Neck and décolleté lift: surgery technique

Plastic surgery is 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. It is not possible to eliminate this defect in other ways, therefore, platysmaplasty (the so-called neck lift in surgery) is considered a fairly common complex of surgical interventions.

Indications for the procedure

There is relatively little adipose tissue in the neck area. Sagging of the skin is formed with age, and in many respects the small fat layer is “to blame” here, and the structural features of the subcutaneous muscles, called “platysma”, is a thin muscular element located directly under the skin and fuses with the dermis. In many people, platysma does not have a continuous surface, but is distinguished by separate muscle clusters, which dehydrate with age and lose their functionality.

Anatomically, platysma is classified as a mimic muscle, therefore 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, 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 of the skin under the chin, drooping of the corners of the mouth, etc.

When can a patient be recommended for a neck lift? First of all, indications are age-related defects, as well as those that have formed due to the individual characteristics of the structure of the neck, or due to a certain lifestyle. Most often, women over the age of 25-30 seek the help of a neck lift surgeon. Older patients undergo a facelift to correct problems such as "turkey neck", "Venus rings", double chin.

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

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

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

Any of these shortcomings can be corrected with a competent neck lift.

Preparation

The doctor, before referring the patient to a neck lift, will definitely conduct a preliminary evaluation consultation: it is necessary to determine the degree of age-related or other tissue changes, to suggest the scale of the upcoming intervention, and to choose the most appropriate type of operation. The doctor will ask the patient about the problems that concern him, about possible contraindications to a neck lift, about those 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 period of rehabilitation and about possible consequences and complications.

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

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

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

A week before a neck lift, the patient should remove any fats and spicy foods from the diet, as well as exclude the consumption of alcoholic beverages.

8-10 hours before the procedure, you can not eat or drink: at the time of the intervention, the stomach must be empty.

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

Technique of the neck lift

Various methods of neck lift are known: surgeons choose the optimal one based on the individual characteristics of the patient. These are the methods:

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

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

An isolated neck lift involves local plasty and shifting of skin flaps: this method is more gentle, but does not give a pronounced rejuvenating effect.[1]

A complex lift is a combined technique that combines the correction of the neck and facial skin. The method may include a lifting procedure, liposuction and contouring.

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

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

• lateral;
• medial.

In a lateral lift, the platysma is peeled off, after which excess adipose tissue is removed. After that, in the area of the temples, incisions are made that envelop the ears and end behind them. Thanks to the method, the platysma is tightened, the tone returns, 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.

With a medial lift, the divergence of the median muscle edges is corrected - the so-called corset neck lift is performed. The tissues are cut under the chin, the subcutaneous muscles are stretched to the center, and a designated neck-chin angle is formed. The platysma is sutured, the skin is sutured.

A neck lift with a back incision is a relatively new technique that has been used in the world of plastic surgery for only 7-8 years. In the countries of the post-Soviet space, such an operation is not particularly common - primarily because of its novelty and lack of practice among specialists.

A neck lift with mesothreads is a minimally invasive procedure with a relatively short recovery period. Thanks to the mesothreads, consisting of polydioxanone, a kind of framework is created, which gradually dissolves in the tissues. At the same time, mesothreads stimulate the production of skin collagen, so the lifting effect persists even after the framework has resolved. There are other frame threads - Aptos. Their composition is represented by caprolactone, so the lifting effect is more pronounced.[2], [3]

Endoscopic neck lift belongs to the category of low-traumatic techniques, since it is performed using an endoscope. Such a lift does not require large incisions and significant tissue exfoliation. However, the effect of an endoscopic neck lift is no less than that of a traditional neck lift. 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 refers to non-surgical methods: the session is painless and relatively easy to perform, and the effect lasts supposedly up to 2 years. The essence of the method lies in the effect of a laser beam on the skin, as a result of which the production of collagen is stimulated, and the skin begins to rejuvenate itself. For a sustainable effect, at least three sessions of laser lifting should be performed. Fractional CO2 laser neck resurfacing is an effective treatment option with long-term efficacy for patients who primarily have skin laxity and wrinkles along with skin surface pigmentation.[5]

