By: George Bitar M.D. & Robert F. Centeno M.D.
Board Certified Plastic Surgeons
“I want to look better, but I don’t want a face-lift.” We hear this in our office all the time. We offer a neck lift procedure to our patients who are unhappy with their necks and do not want -or do not need- a facelift. When the neck area begins to sag, it can make you look older. The reasons why men and women choose to have neck lifts in their thirties, forties, and up to their seventies vary from wanting to look good to being able to shave better.
When someone looks in the mirror and is unhappy with their face, it can sometimes be difficult to verbalize why they are unhappy. Assuming that genetics and the aging process play a role in a person’s unhappiness with their appearance, it is important to identify the problem and offer a surgical solution:
If a patient is unhappy with excess fat in their neck but has good skin tone and good muscle tone of their neck, then he/she is a good candidate for neck liposuction.
If a patient is unhappy with excess fat in their neck and has loose skin and/or muscle in their neck, then he/she is a good candidate for a neck lift.
If a patient is unhappy with laxity in their neck as well as their jowls and jaw line then he/she is a good candidate for a mini facelift.
If a patient is unhappy with their neck, jowls, and cheeks then he/she is a good candidate for a face-lift.
If a patient is unhappy with droopy eyebrows and wrinkles in the forehead then he/she is a good candidate for a forehead lift.
An initial consultation is set-up where we discuss the neck lift procedure and whether you are a good candidate for the surgery. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are asked to stop smoking, if you are a smoker, two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery that you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.
We perform the suture suspension neck lift technique. This technique requires one and a half hours to perform on the average, and you go home a couple of hours later. It involves making small incisions under the chin and behind the ears, which are easy to hide. The neck muscles are tightened, the excess skin is trimmed, and the neck is sculpted with a small liposuction wand to create a more aesthetically pleasing neck. A special suture is used to lift the muscles and give the neck a long-term youthful look, as well as a well-defined jaw-line, despite the pull of gravity and the aging process.
We use a special FDA approved fibrin sealant to speed up the recovery process and decrease the amount of swelling and bruising, typically encountered in this procedure. As a result, we have had high patient satisfaction due to the decrease in “downtime” from work and social events.
This technique requires three hours to perform on the average, and you go home a couple of hours later. It involves making small incisions under the chin and behind and in front the ears, which are easy to hide. The neck muscles are tightened, the excess skin is trimmed, and the neck is sculpted with a small liposuction wand to create a more aesthetically pleasing neck.
By use of the special FDA approved fibrin sealant, recovery time, bruising, swelling, and pain are decreased significantly.
The scars are practically hidden behind the ears and under the chin. No scars appear in front of the ears.
This neck lift technique enables a patient who is only bothered by their neck to have an excellent long-term alternative to a face-lift.
This technique is flexible and can be adjusted to different shapes of necks with varying amounts of fat, laxity of skin, and laxity of muscle, with excellent long- term results.
If a patient has significant aging of their face and are a good candidate for a face-lift then a neck lift may not be sufficient.
The special suture used to create a well-defined jaw-line may be tight the first few days causing discomfort, but the discomfort disappears in a couple of weeks usually. This is a great trade-off given the long-term results that this technique affords the patient.
At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible , anticipating problems or set-backs, and addressing them before they happen. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class hospital with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.
Bleeding after a neck lift is rare. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. The use of tumescent solution before liposuction of the neck is performed during a neck lift minimizes bleeding. Furthermore, the use of the special fibrin sealant minimizes bleeding as well. In my practice the rate of significant bleeding is less than 1%. The treatment of a hematoma or a blood clot under the neck skin is to open the incision and evacuate the blood clot. Typically this is a straightforward procedure.
The most important step in avoiding infections, in my opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, my patients are prescribed a one-week course of antibiotics to minimize infection. As a result of these extra precautions, my rate of infection after a neck lift is extremely rare. It may occur at the superficial incision level behind the ears where the tension is highest, and a small open wound may occur which will usually heal nicely with dressing changes and antibiotic ointment.
In a neck lift, there is manipulation of a relatively large amount of skin and the closure of skin under some mild tension. Because the incisions are under tension, there can be either loss of some skin or a small opening of the wound behind the ears. This is treated with dressing changes and cleaning of the wound in the office as needed. This can occur in about 1% of patients. Usually the wounds heal very well and nothing further needs to be done with nicely hidden scars. Very rarely, we will do a scar revision to improve the appearance of that scar.
One advantage of a neck lift over a face lift is that there are fewer nerves in the neck that may be affected by surgery. The result is a minimal rate of nerve injury. In rare instances, temporary loss of sensation from a “stunned” nerve or a bruised nerve may occur in the time period after surgery. This may result temporarily in an uneven smile, but full nerve function usually returns within days to weeks.
Smoking is an absolute contraindication in neck lift. The carbon monoxide and nicotine in cigarette smoke causes severe reduction in blood supply to the skin and breast tissue during healing. This results in delayed wound healing, wound separation, death of the skin, and a higher risk of infection. Cotinine testing is performed in patients with a smoking history to ensure that they are safe when having this procedure.
Our office will provide you with a detailed post-operative instruction sheet that will be individualized to your needs. I usually see patients the day after surgery in one of our offices to make sure that everything is O.K., and that you are healing as planned. Multiple visits in the year after the procedure will ensure the best outcome possible.
For more information about this procedure, please visit our website at www.DrBitar.com , or call our office and speak to our friendly staff member at 703-206-0506.
Information on this web site is for information only. Do not use the information to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.
Algorithm for Simplified Neck Rejuvenation
A book chapter written by Dr. George Bitar and Dr. Vincent Giampapa in the book "Simplified Facial Rejuvenation" by Mel Schiffman et. al.
Before You Go to New York for Cosmetic Surgery...
"If you want the best bagel, you go to Zabar's, the best show you go to Broadway, and the best neck lift, you go to New York. So, I did, and I learned how to perform the best neck lift there."
A New Neck Lift Technique
"When the neck area begins to sag, it can make you look older than you are. With this in mind, both men and women in their thirties and forties are having neck lifts and not waiting for their faces to sag to get a facelift."
Use of Fibrin Sealant in Neck Contouring,
Aesthetic Surgery Journal, Nov/Dec. 2002, 22(6)519-525
(VIEW ARTICLE HERE) (.pdf)
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Before & After
Pain Level After Surgery
|Duration of Surgery||1 hour|
2 minimal scars behind the ear
|Final Results||6-12 months|
|Return to regular activity||1 week|
|Resume Exercise||4 weeks|
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