Facelift, neck lift, mini facelift, LifeStyle lift, Quick lift, SMAS lift, deep plane facelift, MACS lift, his lift, her lift, your lift, my lift. It is so confusing! Even I get confused and I am a plastic surgeon. When considering facial cosmetic surgery, it is almost impossible for you, the cosmetic surgery patient or consumer, to know exactly which procedure will give you the best results, especially when it comes to your face. There are so many different procedures, surgical and non-surgical, to choose from! In addition, there are plastic surgical procedures that focus on one specific feature of your face while others concentrate on improving an area or your whole face and neck. If you are considering one of the many so called age erasers that the cosmetic industry offers but are not sure which ones are best for you then read on. I will try to bring some clarity to the facelift or neck lift conundrum.
In her book “I Feel Bad About My Neck: And Other Thoughts On Being A Woman”, Nora Ephron turned the taboo topics of physical decline, emotional regrets and mental challenges into wry comic fodder. She advised readers to begin neck coverage by age 43, because makeup, Botox and other visual tricks for your face can be easily betrayed by the sight of a bare neck: “Our faces are lies and our necks are the truth. You have to cut open a redwood tree to see how old it is, but you wouldn’t if it had a neck.” I am not sure that you need to cover your neck when there are great treatment options for fixing that saggy neck Ms. Ephron is talking. What if the problems of aging are showing up in your face and not your neck and you probably need to do something if it really bothers you.
Let’s Talk About Facial Aging (and the Neck)
As we age we get smaller. Literally. Think about those 90-year-old folks you have met or know. They will tell you that they are much smaller than they once were. This is a gradual process that starts somewhere in your 20’s. Your skin loses collagen and you lose muscle mass and bone mass as you get older. In addition, your skin loses elasticity (it essentially stretches). Although this happens throughout your body, your face seems to show aging sooner. As the skin of your face loosens and the tissue loses volume, your facial skin begins to hang on your face, Wrinkles begin to appear, fat bags seem to come out of nowhere and everything seems to descend towards the bottom of your face.
Plastic Surgery to the Rescue: Neck Lift or Facelift?
What Exactly is a Facelift?
Let us start with some basics. Many are confused about what areas facelift surgery will help. For instance, many people think that a facelift involves tightening the whole of your face, including your forehead. In fact, a traditional facelift focuses on the lower region of your face. This region includes everything from underneath your cheeks down towards your chin and jaw and includes your neck. The skin is pulled back towards the hairline and any extra tissue is trimmed away. Pockets of extra fat can also be removed if necessary. This procedure smooths out wrinkles in your cheeks and tightens the skin around your chin and jawbone and neck.
How is the Neck Lift Different?
As mentioned, the neck is one of the first areas of the body to show signs of aging. Loose skin, loose muscles and sometimes excess fat under your chin combine to make you look older, and sometimes heavier, than you really are. The aging in the neck and accompanying jowls often result in the dreaded double chin or “turkey gobbler” look that is sometimes called a neck waddle.
A neck lift is a surgery that is designed to improve the appearance of your neck by tightening and smoothing your saggy neck skin muscles so that your neck and jaw line become more defined. Extra fat deposits under your chin are also removed or repositioned. It is very important that this procedure is done correctly. If a neck lift is pulled too tight, or lifted excessively, it may make your neck uncomfortable or not look right as compared to your face or your chest. Under correction or lifting will not have as noticeable of an impact and you may be left with only disappointment rather than a better-looking neck. When a neck lift is performed correctly, your chin and jaw are well-defined without any excess skin or fat around your neck.
A Neck Lift and a Facelift Are Very Similar
A neck lift and a facelift are similar or related surgeries. The neck lift, simply focuses on the lower face or everything from your chin area or jowls, along the jaw line and down to the base of your neck. A facelift deals, not only with the lower region of your face but also the region from your jaw line to just below your eyelids. The two areas are obviously connected and combined, can have a big impact on how you look.
In summary, you may need to have a neck lift if your problems, concerns and goals all revolve around your neck. If your problems extend up into the mid-face (the area that is defined or bordered by your lower eyelid area, your ears, your jaw line and your marionette, laugh line, side of your nose) then you need a facelift. Rarely do we see a patient who only needs their mid-face or cheek area lifted and not their neck, but if we do that will be an upper facelift.
Because the mid-face and the neck are so close together, it’s not uncommon for plastic surgeons both in the same surgery or full facelift. However, patients sometimes say that a facelift is too much for them. Most plastic surgeons will only suggest the larger surgery if they think that is what you need to get a good result. In addition, many of the newer techniques like a MACS facelift are much easier on you. Creating smoother and tighter skin in both your neck and your mid- face can often produce have a far more dramatic impact on your face in terms of creating that more youthful, refreshed look you want, than each procedure would individually.
What is the Difference Between All the Other Facelift and Neck Lift Terms?
It is all semantic confusion. For instance, a LifeStyle Lift is really a company that trademarked the term and had facelift offices around the country until they went bankrupt. It is synonymous in the plastic surgery world with a smaller or shorter incision, which is good, and an operation that only lifted the skin, which is bad, since your skin will soon go back to where it was unless the underlying structures are lifted and supported. A Quick lift, an S lift and other lifts that imply an easy “face fix” are similar operations. They are really marketing terms for a short scar, skin only, limited facelift.
