Open Neck Lift

An open neck lift is a surgical procedure performed under general anesthesia. The procedure involves making an opening on the skin through which the surgeon can visualize anatomic structures of the neck. The goal is to modify each one of these structures as needed to accomplish the desired results. An open neck lift is for changing or improving the contour of the neck to make it look better.

There are many important structures in the neck that can be directly visualized and protected during open neck lift. An open neck lift allows the surgeon to see both the superficial and the deep structures and fix all of them. One thing about a sagging neck is that most patients think it is just their sagging skin when, in fact, it may be the band of muscle called the platysma that is causing the problem. A full, sagging neck may also result from the accumulation of fat both beneath the platysma muscle and on top of that sheet like muscle.  The platysma muscle is very close to the surface of the skin.    Fats in the neck located underneath it cannot be removed by just doing liposuction simply because it is too dangerous to do so. The only way to get rid of this fat under the platysma is to remove it through open neck lift. A possible alternative treatment for isolated platysma muscle bands is Botox injections. Platysmaplasty refers to molding of the platysma muscle to get rid of the bands and improve the appearance of the neck. There are different types of platysmaplasty but it is basically cutting, rearranging, or suturing the platysma so it is not sagging.

Probably the biggest downside of an open neck lift is that it is a more involved surgical procedure than liposuction alone.  Only qualified plastic surgeons should be enlisted for necklift, not dermatologists or other specialists. Necklift is usually performed under general anesthesia. Necklift is very effective in correcting features of the aging neck, and the results are long-lasting. The great results stem from the fact that the surgeon can really see what they are working on and what needs to be corrected.

Also, there are other components that contribute to the poor neck aesthetic other than aging. The submandibular glands, extra skin, loose muscles, and deep fat can all be fixed via open neck lift.

CANDIDACY

An open neck lift and/or platysmaplasty may be performed on both young and old patients. Anyone who is generally healthy and does not like their neck contour is a suitable candidate for the procedure. Contour problems often arise either because the patient has lots of fat in the neck or the patient has big folds of fat above and underneath the platysma muscle.

NON-SURGICAL OPTIONS

The only way to do platysmaplasty is through surgery. But if the patient does not want to undergo surgery then treatment with Botox Cosmetic® is the closest alternative. Botox® is only for patients who have very minimal fat and sagging skin. It is ideal only for those whose problem is the muscle band because Botox® works to relax the muscle. Botox® treatment certainly has its own advantages because it is non-invasive, less expensive, and has a shorter recovery time. The only thing it fixes is the muscle. It does not affect the skin and fats. It fixes the muscle well but the effects are temporary and generally last only for about nine months or so. Open neck lifts produce more dramatic and longer-lasting results.  Liposuction of neck fat is another alternative.  Although liposuction is surgery, it is less invasive than open neck lift.  Liposuction of the neck may be performed under local anesthesia.  Liposuction removes neck fat on top of the platysma muscle only, not deep neck fat.  Liposuction doesn’t improve sagging due to extra neck skin or due to the platysma muscle.  Skin tightening procedures like radiofrequency or ultrasound energy are additional non-surgical options for improvement of the neck.  Energy delivered beneath neck skin by physicians using specially designed devices damages the dermis, the deep layer of neck skin.  In healing from the reversible injury, neck skin becomes tighter, and some wrinkles may resolve.  Ulthera® and Thermi-RF® are two such devices.  A newer non-surgical choice to treat neck fat is Kybella®, an injectable drug (deoxycholic acid) that dissolves fat.  Kybella® is a purified natural product, identical to a chemical produced by your liver and secreted in bile to dissolve and help digest fat.  Yet another non-surgical possibility is Coolsculpting®, a device marketed and FDA approved to freeze fat cells of the neck, after which your body may absorb the damaged cells, and the neck then shrinks down for some degree of contour improvement.  Most of these non-surgical measures are less effective than necklift, so often require several treatments to achieve a satisfactory result.

LIMITATIONS

There are practically no limitations to the improvements one can get from an open neck lift. The procedure can improve any kind of neck contour problem. There are certain conditions that could prevent a patient from getting an open neck lift or at least make it difficult for the surgeon to do the operation on him or her. An example would be if the patient has had a previous surgery like thyroid surgery, tracheostomy, cervical spine surgery, or even a neck liposuction. Any procedure that leaves a scar on the neck will make an open neck surgery more challenging to perform. Other contra-indications are bleeding disorders or any condition that requires a patient to take blood thinners and anticoagulants. Performing an open neck lift in these patients can cause them to bleed in the neck. Simply put, the limitations have nothing to do with the results but rather with patient selection.

RISKS

If open neck surgery is done well and the patient is ideal for the procedure, there should not be serious complications. Among possible complications is nerve injury. Underneath the platysma is a nerve that supplies the lower lip. If that nerve becomes affected, the patient will experience lower lip paralysis. It is usually transient, and lasts for weeks to months. Another complication is seroma which is the presence of fluid underneath the skin of the neck. Seroma happens if the area hasn't been drained adequately or if the fluid just collects in the area. Seroma can be prevented by draining the neck after surgery, a common practice.

RECOVERY

Contrary to what many people think, an open neck surgery does not actually require a very long downtime. After the surgery, the neck will be stiff for about a week or two. Patients are advised against operating a vehicle during that period. A week following the operation, the patient will start to look good again and may resume his or her normal life.

RESULTS

Result will be seen a few weeks after the procedure once all the swelling and bruising have subsided. The changes are permanent. An open neck lift is a one-time surgery. No repeat or revision treatments are required unless the patient sees a problem with the results.

MAINTENANCE

Follow-up and maintenance treatments are not necessary. The area will still age but it will never be as bad as before the neck lift was performed. The neck is always going to look better so the results last forever in that sense.

FINAL THOUGHTS

Open neck lift is a surgical operation that produces permanent improvement in neck contour and appearance. It is a complex, but commonly performed procedure that should be performed by an appropriately trained and certified surgeon in an accredited facility.   If a patient is considering undergoing an open neck lift, a surgeon that has significant experience with the procedure is recommended.

Written by Cosmetic Town Editorial Team- AA

Based on an exclusive interview with Steve Laverson, MD in Encinitas, CA