Neck and décolletage lift: technique of the operation

Plastic surgeries are performed on almost any part of the body, including the neck. For example, such a popular surgical procedure as a neck lift allows people to get rid of such an aesthetic problem as sagging skin under the chin. Other methods fail to eliminate this defect, so platysmoplasty (as a neck lift is called in surgery) is considered a fairly common complex of surgical interventions.

Indications for the procedure

There is relatively little fatty tissue in the neck area. Sagging skin develops with age, and both the small fat layer and the structural features of the subcutaneous muscles, called the "platysma", are largely to blame. This is a thin muscle element located directly under the skin and fused with the dermis. In many people, the platysma does not have a continuous surface, but is distinguished by separate muscle clusters, which become dehydrated with age and lose their functionality.

Anatomically, the platysma is classified as a facial muscle, so it does not participate in the motor activity of the neck, but is activated only against the background of certain emotional states - for example, when a person experiences severe pain, or is very scared or angry. Since we experience such emotions, frankly speaking, infrequently, the platysma is almost always in a relaxed state. With age, blood circulation in the tissues of the neck slows down, the muscles become less elastic and flabby. As a result - sagging skin under the chin, drooping corners of the mouth, etc.

In what cases can a patient be recommended to undergo a neck lift? First of all, age-related defects are considered an indication, as well as those that have formed due to individual features of the neck structure, or as a result of a certain lifestyle. Most often, women over 25-30 years old seek the help of a surgeon for a neck lift. Older patients undergo a lift to correct such problems as "turkey neck", "rings of Venus", and a double chin.

Turkey neck is a defect that develops with age in absolutely all people, as it is associated with the natural loss of elasticity of the skin and muscle tissue.

Rings of Venus are a common aesthetic defect caused by excessive accumulation of fatty tissue in the neck area. This, in turn, is associated with a gradual weakening of blood circulation and a slowdown in metabolic processes. Externally, the problem looks like the formation of peculiar ring-shaped thickenings around the neck.

A double chin is an equally common problem, associated not only with excess weight, but also with age-related tissue thickening in the neck area.

Any of the listed shortcomings can be corrected with the help of a proper neck lift.

Preparation

Before referring a patient for a neck lift, the doctor will necessarily conduct a preliminary assessment consultation: it is necessary to determine the degree of age-related or other tissue changes, assume the scale of the upcoming intervention, and choose the most appropriate type of surgery. The doctor will ask the patient about the problems that bother him, about possible contraindications to a neck lift, about the defects that need to be eliminated and corrected. In addition, the patient will be informed about how the neck lift will be performed, how long the procedure will last. The doctor will definitely provide information about the further rehabilitation period and about possible consequences and complications.

In preparation for a neck lift, the patient will undergo a diagnostic examination. Preoperative images will also be taken to subsequently analyze all changes.

Two weeks before the neck lift, the patient must stop taking medications that affect blood clotting - this includes acetylsalicylic acid and other drugs with a similar effect. If a person is forced to take any medications on a regular basis, then the operating doctor must be warned about this in advance.

14 days before the procedure, the patient must quit smoking (or at least significantly reduce the number of cigarettes smoked). The fact is that smoking provokes spasm of blood vessels, which can lead to deterioration of blood flow in the tissues, both during the intervention and during the rehabilitation period.

A week before the neck lift, the patient should eliminate any fats and spicy foods from the diet, as well as avoid drinking alcohol.

You must not eat or drink for 8-10 hours before the procedure: your stomach must be empty at the time of the procedure.

The operation itself usually lasts about 30-40 minutes, after which the patient is sent for inpatient observation.

Technique neck lifts

There are various methods of neck lifting: surgeons choose the optimal one based on the individual characteristics of the patient. We are talking about the following methods:

• neck liposuction;
• isolated neck lift;
• complex neck and face lift;
• cervicoplasty;
• radical platysmaplasty.

Neck liposuction is performed through a small incision (about 3.5 cm), through which excess fatty tissue is removed. This technique is optimal for eliminating a double chin.

An isolated neck lift involves local plastic surgery and skin flap shifting: this method is more gentle, but does not provide a pronounced rejuvenating effect. [ 1 ]

Complex lifting is a combined technique that combines correction of the neck and facial skin. The method may include a lifting procedure, liposuction and contour plastic surgery.

