Q: Dr. Eppley, I am a 63 year old female who is interested in a direct neck lift but am concerned about the scar that will result. I have had two facelifts but each one has failed to really improve my neck like I want. I have been recommended now to have a direct neck lift because they say there is no more loose skin to tighten. I value my face and neck very highly since I had double mastectomy years ago and never had any type of reconstruction. What is your advice about the direct neck lift scar?
A: As I always say to patients with difficult scar choices, the only way to be sure of having no regrets is to never have the scar in the first place. In listening to you, I just don’t see that the scar no matter how it is done is every going to truly be acceptable. And you don’t merely want to tradeoff one problem for another and then just dislike your neck for a different reason. The only way any form of a direct neck lift would even be acceptable to any patient is when they can unequivocally say that the scar is absolutely better, no matter how it looks, than what it is a substitute for. This is clearly not the case for you. As a plastic surgeon I would certainly not be comfortable placing a scar in an aesthetic operation when the patient is very equivocal about its trade-off. This is magnified in you who now values the importance of how their face and neck looks as a some form of ‘compensation’ having lost other body parts.
On a different note and tact, I would question why none of your facelifts could not adequately address this neck issue. That is very uncommon/rare in my experience. I suspect this is a technique issue and thus I would question the statement of ‘ there is no more loose skin that can be tightened’. You may merely have reached the limits of what your surgeon can do. I would not take that as gospel that further neck improvement can not be obtained by a facelift approach.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a direct neck lift but have concerns about the length of the neck scar. I have had two facelifts but my neck wattle persists so I am tunring towards a more direct approch. Here are some pictures as I do not like my profile. Can I direct neck lift be done with a shorter scar?
A: There is no question that the final ‘piece’ to optimizing your facelift result is the central neck area. In a traditional direct neck lift, the bottom portion of the scar ends in an inverted T shape excision of skin along a horizontal skin crease which is usually over the thyroid cartilage. (most people perceive that it ends in a straight vertical line but that is a misconception) It ends like that to work out any excess skin. What really creates the sharp neck angle (besides the tissue excision) happens above that at the cervicomental angle) In a shortened or more limited version of a direct neck lift, the lower end of the scar can be completely vertical. (the upper end is now an upright T at the submental skin crease) This now becomes what is more classically perceived as a submentoplasty. This can certainly improve your neck wattle but not to the degree of the classic direct neck lift with the lower scar location. In conclusion, as long as the scar does not drop below the cervicomental angle area then that would be a good compromise between improvement and the creation of a scar.
Dr. Barry Eppley
Q: Dr. Eppley, I think I am interested in a direct neck lift. I am 68 years old, slim and sporty. I have had two face lifts, the second had to be redone completely five months later so this makes in reality three face lifts with the last one being done five years ago which still holds pretty well except for the neck. My surgeon suggested to have a direct neck lift, since I have no skin elsewhere to cut off. I saw that you are a specialist in direct neck lifts. I hesitate to have this vertical scar, although my scars fade away pretty well but in the middle of the neck would be awkward. I do dancing for my pleasure and my friends in the class would see the scar. There is little skin to be taken away. I have still a nice line around my face, but the profile is not nice looking, it makes a direct line from the chin to down to the neck. If I turn my head or lift it a little it is ok. Did you ever do a direct neck lift on a lady? How is the scar? Many thanks in advance.
A: I have done many direct neck lifts with the vast majority being in older men. I have done a few in older women as well but these were for considerable amounts if neck sagging and they were seeking an economic solution for their neck wattles. In a female I do not consider it as good a scar as in men. Based on your description of having only a little loose skin and being very sensitive about the scar in advance, I would be hard pressed to say this is a good procedure for you. While there is no questioning the simplicity and effectiveness of the procedure, it is simply an issue of the aesthetic trade-off. Is it better to have no scar and a loose neck or a sharp neck angle with a fine line scar? You simply have to choose which aesthetic problem would bother you less…and based on your description alone it sounds like a scarless but undesireable loose neck skin would be better than the scar trade-off.
Dr. Barry Eppley
Q: Dr. Eppley, I am 59 years old with a younger looking face and body but an old, wrinkly neck. My neck does not match the rest of my face or body and makes me look old. From what I’ve read, a direct necklift may work to improve the appearance of my neck but would be of interest to me since it may cost less but I’d like to know what you think. I have attached some pictures which shows my wrinkly saggy neck.
A: Thank you for your inquiry and sending your photos. You have a most unusual amount of neck aging compared to that of your face. And the direction of your neck sagging is mainly horizontal and not vertical. Many men develop so called turkeynecks which are largely a vertical skin sagging problem. This is the typical direction that direct neck lifts treat which is a vertical neck skin removal with some minor horizontal skin removal at both ends of the vertical excision.
Your neck, however, shows a substantial amount of horizontal skin laxity as seen by your many horizontal neck wrinkles. This indicates that a direct necklift for you must have a different excisional pattern. Using your horizontal neck wrinkles, two to three inches of neck skin can be removed across the width of the neck keeping the final scar in a horizontal neck wrinkle line. The only question is whether a vertical component to the skin excision needs to be done as well. I can not tell that from your photos since your face is tilted upwards in the photos you sent which may artificially make any neck wattle look better than it really is.
There is also the option of a more traditional facelift approach which will also work very effectively as well, albeit with more recovery and expense.
Dr. Barry Eppley