A rhytidectomy, commonly known as a facelift, is a surgical procedure designed to address the visible signs of aging in the face. It focuses on repositioning underlying tissues and removing excess skin to restore a more youthful appearance. The facelift remains one of the most frequently performed cosmetic surgeries globally, reflecting its effectiveness in facial rejuvenation. Its purpose is to counteract the effects of gravity and loss of elasticity over time.
The Scope of a Modern Facelift
A modern facelift, particularly what is often termed a “lower facelift,” is designed to rejuvenate the lower third of the face and the adjacent neck region. The primary goal is to address jowling, which is the sagging of skin and fat along the jawline, and the descent of the lower cheek tissues. Restoring a defined jawline is impossible without treating the skin and tissue immediately below it.
Therefore, the modern standard of care almost always includes the upper neck to ensure a cohesive and natural-looking result. The surgeon typically extends the tissue tightening and skin removal process up to the cervicomental angle, which is the angle formed by the chin and the neck. This inclusion helps eliminate the appearance of a double chin and creates a sharper transition between the face and neck.
The extent of neck inclusion is determined by the patient’s anatomy and the surgeon’s technique. It generally involves manipulating the superficial musculoaponeurotic system (SMAS) layer in the lower face and upper neck. By lifting and repositioning these deeper tissues, the surgeon improves the definition of the jawline and the upper neck without relying on excessive skin tension. Without this combined approach, an improved jawline may contrast sharply with a loose, aging neck, resulting in a less harmonious outcome.
Dedicated Neck Lift Procedures
For patients with more advanced signs of aging in the neck, a standard facelift’s incidental neck correction may not be sufficient. In these cases, a dedicated neck lift, often referred to as a lower rhytidectomy, becomes necessary to achieve optimal results. This dedicated procedure focuses solely on addressing significant skin laxity and muscle banding below the jawline.
A neck lift typically involves two main components: cervicoplasty and platysmaplasty. Cervicoplasty is the technique used to remove excess, sagging neck skin, which is effective for those with a “turkey wattle” appearance. Platysmaplasty, conversely, focuses on the platysma muscles, which are thin sheets of muscle that run vertically in the neck.
These muscles can separate and weaken over time, creating highly visible vertical bands. Platysmaplasty involves suturing and tightening them to create a smoother, firmer neck contour. The procedure may also include submental fat removal through liposuction, often performed through a small incision placed discreetly under the chin. A full neck lift can be performed alone or in conjunction with a facelift when significant correction is needed.
How Facelift Variations Determine Neck Inclusion
The term “facelift” is broad, and the extent of neck treatment varies significantly based on the specific surgical technique chosen. The lower facelift is the variation most likely to include comprehensive neck treatment, focusing on the entire lower third of the face and neck. This approach is ideal for patients with neck laxity and moderate jowling, often extending the repositioning of the SMAS layer down into the neck.
In contrast, a mini-facelift, sometimes called an S-lift or short-scar facelift, is a less invasive option that focuses primarily on the upper jowls and cheeks. These limited-incision procedures are intended for patients with mild to moderate facial sagging and often exclude significant work on the deeper tissues of the neck. While a mini-facelift may offer some improvement to the jawline, it typically does not address pronounced skin folds or muscle banding in the lower neck.
Advanced techniques, such as the Deep Plane facelift, offer a more integrated and dramatic improvement to the neck and jawline. This technique involves releasing and repositioning tissues beneath the SMAS layer. It provides a unified lift to the mid-face, lower face, and neck structures, achieving a powerful, long-lasting contouring effect that seamlessly connects the face to the neck.