The Book entitled ‘I Feel Bad About My Neck’, that came out a few years ago, bespoke of an inevitable aging problem. Necks unfortunately don’t lie. The folds of skin hanging down from one’s jawline are like rings on a tree. While Botox, injectable fillers and lasers can do a lot for the face above the jawline, the neck has been the poor sister of non-surgical rejuvenation. The neck can even look comparatively worse as the rest of the face above it gets a few less wrinkles and becomes more plumped with these treatments.
While a necklift is the only sure thing for the most ideal and long-lasting improvement, not everyone has a wattle that is so deserving. Less-invasive options have cropped up over the past few years that are promising and have caught a lot of press. One of the more recent ones uses ultrasound waves to help grow collagen under the skin to create a tightening effect. Targeted towards early neck aging patients, usually under the age of 55 years old, it can improve some of that loose skin under the chin. This has led to it being touted on numerous popular TV shows and magazines.
Enigmatic of many new and inadequately studied cosmetic treatments, Dr. Oz (a heart doctor) proclaimed on his show that this was the equivalent of a non-surgical facelift. He spoke how it could get rid of a sagging neck immediately and that it was pain-free. Its discussion on the show also left a distinct impression that such a device was cleared by the FDA for neck treatments… when it is not.
The reality is that ultrasound, and other collagen-stimulating treatments, do have some skin tightening properties but the effects take months to appear…and numerous treatments. Any immediate effects are temporary due to the heat created in the skin but real collagen takes much longer to form. The manufacturer claims that these results can last up to a year or longer but actual clinical trial data has only followed patients up to 3 months after treatment. Costing up to several thousand dollars, most patients won’t be happy with that investment even if the results did last for one year.
While many people think that surgically tightening the neck also requires that the face be lifted as well are not aware of more recent advances…that catch much less press than trendy devices. There are isolated necklift procedures and many more men get isolated necklifts than women. Most women are concerned about the jowls and the neck while most men are actually more focused on just the neck alone. The influence of time on a man’s face, even including baldness, is pretty well tolerated but a neck wattle is usually not viewed as a graceful sign of aging. I have had many men tell me that the only thing that they think makes them look old is their neck.
While creams, exercises and these newer skin tightening devices all have purported neck benefits, most people by the time they notice their neck problem are beyond the help of these approaches. Something less appealing, but infinitely more effective, is the spectrum of necklift surgery options.
Dr. Barry Eppley
Q: I am interested in changing the shape of my neck. I want a visible Adams apple as my neck is too flat and feminine. Can it be done? How would it be done? Imperative to get an answer please!
A: When it comes to tracheal or thyroid cartilage (Adam’s apple) surgery, the standard operation is that of reduction. Known as Adam’s apple reduction (technically reduction chondrothyroplasty) it is done by shaving down the upper v-shaped edges of the thyroid cartilage through a small horizontal incision directly over the thyroid prominence.
Thyroid augmentation is a very rare request but can be just as easily done. Through the same type of horizontal incision, the upper edges of the thyroid cartilages are exposed and built up with a variety of potential materials. Then the strap muscles are closed over the augmentation and the skin closed. Essentially, the reverse of a thyroid cartilage reduction is done. This is a one hour operation done under general anesthesia as an outpatient. There is minimal discomfort and swelling afterwards. There are no restrictions after surgery.
The key element of thyroid augmentation is what type of material to use. Ideally, cartilage is best and the loosely attached ninth rib at the subcostal margin has the right shape and size to be fashioned into a v-shape. But patients are unlikely to want the discomfort of its harvest and the small scar. This leaves a variety of synthetic material choices. Either a Gore-Tex or porous polyethylene (Medpor) block can be carved and secured by sutures to the existing thyroid cartilage framework.
Q: I had liposuction done on my neck when I weighted 185 lbs with about 15% to 16% body fat. I had a good immediate change in the shape of my neck from that procedure. I am now 170 lbs and about 12% to 13% body fat. The great results from the liposuction have persisted as I would have suspected. What I am wondering is what will happen if I gain weight back to where I originally was around 185 lbs. I am not planning to but I am curious as you never know what the future holds. Does it matter if my weight fluctuates between 170lbs and 185lbs? Will the fat return in my neck if I gain weight back?
A: The long-term results of liposuction on most areas of the body are highly dependent on the stability of one’s weight. The neck may be a slightly more privileged site (resist fat re-accumulation) than the stomach or flanks for example, but fat can definitely return there if one gains enough weight back. I think as long as you stay under your weight at the time of your original surgery, then your neck liposuction result should be unchanged. The percent body fat and weight ranges that you are talking about are not significantly large (170 to 185 lbs) so that change will likely not make much if any difference in the neck. However, it behooves you to keep the weight off as the amount of fat that was originally in your neck was there for a reason…so don’t give it a second chance to come back to an area that it once enjoyed.