Cervicoplasty involves the removal of sagging tissues that have lost elasticity: excess skin in the neck and chin area is excised.

If radical platysmaplasty is performed, the neck lift can be performed in one of the following ways:

• lateral;
• medial.

During lateral lifting, the platysma is peeled off, after which excess fatty tissue is removed. After this, incisions are made in the temple area, enveloping the ears and ending behind them. Thanks to this method, the platysma is tightened, the tone is restored, the contours become clearer (the tissues are pulled up and fixed behind the ears). The procedure is often combined with SMAS lifting, correcting the lower half of the face and neck.

During a medial lift, the divergence of the medial muscle edges is corrected – the so-called corset neck lift is performed. The tissues are cut under the chin, the subcutaneous muscles are pulled to the center, and the designated cervical-mental angle is formed. The platysma is sutured, and sutures are applied along the skin.

Neck lift with a back incision is a relatively new technique that has been used in global plastic surgery for only 7-8 years. In the post-Soviet countries, this operation is not particularly common - primarily due to its novelty and the lack of practice among specialists.

Neck lift with mesothreads is a minimally invasive procedure with a relatively short recovery period. Thanks to mesothreads consisting of polydioxanone, a kind of framework is created that gradually dissolves in the tissues. At the same time, mesothreads stimulate the production of skin collagen, so the lifting effect is maintained even after the framework is absorbed. There are other framework threads - Aptos. Their composition is represented by caprolactone, so the lifting effect is expressed more powerfully. [ 2 ], [ 3 ]

Endoscopic neck lift belongs to the category of low-trauma techniques, since it is performed using an endoscope. This type of lift does not require large incisions and significant tissue peeling. However, the effect of endoscopic neck lift is no less than that of traditional neck plastic surgery. Punctures for the endoscope are made in the folds behind the ears. General anesthesia is used, and the doctor sees the entire course of the operation on the monitor: the surgeon redistributes soft tissues, fixes muscles and tightens the skin in the required direction. Endoscopic neck lift is almost always performed simultaneously with chin liposuction and face lifting. [ 4 ]

Laser neck lift is a non-surgical method: the session is painless and relatively easy to perform, and the effect lasts for up to 2 years. The essence of the method is the effect of a laser beam on the skin, which stimulates collagen production, and the skin begins to rejuvenate itself. For a lasting effect, at least three laser lifting sessions should be performed. Fractional neck rejuvenation with CO2 laser is an effective treatment option with long-term effectiveness for patients who mainly have sagging skin and wrinkles along with pigmentation of the skin surface. [ 5 ]

Radiofrequency-assisted liposuction (RFAL) for neck and face contouring is a safe procedure for achieving significant reductions in skin laxity and fat deposits in the chin and cheek areas. [ 6 ]

The Hollywood neck lift is a unique technique developed by New York plastic surgery specialists called the Hollywood neck lift. This technique effectively tightens the chin and neck, removes loose skin, and restores youthful features to the neck and face. This neck lift received its Hollywood name due to its high popularity among Hollywood actors. After the procedure, patients quickly returned to work, and the scars remained invisible to others. The Hollywood neck lift is performed not only in the United States, but also in our country, since the technique has become widespread among most of the world's plastic surgery clinics.

Combined use of ultrasound liposuction and limited incision platysmoplasty to correct sagging neck skin. This combination therapy is minimally painful and consistently results in significant improvement of the cervicomental angle. [ 7 ]

Contraindications to the procedure

The surgeon will not perform a neck lift if the patient has the following contraindications:

• acute infectious and inflammatory processes, periods of exacerbation of chronic inflammatory pathologies;
• malignant and benign tumors and autoimmune processes;
• impaired blood clotting;
• absolute loss of elasticity and turgor of the skin;
• diabetes;
• decompensated diseases of the heart and blood vessels;
• allergic predisposition of the body, acute periods of allergic reactions;
• insufficient kidney and/or liver function;
• damage and diseases of the skin in the area where the operation is supposed to be performed.