A MACS lift, SMAS facelift, SMASectomy facelift, deep plane facelift and traditional facelift are all very similar operations. Some employ extended incisions, which may not be necesary. These terms imply the internal supporting structures of your face will be lifted and supported in some ways. This is good since it will give longevity to your procedure. These facelifts are technical terms for how a procedure is done, often to get the same result. Many surgeons will say ’their way is better” and it may be, in their hands. Numerous studies however, have shown that there is little difference between most techniques in term of results and longevity, which is what matters most to patients. Some facelift techniques have more complications. For instance, a deep plane facelift, if done properly, takes longer, has more swelling and has more potential for nerve complications. In fact, some of these technical descriptions are used for for marketing purposes.
Neck Lift Terms
Thankfully there are not as many neck lift terms to deal with. In addition to the term neck lift, there are also terms like:
- platysmaplasty which is a tightening of the muscles between the chin and your collar bones done through a small incision under the chin.
- neck liposuction which is not really a lift but, if you have extra fat under the chin, liposuction can give the appearance of a neck lift. Neck liposuction will not improve things if you have extra skin.
- Kybella is a non-surgical injection for fat removal injection that gives similar results as liposuction and can also “lift” the neck.
- Suspension lift is a set of quilting sutures lift that are placed under the skin of the neck. These sutures are usually attached to the tissues just below your ears and are placed under the skin to give a lift to the neck by creating a “hammock” of sutures under your chin. In the right hands this can be an effective solution to the saggy neck when an “in between” approach is needed.
How do I know which Facelift is best for me? A Facelift or a Neck Lift?
Knowing whether you need a neck lift or a facelift comes down to what you want or what your cosmetic goals are. Do you have trouble with loose skin and a double chin around your neck? Do you have wrinkles around your cheek? Does your jawbone need better definition? By answering these questions first, you will likely be able to figure out what you will need or what is best for you. If you come to see me for facial wrinkles or a saggy neck, knowing your goals for surgery will help the two of us decide what procedures will help you reach those goals.
What About a Mini Facelift or Mini neck Lift?
A mini facelift or mini neck lift, at least as I define them, are really a smaller or limited version of a facelift or neck lift. In other words, short scars are used and less skin is raised to tighten the cheeks, jowls and neck. A mini lift, mini facelift or mini neck lift is simply a less aggressive surgery. It is really for the patient who has a little sagging skin and wants more of a result than fillers can produce.
Non-Surgical Options for Neck Lifts and Facelifts
“Do I really have to have surgery?” is a common question. Well you never NEED to have an elective cosmetic surgery. You can always go without any intervention but that is likely why you are reading about facelifts, neck lifts and facial rejuvenation.
One of the reasons you are looking “more mature” is that you have lost volume. Thus, adding some volume back to the right areas can go a long way to restoring that more youthful look. Volume can be added by:
· Fat Grafting
Fat grafting is a routine way to add volume back to your face that is used by a lot of plastic surgeons and dermatologists. It is not without its problems, however. First, you must have enough fat somewhere and, if you do have enough fat, a surgical procedure, liposuction, is needed to harvest it. Most patients and surgeons do not see this as much of a problem. The much larger concern with fat grafting is the unpredictability of fat. A quick search for fat graft survival on Google scholar will bring up a number of articles that show that fat is not that great since only 35% to 85% of fat injected as a filler will survive the first year. That is a problem in the face because we cannot predict what the final result will be.
Unlike fat grafting, facial fillers like Juvederm, Restylane and Radiesse are all very predictable and can give very nice results in the right places and in the right patients. They are, however, a temporary fix since they only last, at the most, 24 months.
As an individual who appreciates value, I would much rather pay a little more for something that will last longer. For that reason, I embrace Bellafill which is a long term filler for your face. It has now been shown to have no volume drop off at 8 years, stimulates your body to make its own collagen, feels and looks very natural and is 100% predictable in terms of results as opposed to fat grafting. I use it routinely for facial rejuvenation. Bellafill is FDA approved for the nasolabial folds but can be used almost anywhere in the face. It is tremendous for fixing lower eyelid bags, lip wrinkles and other areas around the mouth that a facelift or a neck lift does not deal with.
Because Bellafill can be used for under the eyes as well as around the mouth it is a great adjunct to facelift and neck lift surgery.
The deep chemical peels for facial rejuvenation can be very effective. Chemical peels such as the Croton oil peel or the modified phenol peel (Hetter peel) can effectively deal with fine lines in the face, tighten the skin to give a “lifted” look and get rid of a lot of sun damage or age spots. The problem is that they can have a significant downtime (up to 14 days) but it is not surgery and some people like that idea.
A Facelift or Neck Lift Consultation
Most importantly, do not bother spending too much time trying to figure out what would be the best type of facelift or neck lift for you but rather spend some time looking at yourself and determining what you want to achieve. Even if you don’t know what would help improve your appearance, a consultation with a qualified plastic surgeon will give you a better idea of what you need. If you come to see me, I will act as your cosmetic consultant. Together we will review your goals for facial rejuvenation, and then I will evaluate your skin, facial structure and the degree of aging that you have. I will give you a list of options for facial and neck rejuvenation and discuss all the pros and cons of each. Knowing that every facial plastic surgery patient would like have less scarring, less invasiveness, and less downtime, together we will arrive at a plan that will help you look younger and more refreshed.
My goal is to give each patient exactly what they need to look their best and feel great about their appearance.