A facelift, or rhytidectomy, is a surgical procedure designed to reverse visible signs of aging by addressing the descent of facial tissues. While the name suggests an exclusive focus on the face, the modern, comprehensive approach almost always includes the neck. Practitioners now recognize that a seamless, natural-looking result requires treating the face and neck as a single aesthetic unit. Ignoring the neck while tightening the face can create an aesthetic mismatch, making neck correction the standard of care for achieving overall harmony.
Defining the Traditional Facelift Scope
The traditional facelift procedure historically focused on the lower two-thirds of the face. The goal was to combat skin laxity and the descent of the superficial musculoaponeurotic system (SMAS). Techniques like SMAS-plication were designed to lift and reposition these sagging structures.
The primary anatomical concerns addressed were deep nasolabial folds and the elimination of jowls. Jowls are formed by the sagging of fat and skin along the jawline, obscuring the definition of the mandibular border. While the traditional procedure improved the jawline contour, its technical reach often ended there, leaving the area below the chin and neck largely unaddressed.
This historical focus meant that significant signs of aging in the neck could remain even if the face looked refreshed. This distinction led to the development of the “neck lift” as a separate or standalone procedure.
The Role of Neck Correction in Facial Rejuvenation
The neck area shows visible signs of aging early. The skin is thinner and more susceptible to environmental factors like sun exposure, leading to the breakdown of collagen and elastin. As a result, patients often present with skin laxity, horizontal neck creases, and a loss of definition in the angle between the chin and neck.
One defining sign of an aging neck is the appearance of vertical platysmal bands, often referred to as “turkey wattle.” These bands are caused by the separation and tightening of the platysma muscle. Over time, the medial edges of this muscle can splay or contract unevenly, creating prominent vertical cords that age the appearance of the lower face and neck.
Another common concern is submental fullness, the accumulation of excess fat beneath the chin. This fat obscures the natural contours of the jaw and contributes to a “double chin” appearance. Correcting these issues is necessary because a tightly lifted face paired with an aged neck creates a distracting aesthetic discontinuity, requiring the neck to be addressed for a harmonious appearance.
Surgical Approaches for the Neck Area
When the neck is included in a comprehensive lifting procedure, it requires a combination of techniques to address the three primary components of aging: fat, muscle, and skin. The initial step involves cervical liposuction, where a cannula is inserted through a small incision, typically hidden beneath the chin, to remove excess submental fat deposits.
Addressing the muscle component involves platysmaplasty, designed to correct visible platysmal bands. Through the same submental incision, the surgeon accesses the platysma muscle and tightens the loose or separated edges by suturing them together in the midline. This internal muscle tightening smooths the vertical bands and sharpens the cervicomental angle.
The final stage involves excising and redraping the excess skin smoothly over the newly contoured neck and jawline. This is typically done through incisions that start in the hairline near the sideburn, continue around the ear, and end in the posterior hair. By combining fat removal, muscle tightening, and skin removal, this comprehensive approach ensures that both the facial and neck contours are unified.