Deep Necklift Surgery

What is a necklift?

A deep necklift is a procedure people undertake to improve the appearance of the neck and jawline and comprehensively address all signs of neck ageing. The process of neck ageing is complex and involves a variety of changes that happen in both the superficial (skin and superficial fat), and deep tissue layers (deep muscles, deep fat, glands and fascia). Surgical correction through a necklift procedure allows for all those elements to be addressed together for the most effective and long-lasting results. See our necklift before and after photos here

How is a necklift different from a facelift?

A facelift is undertaken when someone wishes to address lower and mid-face decent, i.e., jowls, heavy nasolabial folds, saginess or loss of cheek volume, and lower face squareness. A facelift resuspends the lax deep layers of the face (SMAS) to improve mid- and lower face heaviness, and restore a more youthful heart-shape to the face. It involves an additional incision in front of the ear and at the hairline. Fortunately, in the right hands this incision can be placed in the natural concavity of the ear area and fade so not noticeable. Read about our facelift here.

Do I need a necklift?

There are a few different reasons someone may benefit from a neck lift.

·      Loss of contour or definition of the neck and jawline. Either as part of the ageing process, or in some patients as part of their genetics, the deep muscle layers in our neck that give us the beautiful contour to our jawline and neck weaken. These include the platysma muscle and the anterior digastrics. The platysma muscle in the neck is the equivalent of the facial SMAS in the face that provides the facial structural integrity and is the target of a deep plane facelift. As we age, the platysma loses it’s tone and becomes lax, causing separation in midline of the neck. This separation can have the effect of prominent vertical bands, known as platysma bands. The anterior digastrics are a pair of muscles in the floor of the mouth, topographically located on either side of the submental area. Laxity of the anterior digastric muscles often can be seen as bulging areas underneath the chin.

·      Deep fat protrusion. There are two layers of fat in the neck, the superficial layer felt just under the skin, and the deeper fat layer which is positioned underneath the playtysma muscle. In some people this deep fat can grow with time, a process also called as hypertrophy. In individuals with platysma weakness, this deep fat layer can protrude or bulge forward, resulting in submental fullness. This layer of fat is unfortunately not amenable to neck liposuction or non-invasive procedures due to its deep position, the only option is surgical removal.

·      Excess neck skin. As we age there is a reduction in the quantity and quality of collagen and elastin in our tissue resulting in loose, redundant neck skin. The superficial layer of neck fat also undergoes a process of thinning with time (atrophy), which in combination with the loss of skin elasticity contributes to skin crepiness with obvious pleats and wrinkles.

·      Submandibular gland protrusion. The submandibular glands are normally hidden away behind the lower jawline and are part of a network of glands that produce saliva. In some people either due to aging or genetics these submandibular glands can grow larger, herniate inferiorly and create some lateral fullness with additional contribution from the anterior digastric muscles. This results in distortion of the crisp jawline and the depth of the submandibular contours. This is often what some clients describe as jowls. In these patients with heavy, protruding glands a necklift is the only option for improvement.

. Hyoid bone position. The hyoid is a relatively small and mobile bone located in the center of the neck and it serves as an attachment for the tongue and floor of mouth muscles. in the younger population this bone is sitting high and posterior in the neck, allowing for a sharp angle between the chin and the neck (cervico-mental angle), ideally between 105°-120°. With the effects of ageing and the generalised laxity and protrusion of the neck structures, the hyoid bone becomes displaced to a more lower and forward position, creating an obtuse cervico-mental angle. This causes loss of definition, which is more evident on the profile view.

·      Combination. In the majority of case the reason a necklift is needed is due a combination of the above aetiology. The exact cause will discern the approach that is needed during the surgery and the incision sites.

Given the various aetiology for neck lift surgery it is easy to understand that this procedure is not limited to a certain age group. Neck lift surgery can provide the solution for someone in their 30s or 40s as well as someone in their 50s. Regardless of the age however, in those patients who present with significant lower face descent and jowling the gold standard is a combination of deep plane facelift and deep neck lift.

I am a man, can I have necklift?

Mr Orfaniotis frequently performs male necklift surgery in his London practice. The pathology and indications mentioned above are more or less the same whether for a male or female patient. Often an isolated necklift in a man can be a dramatic transformation as it can reveal a beautiful strong jawline that has been hidden for years underneath the protruding deep structures. The technical approach differs slightly between a male and female face as excpected as there are different geometric considerations as to what makes a male vs female face beautiful.

What scars are there after a neck lift?

Neck lift scars differ depending on the indication for surgery. For those patients where there is not an abundance of excess skin then a single 3cm incision hidden underneath the chin (submental incision) is only needed to gain access to the deeper structures. This is “isolated” deep neck lift is less common and only reserved for young patients with good quality skin, who present with anterior neck heaviness due to genetics. For those where there is excessive skin and generalised neck laxity that needs to be removed, an additional incision is required around the earlobe and behind the ear. This additional post-auricular incision is Mr Orfaniotis’ preferred option when lateral platysma laxity is also present. It allows access in order to tighten of the lateral part of the platysma to the post-auricular area (mastoid) and improve definition of the angle of the jaw (mandible). This type of neck lift is more effective in addressing the majority of the neck concerns and is the most commonly used by Mr Orfaniotis. The scars from a necklift are placed in natural grooves of the chin and back of the ears to minimise their visibility. Scars take up to a year to fully mature. At the end of the year the scars should be a light silvery colour only visible on close inspection.

How is a neck lift performed?

