Neck Lift

Age 34: Chin Implant, Neck Lift, Facial Liposuction

This is a 34 year old female who is 5’4” and 136 pounds who was interested in facial changes. She says that she has always had fuller cheeks and a weak chin and that this has always bothered her. She says that it got worse after having several children. On examination, she had a relatively long midface with a weak chin, poor definition of the mandibular border, fullness in the jowl area on both sides, weakness in the cheekbone area and a very asymmetrical face (the left half is quite different from the right half).

We discussed options at length. We decided to be relatively conservative to start with. I performed a chin implantation and liposuction of the fat beneath her chin. I also performed liposuction of her lower face and transferred this fat to her upper cheek area on both sides as well as to her lower lids. No other procedures were performed.

The difference is quite interesting indeed. To an untrained eye, one might note that she appears “different” but not knowing why. To a trained eye, and to someone who has before and after photos to compare, I note the following:

  1. Her face is different on global view—the “big picture”. It is more symmetrical, more sculpted, less full and more attractive.
  2. The creases below her eyes are gone with the fat filler.
  3. Her jowls and nasolabial creases are improved.
  4. The side view of her face illustrates the most drama—improved chin projection, better neck angle and overall improved facial balance.
  5. There is mild collapse of the skin on the medial aspect of her cheeks as we anticipated after the removal of so much fat.
  6. Look how improved the definition of her jawline is. This was from the implant as well as the liposuction of a thick fatty layer of tissue on top of her jaw bone. This separates her face from her neck.

She is very pleased with her outcome, as am I. We discussed additional levels of refinement (now that she fully trusts her surgeon!) We discussed several options including doing nothing, performing a face lift even at her relatively young age, and transferring more fat to selected areas. I recommended an elegant face lift that I believe will complete her journey and will provide for the best result that is befitting of a young woman her age.

Take home points:

  1. Facial liposuction requires expert skills and judgment.
  2. Fat transfer is an “art” and is unpredictable in its take. Fat is more likely to take in the face than in the body. The procedure continues to evolve and someday it may be perfected but right now it is imperfect. However, the downsides are minimal so it is often worth pursuing.
  3. Chin implants are a powerful tool to enhancing the face of a patient with a weak chin. It improves facial balance and harmony, improves the jawline and the neck as well.
  4. Her face is still asymmetrical after fat transfer and liposuction. A face is asymmetrical because of asymmetry of the underlying bony structures and this doesn’t change with manipulation of the overlying tissue.

Neck Lift

This is a young woman who had complaints about the fullness in her anterior neck. It bothered her quite a bit. She is seen here after an anterior neck lift only. There are not incisions except one below the chin. Liposuction was performed to contour some of the superficial fat, fat was reduced beneath the muscle of the neck, and muscle was actually removed from the lateral neck area on both sides (the digastric muscles).

She is seen here about 8 months after her procedure. She couldn’t be happier. In fact, she has a new hair style that is short. She wouldn’t wear short hair because her neck bothered her too much and though short hair would make it more noticeable.

Lessons to learn from her case:

  1. One option was to do nothing as her neck certainly wasn’t BAD. But it bothered her enough and I felt I could obtain a good result so I went ahead with her procedure. I’m glad I did as this had a high impact on her (more than most could imagine for such a small “defect”).
  2. Liposuction alone would not have helped her. She needed to have her neck opened to take a look at and possibly treat the underlying muscles—which I did and it provided for most of the benefit.
  3. Sometimes more is more.
  4. It amazes me how relatively small procedures can have a profound positive impact on a patients overall well-being.  The key to success is picking the right patient and performing the right procedure.
  5. A full neck procedure is often reserved for older patients with poor quality skin. This is incisions under the neck and around the ear and in the hairline behind the ear. It is more complicated, lengthens recovery, and is often associated with the use of post-operative drains.
  6. Plastic surgery on the young with great quality skin is often rewarding. It’s nice to be young!

 

Age 43: Neck Lift

This is a 43 year old mother of three who is 5’5” and 130 pounds who was interested in neck rejuvenation. You can clearly see in her pre-operative photographs that she has a full neck with no neck angle and poor definition of her jawbone (it appears like her face runs right into her neck without the usual break you would see from the outline of the jawbone).

She is seen here after an anterior neck lift (this is liposuction of the neck and then contouring of the muscle, skin and fat from an incision beneath the chin). There is no incision around or behind the ears and NO skin was removed. She is seen here about 8 months after her surgery.

