A neck lift is a surgical procedure that tightens loose skin and muscles between the jawline and collarbone, typically taking one to three hours. It combines up to three techniques depending on what’s causing the sagging: removing excess skin (cervicoplasty), tightening the underlying neck muscle (platysmaplasty), and removing or suctioning out fat. Here’s what actually happens before, during, and after the procedure.
Anesthesia and Surgical Setting
Neck lifts are performed under general anesthesia or local anesthesia with sedation. General anesthesia is more common, but some surgeons offer local anesthesia for patients who are good candidates. The procedure doesn’t require a hospital stay. It can be done in a hospital, an outpatient surgical center, or even a private surgical suite in a surgeon’s office. You go home the same day.
Where the Incisions Go
A traditional neck lift uses two incision sites. The primary incision starts in the hairline near the sideburn, continues down and around the ear, and ends in the hair behind the ear. This gives the surgeon access to the skin and muscle along the side of the neck and jawline while hiding the scar in natural creases and hair.
A second, smaller incision is often made under the chin. This one serves double duty: it’s the access point for liposuction beneath the chin and for repairing the platysma muscle that runs down the front of the neck. Not every patient needs both incision sites, but most do.
Removing Excess Fat
If there’s extra fat beneath the chin or along the neck, the surgeon addresses it first. For patients with good skin elasticity who mainly have stubborn fat deposits, liposuction alone through the under-chin incision may be enough. A thin tube is inserted to suction out localized fat that hasn’t responded to diet or exercise.
When fat sits deeper, beneath the platysma muscle, the surgeon may need to directly remove it rather than suction it. Deeper structures like pads of fat below the muscle, the muscles under the jaw, and even the salivary glands near the jaw can all contribute to a heavy or undefined neck contour. In these cases, the surgeon works through the submental (under-chin) incision to precisely manage each layer.
Tightening the Neck Muscle
The platysma is a broad, thin sheet of muscle that spans the front of the neck. Over time, its two halves can separate in the middle, creating visible vertical bands. During platysmaplasty, the surgeon accesses this muscle through the incisions under the chin, behind the ears, or both. The separated edges of the muscle are stitched together along the midline, recreating a smooth, firm sling across the neck. In some cases, a portion of the muscle is removed entirely to reduce bulk.
Removing and Repositioning Skin
Once the deeper layers are reshaped, the surgeon addresses the skin itself. Through the incisions around the ears, the skin of the neck and lower face is lifted away from the underlying tissue, then redraped in a tighter position. Excess skin is trimmed away, and the remaining skin is secured with stitches or tissue glue. This step, called cervicoplasty, is what eliminates the visible sagging and creates a cleaner jawline.
The amount of skin removed varies significantly from person to person. Someone with moderate laxity might need only a small adjustment, while a patient with significant loose skin after major weight loss could require removal of several inches of tissue.
What Recovery Looks Like
The first day after surgery is the most uncomfortable. You’ll feel groggy from anesthesia and will need someone to drive you home and stay with you that night. Pain medication is typically most needed on day one. Your surgeon will fit you with a compression garment that wraps around your head and under your chin, designed to reduce swelling and support the newly tightened tissues.
Around day two, you’ll have a follow-up visit where your surgeon removes or changes the surgical dressings and checks the incisions. The compression garment needs to be worn continuously, day and night, for one to three weeks, removing it only to shower. After that initial period, your surgeon will likely have you continue wearing it at night for several more weeks. It should feel snug but not tight enough to restrict breathing or cause pain.
Sutures come out anywhere from the end of the first week through week three, depending on how you’re healing and the specific techniques used. By the end of the second week, most people feel well enough to return to work and start light activities like walking. Swelling and bruising take longer to fully resolve, often several weeks, and the final result continues to refine over a few months as tissues settle into their new position.
Risks and Complications
The most common surgical complication is hematoma, a collection of blood beneath the skin, which occurs in roughly 3% of neck lift procedures. If it develops, it typically needs to be drained promptly.
Nerve injury is the other notable risk. The nerve most frequently affected is the great auricular nerve, which provides sensation to the ear and surrounding skin. Damage to it can cause numbness around the earlobe. The most commonly injured motor nerve is a branch of the facial nerve that controls the lower lip. Injury to this nerve can cause temporary or, rarely, permanent weakness when smiling or making facial expressions. Choosing a board-certified plastic surgeon with significant neck lift experience is the most practical way to reduce these risks.
How Long Results Last
A neck lift doesn’t stop aging, but the improvements are long-lasting. Most patients can expect results to hold for 10 to 15 years, though this varies with genetics, skin quality, sun exposure, and weight fluctuations. The muscle repair and fat removal are essentially permanent. Skin will continue to lose elasticity over time, but from a significantly better starting point than before surgery. Over 22,000 neck lifts were performed in 2024, making it one of the more established facial plastic surgery procedures.