Consequences after the procedure

Some consequences after the procedure sometimes cannot be avoided:

• Hemorrhages, hematomas, accumulations of serous fluid are associated with tissue damage and manifest themselves through pain, the appearance of bruises or small seals in the area of suture application, the presence of dense strands behind the ears. In most cases, this consequence can be noticed within the first 24 hours after a neck lift. If the problem is detected later, it worsens the prognosis and can cause complications - for example, tissue necrosis.
• Large hematomas or seromas caused by the release of large amounts of blood or serous fluid into the tissues require surgical intervention. They are removed through previously made sutures, which are then reapplied.
• Hair loss in the neck lift area (behind the ears or in the temple area) is explained by damage to the hair follicles during the procedure. As a rule, hair restoration occurs without additional participation of the doctor, some time after the neck lift. If restoration does not occur, the doctor may recommend a hair transplant.

Under certain conditions, not only temporary consequences but also quite serious complications develop after a neck lift. Although, according to statistics, this happens relatively rarely.

Complications after the procedure

• Skin necrosis develops as a result of blood flow disturbance caused by thinning of tissues or excessive tension to the suture line. After a neck lift, necrotic processes are most often recorded in the area behind the auricles.
• Infection may occur against the background of a large hematoma or necrotic processes. In addition, infection may occur if hair accidentally gets into the incision area during suturing. This problem is usually eliminated by taking a course of antibiotics.
• Excessive accumulation of pigment in the skin, or depigmentation, is observed with increased skin sensitivity, as well as with the formation of extensive intradermal bruises.
• Contour deformation of the face can occur as a result of hematoma formation, displacement of skin areas, damage to the superficial neck muscles, or excessive removal of fatty tissue in the chin area. Often, such a problem that occurs during a neck lift requires repeated surgical intervention.
• Formation of keloid tissue in the area of scarring is often found in patients with a hereditary predisposition to such a complication. In normal people, the suture is completely tightened within a maximum of 10-12 months: as a result, an ordinary scar is formed. If there are violations in healing, then keloid tissue grows in the scar. To prevent complications, it is necessary to identify the predisposition to keloid growths at the stage of planning a neck lift or any other operation.

Care after the procedure

For several days after the neck lift procedure, the patient will be under the supervision of a doctor, in a hospital setting. In case of significant pain discomfort, he will have to take painkillers. In general, slight nagging pain in the neck area can be felt for about 10-14 days, after which it gradually disappears as the wound heals. At the same time as the pain, hematomas disappear, swelling subsides.

The stitches are removed 1-1.5 weeks after the intervention. To speed up tissue recovery, the doctor may prescribe physiotherapy - first of all, this method is necessary to restore the function of the neck muscle tissue.

After the neck lift, the doctor applies a modeling bandage frame to the patient, which is subsequently replaced by a special compression cervical corset. It will have to be worn for 3-4 weeks.

Additional medical recommendations may include the following:

• During the period of tissue recovery after a neck lift, you cannot go to a bathhouse or sauna;
• you must not take a hot shower or bath;
• You cannot visit a solarium, sunbathe on the beach or swim;
• any physical activity should be limited (it is not advisable to run, jump, carry heavy objects, or bend over);
• It is advisable to sleep in a semi-recumbent position; you can use a high pillow for this.

If you follow all of your doctor’s advice correctly, the risk of complications after a neck lift will be reduced to zero.

Reviews

Most often, plastic surgeons offer patients a neck lift in three options:

• lateral lifting with tissue tightening using horizontal suturing;
• medial lift, which involves vertical suturing of tissues up to the center of the neck;
• mixed type of lifting – lateral-medial type.

According to experts, the last of the methods listed is considered more effective, since it helps to tighten all sagging tissues of the neck, which noticeably affects the expression of the neck contours.

As patients themselves say, a lateral-medial neck lift helps to literally rejuvenate even women over fifty. The main condition is to choose a good clinic and an operating surgeon who has sufficient qualifications and a license to perform such corrective surgeries. When deciding on the procedure, it is also important to check how modern the equipment is used in the intervention. If the patient is dealing with a clinic of the appropriate level, then the ideal results of a neck lift will be as follows:

• the angle between the neck and chin will be leveled;
• the skin will become smoother and more elastic;
• clear neck contours will appear.

It is better if the neck lift is performed in combination with facial rejuvenation. In this case, you can expect an optimal rejuvenating result.