You can clearly see a big difference in her appearance:

  1. The side view is much more dramatic than the frontal view. This is similar to the results of most nose jobs.  Most patients complain that they don’t like their profile appearance in photographs—that is why they sought treatment.
  2. There is an improved neck angle and much less fullness in her neck and the area beneath her chin is much flatter and angulated than before.
  3. The scar beneath the chin hides well in the natural crease.
  4. The results are not perfect. There is some skin laxity evident and the contour isn’t like a twenty year old. It is impossible to obtain a “perfect neck” with any technique. There are degrees of improvement, and in her case a TON was achieved through a small incision with a “simpler” procedure.
  5. This option that she choose was based on the fact that she is younger and that her skin still has some youthful elasticity that would help you achieve a nice result with good skin retraction. More advanced aging might require a neck lift with incisions around the ear and behind the ear in the hairline (a full neck lift).
  6. Liposuction of the neck alone can help in some cases, but making a small incision beneath the chin to look for the fat BENEATH the muscle can make all the difference between a good result and an amazing result. There are TWO levels of fat on the neck and only the fat beneath the skin can be treated with liposuction. The fat beneath the muscle needs to be removed directly by your surgeon and the separated muscles sutured.
  7. The recovery time with an anterior neck lift (limited neck lift) is shorter than a more complex full neck lift with longer incisions in different areas.
  8. Poor necks tend to run in families. Most patients complain of the necks that they see in their mothers or fathers and they will usually reach a point as they get older and seek out someone to help the situation before it gets too noticeable.
  9. Using neck compression garments and a dough roller on the skin of the neck helps the skin retract nicely and evenly. Patients who “work” their neck with a roller device and massage will reap the benefits of their efforts tremendously.
  10. A full neck lift in the future as she becomes older is always an option for continued improvements. Avoiding the more extensive scarring associated with more complex procedures when you are younger is a good thing. Everyone prefers doing less complex procedures but not at the expense of an unsatisfactory result because you actually would have benefited from more (more is more and less is less). Your surgeons judgment is critical to help you determine what is best for you, taking into consideration your anatomy, goals, recovery time, general health and expectations.

Age 46: Necklift

This is a 46 year old mother of three who was interested in improvements to her neck area. She had good skin, a weak chin and fullness of her anterior neck that that was unflattering. She is seen here after simple liposuction alone. Note the improvement in her neck angle and overall appearance. Not all patients are good candidates for liposuction alone of their necks. The biggest limiting factor in quality outcomes is the quality of the skin. Great skin with good elasticity is needed for best results. For those who are not as lucky, open neck lifts and skin removal may be needed to obtain the desired result.

Age: 51 Facelift/Necklift

This is a 51 year old female who desired facial enhancements. She wanted improvements in her neck and jowls as well as her nasolabial folds (the two skin folds that run from each side of the nose to the corners of the mouth). She had a small amount of skin excess on her upper lids. She was an attractive woman in general, so any consideration of enhancements had to keep that in mind.The question for the surgeon is what to do?

So this is where the “art” comes in, not to mention experience and self-limitations. This is what makes one surgeon different from another. What to do also very much depends on what the patient wants–his or her goals. An experienced surgeon will take into consideration that most patients have tremendous anxieties and fears and they often prefer to limit procedures so there is less risk and cost.

To provide them with what they think they want or what the surgeon knows will bring them to where they want to be, this is the educational part of all patient discussions. It is important to develop an understanding of the makeup of the patients personality, goals and fears, not to mention their expectations. There are times to “dabble” with less invasive, non-surgical modalities and then there are times to get it right, with procedures that have withstood the test of time (face lift, blepharoplasty, neck lift and brow lift for example).

In her case, in my experience, the best way for me to make improvements in her neck, jowls, nasolabial folds and jawline is to perform a face lift and neck lift with incisions around her ear and under her chin–a whole lot of improvements were accomplished through these very limited incisions. I performed a skin upper lid blepharoplasty and a full face TCA or acid peel to improve the appearance and texture of her skin. She is seen here 12 days after her procedures. She is a good healer, and in general, it would take somewhat longer for most patients to look as good as she does after surgery.

From the patient:

Dr. Caridi…

I’m not sure I can conjure the perfect words to express how I’m feeling after looking at my before and after pictures. I am so incredibly happy with everything you have done for me…the results are far beyond my expectations! Thank you so much for taking the time to work with me to come up with just the right plan for my procedure and for your artful execution…I am truly touched by the results.

Warmest regards to you and your staff…

Age: 54 Neck Lift, Neck Lipo, Chin Augmentation

This patient desired a chin implant for a “weak chin.” She was also interested in improvements in her neck area. She is seen here about a year after an anterior neck lift and a “Porex” chin implant. The chin implant was placed on the lowest, most anterior portion of her chin bone and the neck “lift” was performed through the same incision beneath her chin. I contoured her neck by performing liposuction of the area including her jowls, and removing a small amount of fat beneath the neck muscle, and suturing the neck muscles together for an improved neck angle and a flatter area beneath her chin.

A chin implant is an impressive method to improve the proportions of the face, add “character” to a weak jaw, and improve the appearance of the neck.

Age: 39 Neck Lift

This male patient desired improvement in his neck area. He says a weak chin runs in his family. On examination he has a relatively weak chin and a significant amount of fat about his neck. He says that no matter how much weight he loses he still seems to always have a full neck.

He is seen here after an anterior neck lift that included liposuction of his cheeks and jowls and neck (75cc fat removal). This means an improvement of the neck obtained by manipulating the fat and muscle through an incision below the chin. This hides very well. These photographs are taken four weeks after his surgery.

