A neck lift, technically known as cervicoplasty or platysmaplasty, is a surgical procedure designed to improve visible signs of aging along the jawline and neck. It addresses concerns such as loose skin, excess fat accumulation, and muscle banding that contribute to a less defined profile. The strategic placement of incisions is designed to keep them hidden within the natural contours of the face and hairline, making them inconspicuous once fully healed.
Primary Incision Placement
The main incisions used for a neck lift are bilateral, mirrored on both sides of the face, and allow the surgeon access to the underlying tissue for lifting and tightening. The path of these incisions follows the natural folds and boundaries of the ear to camouflage the resulting fine line. Typically, the incision begins within the temporal hairline or the small tuft of hair known as the sideburn.
From this starting point, the incision traces a line downward, continuing just in front of the ear. It is often placed strategically within the crease where the ear meets the face or along the rim of the tragus. This careful placement utilizes the ear’s anatomy to conceal the scar from direct view. The incision then curves beneath the earlobe, following the natural contour, before moving upward and settling in the crease behind the ear.
The incision continues from the crease behind the ear into the posterior hairline, extending for a variable distance into the scalp. This portion allows the skin and superficial muscular aponeurotic system (SMAS) to be lifted, repositioned, and secured with the necessary tension to smooth the neck and jawline. The length of the incision in the hairline is determined by the degree of skin laxity and the amount of excess skin that needs removal. By terminating the primary incision within the hair-bearing scalp, the resulting scar is usually covered by the patient’s hair.
The Central Submental Incision
In addition to the primary bilateral incisions around the ears, a separate, smaller incision is often made directly under the chin, referred to as the submental area. This incision is typically small, measuring only 1 to 2 centimeters in length, and is placed within a natural crease or shadow beneath the chin. The purpose of this central opening is distinct, focusing on the center of the neck.
This access point allows the surgeon to address issues deep beneath the skin and fat layers that cannot be reached from the side incisions alone. It is primarily used to perform a platysmaplasty, which involves tightening the edges of the platysma muscle. When the platysma muscle loosens with age, it can separate and form prominent vertical “bands,” and this incision provides the path to suture those edges together.
The submental incision also provides direct access for precise fat removal, such as liposuction or direct excision of localized fat deposits. It enables the surgeon to manage other deep neck structures that may contribute to a full or obtuse neck angle, such as the submandibular glands or subplatysmal fat. Because of its discreet placement in the shadow of the chin, this scar is usually inconspicuous once healed.
Minimizing Visibility and Scar Care
The final appearance of the neck lift incisions is influenced by both surgical techniques and diligent post-operative care. Surgeons employ specific closure methods to minimize scar visibility, particularly in the hair-bearing areas. One method is the trichophytic closure, where the incision is made with a bevel that intentionally cuts through hair follicles.
This technique allows the hair shafts to grow directly through the scar line, camouflaging the fine scar with the patient’s hair. Minimizing tension on the closure is important, as excessive pulling can widen the scar. The deeper tissue is secured to bear the load, allowing the skin to be closed without strain. This tension-free closure promotes a thinner, less noticeable scar line.
Post-operatively, scar management focuses on protecting the healing tissue and promoting maturation. Patients are instructed to clean the incision sites as directed by their surgeon to prevent infection and keep the area moist. Avoiding sun exposure is important for at least six to twelve months, as ultraviolet light can cause fresh scars to hyperpigment, making them darker and more noticeable. Once the incisions have fully closed, topical treatments like silicone gel sheets or creams can help soften and flatten the healing tissue.