements, because they effect the body’s ability to clot. If you aren’t clotting well, you’re going to have a lot of bruising and perhaps even some bleeding afterwards.
Also, if someone is going under anesthesia, even very light anesthesia, we’re always careful. If you’re over the age of fifty-five as a woman or over the age of forty-five as a man, we recommend a visit with your medical doctor for clearance. We always visit with people a couple weeks before surgery to go over the details, give the instructions, and answer any questions.
NB: How long is recovery?
Dr. Sanders: If you’re talking about a lifting procedure, I ask patients to take about ten to fourteen days off from their normal activities. You need to stick around the house, not do a lot of talking, and just relax. Since you’ve separated the skin from the underlying muscle, that has to have time to heal back. If you do too much, you will again separate the skin from the muscle, leading to fluid formation, which may lead to scarring. Plus, you increase the chance of bleeding if you’re elevating your blood pressure.
Whereas, if you’re doing a treatment like liposuction, the recovery is much less restrictive. You’re able to get up and move about fairly quickly—but no one is exercising after these procedures for a minimum of two weeks.
NB: Are there any issues that are associated with lifting the neckline or jaw that could arise after a procedure?
Dr. Sanders: Certainly. If you’re talking about an actual surgical procedure, there’s the chance of bleeding, which is something that we try to minimize. We’re also cognizant of infection as well as scarring.
Additionally, there can be skin issues. Many times, patients will go: ‘It didn’t hold up as well as I thought or the lift didn’t stick as well as I hoped it would.’ This happens a lot with people who have what I would call crepiness of the neck. Post-lift, it will look fine, but then six weeks later they’ll start to see the crepiness again. For these patients, I tell them that a neck lift isn’t going to fix this issue. Instead you may want a neck lift followed with something like micro-needling with PRP or even a radio frequency treatment to try to tighten up the crepiness. While a neck lift tightens loose skin, it doesn’t change the quality of the skin. I always suggest that patients visit with the folks in the medical spa to talk about skincare and nonsurgical options that they may want to adopt going forward. Not only will it help them look better, but it will also prolong or even enhance the results that we’re able to give them in surgery.
NB: Speaking of prolonging the results, how long does a lifting procedure last?
Dr. Sanders: Depending upon your age and the quality of your skin, it generally takes somewhere between five and ten years for you to get back to where you were before we did anything for you. It’s a little bit like we set the clock back, you catch up, and then we push it back again. It allows people to go through life pretty much maintaining a certain look. But at the end of the day, if it doesn’t bother you, then you don’t need to do anything.
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