The extend of Neck lift surgery depends on the individual concerns and clinical findings. A “full” or “heavy” neck usually requires reduction and contouring of all the structures mentioned above; fat, muscles, glands and hyoid. The deep fat and submandibular glands are reduced, the digastric muscles can be debulked and tightened, and the platysma muscles are freed up and repaired in the midline. Patients with generally “skinny” and lax neck tissues may benefit from a more simple operation which only involves platysma repair. When there is additional facial laxity, with lower face heaviness and jowling, then a neck lift on it’s own could create some imbalance between the face and neck, hence the recommendation would be to have a face and neck lift combination in order to obtain more natural and harmonious results.

What are the functional implications of submandibular gland (SMG) reduction ?

SMGs are part of a very rich network of glands that produce saliva, which also includes the parotid and lingual glands. Studies have shown that eduction of the SMG does not cause any salivary dysfunction in the long-term. Only exemption are patients who already suffer from dry mouth (xerostomia), or previously undergone parotid removal surgery.

Where does Mr Orfaniotis perform necklift surgery.

Mr Orfaniotis is one of the leading surgeons for deep necklift surgery in London. The procedures are performed under general anaesthetic at state of the art operating facilities near Sloane Square, and Battersea.

What are the risks with a necklift?

As with any surgery there are general risks and more procedure specific risks. General risks of surgery include those relating to general anaesthetic, blood clots in the chest and legs, post-operative nausea and vomiting, bleeding, and pain. Procedure specific risks to a necklift include scarring, prolonged swelling, recurrence of laxity, nerve damage, and asymmetry. For those patients needing submandibular gland reduction there is a higher risk of bleeding as these glands are closely intertwined with a blood vessel in the face. That is why neck lift surgery is best advised undertaken by someone who is trained specifically in head and neck reconstruction surgery as they have many hours of experience with these deep structures of the neck. During your consultation Mr Orfaniotis will take time to discuss the risks in further details. To book your consultation click here.

What is the recovery like after a necklift?

Mr Orfaniotis has invested in a specific facial post-operative recovery team to help look after you during your neck lift recovery . This is led by an anaesthetic doctor who specialises in recovery and who you meet pre-operatively to ensure you are not only optimised for the procedure, but also the recovery too. Mr Orfaniotis feels this is an important part of all patient’s journey and it is essential that his team provides 24/7 doctor led dedicated

Post-operatively there will be bruising with can last up to 10-20 days. The extent of the bruising will depend somewhat on your genetics and how extensive the surgery is. There is some pain and discomfort that on average lasts up to for 3-7 days. Our specialist recovery team monitor you during this time to make sure you are comfortable throughout. The recovery team also help with the removal of any sutures which would happen around day 7. The first post-oprative apppointment is at 48 hours where the wounds will be carefully inspected and cleaned and the drain as well as the hemostatic net sutures will be removed. As the neck contains many lymphatic channels there is some expected swelling post-operatively. In some people this can settle within 2-4 weeks, in others it takes a bit longer, particularly when a significant reduction of the deep fat and submandibular glands was carried out. Most patients are back to work in person 2 weeks following the surgery.

How long does a necklift last?  

A deep necklift surgery is a permanent result. However, it cannot stop the aging process, and everyone will age on top of the result in the years to come. What the benefit of a necklift is however is that it rewinds the clock, so you are starting off from a better place. During your peri-operative assessment a holistic approach is taken by Mr Orfaniotis and his team. Recommendations can be made on how to optimise your surgical result in the long-term including supplement choices, diet, skincare and additional non-invasive treatments.

Are there any non-invasive alternatives to a necklift?

Unfortunately, once the muscle layer in the neck has weakened and there is excess skin or deep fat protrusion, there are no non-invasive procedures that can restore the contour and definition of the neck and jawline fully. There are many fat dissolving treatments marketed for submental (under the chin) bulging, however through understanding the mechanisms discussed above, it becomes obvious that without the muscles been fixed and fat removed through surgery, the improvement will be minimal. Skin quality can certainly be improved through non-invasive methods such as devices that combine radiofrequency with microneedling, or Profhilo injections which stimulate the local production of collagen. Indeed, skin quality is an important aspect whether a necklift is performed or not, and these treatments are often recognised by Mr Orfaniotis as helping optimise and maintain results.

Would previous use of non-invasive treaments compromise the necklift result?

It si possible that previous surgical of non-surgical treatments can have a negative impact on the outcomes of neck lift surgery. Previous aggressive liposuction, VASER, skin tightening devices targeting the superficial layers under the skin, fat dissolving injections, can all cause a variable degree of internal scarring, and as a result make surgery more complex and less effective. The main concern is the difficulty in separating the platysma muscle within the scar tissue, which results in a thin friable layer, with possible areas of perforation. The platysma muscle is essential in obtaining the desired neck contour and jawline definition, and its integrity is paramount for successful results. Mr Orfaniotis will make a detailed assessment during a face-to-face consultation and answer these concerns on a individual basis. Unfortunately it is impossible to accurately predict the amount of scarring before surgery, and is very rare that any investigation can give an answer to that. Hence the decision to proceed with surgery if you had any of those treatments must be taken with consideration of those risks.

Can I have a necklift after a facelift?

Absolutely. You can have a necklift after a facelift. Often Mr Orfaniotis has clients who consult with him from this position. In most cases it is because a neck lift was not indicated at the time of facelift. However, in some cases it can be that their expectations from a facelift were not met as they had actually presented with a neck issue. For Mr Orfaniotis clients he does a thorough assessment during the consultation and explains the differing result a facelift versus a necklift would achieve to avoid this mismatch in expectation.

When is best to combine a facelift and a necklift?

If both mid face heaviness and jawline/neck definition are needing to be improved, then it is better to undertake a facelift at the same time as a necklift.

How much does a necklift cost? 

Prices for a necklift start from £17,500. Click here to see our full price list and booking details.

To book a consultation with Mr Orfaniotis please call +44 (0)207 177 8118, or email enquiries@orfaniotis.co.uk