Radiofrequency liposuction (RFAL) for neck and face contouring. It is a safe procedure to achieve a significant reduction in skin laxity and fat deposits in the cervico-chin and cheeks.[6]

The Hollywood neck lift is a unique Hollywood neck lift technique developed by New York plastic surgeons. This technique provides for effective tightening of the chin and neck, getting rid of sagging skin, restoring young features of the neck and face. This neck lift got its Hollywood name because of its high popularity among Hollywood actors. After the procedure, patients quickly returned to work, and the scars remained invisible to others. The Hollywood lift is done 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 ultrasonic liposuction and limited incision platysmaplasty to correct aging skin of the neck. This combination therapy is painless and invariably leads to a significant improvement in the cervico-chin 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 mood of the body, acute periods of allergic reactions;
• insufficient kidney and / or liver function;
• damage and disease of the skin in the area of the proposed operation.

Consequences after the procedure

Some consequences after the procedure can sometimes not be avoided:

• Hemorrhages, hematomas, accumulations of serous fluid are associated with tissue damage and reveal themselves as pain, bruising or small seals in the area of suturing, the presence of dense strands behind the auricles. In most cases, this effect can be noticed within the first 24 hours after a neck lift. If the problem is discovered later, then this worsens the prognosis and may cause the development of complications - for example, tissue necrosis.
• Significant hematomas or seromas, due to the release of a large amount of blood or serous fluid into the tissue, require surgical intervention. They are removed through previously made sutures, which are then reapplied.
• Hair loss in the area of the neck lift surgery (behind the auricles or in the temporal area) is due to damage to the hair follicles during the procedure. As a rule, hair restoration takes place without additional participation of a doctor, some time after a neck lift. If there is no recovery, the doctor may recommend a hair transplant.

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

Complications after the procedure

• Skin necrosis develops as a result of impaired blood flow caused by tissue thinning or excessive tension to the suture line. After a neck lift, necrotic processes are more often fixed in the area behind the auricles.
• Accession of an infection is possible against the background of a large-scale hematoma, or necrotic processes. In addition, infection can occur when hair accidentally gets into the incision area during suturing. This problem usually resolves with 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 bruising.
• Contour deformity of the face can occur as a result of the formation of hematomas, displacement of skin areas, damage to the superficial cervical muscles, and excessive removal of adipose tissue in the chin area. Often such a problem that arose during a neck lift requires repeated surgical intervention.
• The formation of keloid tissue in the area of scarring is often found in patients with a hereditary predisposition to such a complication. In ordinary people, the seam is normally completely tightened for a maximum of 10-12 months: as a result, an ordinary scar is formed. If violations occur in healing, then keloid tissue grows in the scar. To prevent complications, a predisposition to keloid growths should be identified even at the stage of planning a neck lift or any other operation.

Care after the procedure

Within a few days after the neck lift procedure, the patient will be under the supervision of a doctor, in stationary conditions. With significant pain discomfort, he will have to take painkillers. In general, slight pulling pains in the neck area can be felt for about 10-14 days, after which they gradually disappear as the wound heals. Simultaneously with the pain, hematomas disappear, swelling disappears.

Sutures 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 muscle tissue of the neck.

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

Additional medical advice may include:

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

If you correctly follow all the advice of a doctor, then 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 lift with tissue tightening by horizontal stitching;
• medial lift, involving vertical stitching of tissues, to the center of the neck;
• mixed version of the lift - lateral-medial type.

According to experts, the last of these methods is recognized as more effective, since it can be used to tighten all sagging neck tissues, which significantly affects the severity of the cervical contours.

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

• the angle between the neck and chin will align;
• the skin will be smoothed, it will become more elastic;
• clear cervical contours will appear.

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