We decided not to place a chin implant because I felt that it would be possible to obtain much definition of his neck without it. We could also always put one in down the line if he felt that it was necessary. A chin implant is ideal in many cases but none better than those who have a very weak chin bone. It’s a fantastic way to add fullness and balance to the lower face (harmony). The implants that I generally use are the non silicone variety as they stay where I put them and provide for impressive outcomes.

A “neck lift” can mean many different things to different people and surgeons. I have found that with a combination of liposuction and an incision beneath the chin that I can accomplish a lot in those patients who still have relatively good skin. Although no skin is actually removed, the skin retracts well in the majority of cases. Older folks and those with loose skin generally will need a procedure that also removes skin. The muscles in the anterior part of the neck are usually tightened as well. The benefit of an open approach to the anterior neck is that it’s possible for the surgeon to look beneath the muscle for a fat pocket beneath the muscle. In many cases the reduction of some of this fat can enhance the results tremendously. Liposuction alone does not remove this tougher, fibrous fat and it is very difficult to determine which fat is where without looking.

A chin implant is quite powerful. When used in the right patient the benefit is very gratifying. Problems associated with chin implants include infection and rotation of the implant as well as other issues. In the best of hands, however, it is a very reliable procedure. In some cases it takes patients time to get used to the new look when an implant is used. Too large of an implant in women can make them look masculine. Chin implants are often used at the time of a rhinoplasty (nose job) to enhance balance and harmony of the facial features.

Age: 35 Neck Lift

This young woman says she always had had fullness of her neck no matter what her weight is. She had good skin with fullness in the anterior part of the neck. There was no evidence of banding of the muscles and her submandibular glands were of normal size.

She is seen here four months after a neck liposuction performed from two tiny incisions beneath the chin. I removed about 45 cc’s of fat. This was performed with IV sedation. Note the obvious improvement in the contour of her neck. There is an improved neck angle and the submental (area beneath the chin) is much flatter than it was before.

Younger patients are more likely candidates for liposuction alone of the neck because they have better quality skin. Senior folks, or those with poor skin often benefit from an anterior neck lift with the incision beneath the chin and greater work on the neck muscle and skin. Incisions behind and around the ears is needed in those who have very poor skin that won’t retract well with an approach from under the chin alone.

Oftentimes it is important to make a small incision under the chin to look for fat that is beneath the muscle that can’t be removed with liposuction alone-if there is a fair amount of fat here the benefit can be enormous. It’s impossible to tell on exam alone where the fat is.

We used sedation in this case because of patient preference. Most people enjoy the benefit of anesthesia to make their experience more comfortable and less stressful. It takes up to a year for the skin to soften after a typical neck lift/liposuction. This is a very rewarding procedure for patients because it makes them look much younger especially when they see themselves in photographs taken from the side view.

Age: 38 Anterior Neck Lift

This is a female patient who is 145 pounds. She was interested in what could be done for her neck. She says it’s “full” and poorly defined. She is seen here after an anterior neck lift. This typically involves an incision in the crease beneath the chin, liposuction or direct removal of fat on the skin flap, and reduction of fat beneath the muscle of the anterior neck. There is also wide skin undermining to allow a redistribution of the skin during the healing phase. You can clearly see the dramatic improvement in the neck and in her face in general. She looks thinner and more youthful. A full neck lift involves incisions behind the ear and skin removal. This is best for older patients or younger ones that have particularly poor, inelastic skin. It’s impressive the improvement that can be obtained from the anterior neck lift procedure that does not involve skin removal. The fat is reduced and the muscle is tightened only. The recovery is shorter than a full neck lift. This procedure is very popular with my patients.

Age: 49 Endoscopic Brow Lift and Neck Lift

This woman was interested in facial rejuvenation options. We discussed all alternatives, including a full face and neck lift. We elected for a brow lift and blepharoplasty as well as liposuction of her neck and lower face without any lifting procedures (I felt we could obtain an impressive result with smaller procedures). She is seen here five months after her plastic surgery. It is important to note that she has lost 30 pounds with the help of weight watchers. The surgery that we performed provided the incentive for her to lose the weight.

The important take home point is that weight loss alone can have a TREMENDOUS impact on your appearance. Look at the details of the photos including the size of her neck and the contour of her lower face. If you need to lose weight I would do this before plastic surgery. It’s unfortunate though that many patients can’t lose the weight without the help of plastic surgery but this is not without the risk of continued weight gain after your plastic surgery investment. This is why it is so important that your surgeon has the experience and judgment as to when to turn a patient away from surgery if he/she feels the outcome will not be in the patients best interest. This patient could have easily gained weight after this liposuction in which case the fat would have appeared unnatural in its distribution.

Age: 51 Neck Lift

This female patient is 5’1″ and 120 pounds. She desired improvement of her neck. I elected to perform an anterior neck lift procedure (an incision beneath the chin with wide undermining of the skin, tightening of the muscles, and fat removal as needed–NO skin is removed). She is seen here at five months after the procedure. Note the improvement in the overall countour, a flatter area beneath her chin, and a crisp neck angle. She has lost 10 pounds which has contributed significantly to her beautiful result.

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