Dr. Barry Eppley
Q: Hello, I am looking the best procedure for diminishing marionette lines, over lips, and most importantly, droopy skin on the neck. What do you recommend?
A: In reading your question, I am going to assume that you mean marionette lines that start at the corner of the mouth and hangs over the corners. (hence the phrase ‘over lips’) When you combine those aging facial features with droopy neck skin, you are talking about a combined neck-jowl problem. Heavy marionette lines that hang over the mouth corners indicates that there is likely some jowling and skin that is falling forward and down…the reason thaty most marionette lines exist. While I obviously have not seen any pictures of you nor have examined you, all of these aging facial issues point to one and only one effective treatment option…some version of a neck-jowl lift. The key issue is the droopy neck skin. Nothing short of this type of a tuck or lift can change a loose neck skin issue. This is often combined with a corner of the mouth lift to get rid of the overhang, a small little procedure done at the corner of the mouth. This will most effectively get rid of the loose neck skin, ‘over lips’ and decrease the depth of the marionette lines.
It would be helpful to see some facial photographs or come in for an evaluation to confirm this potential recommendation. These are common facial aging problems where patients are often searching for some ‘simple’ or non-surgical approach where such treatments do not really exist. You want to avoid wasting money on any non-surgical treatments that really have no hope of making a substantive difference…and there are lots out there that sound good but don’t work very well.
Dr. Barry Eppley
Q: I am 52 years old and have myasthenia gravis. I had a thymectomy 23 years ago and currently have very minimal symptoms. I am interested in reducing the appearance of aging, especially in the neck and jowls. Is the IGuide or another minimally invasive procedure recommended for patients who have myasthenis gravis? If not, what are my options to improve my appearance?
A: Having the condition of myasthenis gravis (MG) poses potential issues for anesthesia for surgery but not for the surgery itself. You are likely interested in minimally invasive facial surgery because of its often association with local anesthesia and potential avoidance of general anesthesia. What you want to avoid with any form of anesthesia is a myasthenic crisis. This occurs when the muscles that control breathing weaken to the point that ventilation is inadequate, creating a medical emergency and requiring a respirator for assisted ventilation. This is most likely to occur in those MG individuals whose respiratory muscles are weak. This does not appear to an issue for you whose has minimal symptoms. Nonetheless, it is best to avoid any form of general anesthesia particularly for elective cosmetic surgery.
The IGuide neck procedure, a more limited type of necklift (e.g., Lifestyle Lift) or both done together are procedures which are effective in individuals with early to moderate neck aging issues. Whether any of these are good procedures for your neck and jowl concerns can only be determined by doing an assessment of some photographs. They can be very successfully performed under local anesthesia supplemented by either oral or light intravenous sedation.
Dr. Barry Eppley
The shape and profile of the neck, even though it is not on the face per se, imparts an impression as to one’s appearance. Whether one is young with a fat neck or older with loose skin or a turkeyneck, a poorly defined neck angle results. While liposuction can remove fat and a necklift can tighten skin, an ideal neck angle is not always achieved.
What is missing from any cosmetic neck operation is a method to tighten the underlying muscles and tissues. By making a more firm ‘hammock’ that extends from ear to ear, the neck angle can be changed significantly. A new device, called the iGuide, has now become available to help create a firmer and more youthful neckline.
The iGuide is an FDA-approved device that is for tightening and lifting of neck tissues. It provides a less invasive technique to improve the neck and jawline with minimal incisions (unlike a traditional facelift) while at the same time shortening recovery time. By not doing wide undermining and elevation of neck skin, the swelling and bruising is much less and one’s recovery is quicker.
The iGuide allows the deeper tissue in the neck to be tightened by essentially creating a ‘neck hammock’ using a permanent suture. Through a series of needle punctures placed along the jawline, a suture is weaved back and forth from side to side to create a trampoline-like structure. This suture weave creates a low-tension support which elevates the tissues below the neck skin, a missing element from current necklifting procedures. This type of suture is not to be confused with the infamous barbed sutures (Threadlift operation) of the past.
From a neck recontouring standpoint, the iGuide has multiple potential uses. For the younger patient with a fuller neck where liposuction alone is not completely satisfactory, a suture weave can provide additional neck angle improvement. For the early signs of neck and jowl aging, a short scar facelift is great for the jowl area but may not always optimally treat the neck angle. The trampoline effect of the suture weave makes for a better neck angle result. Older patients with a turkeyneck may still require a more traditional necklift however.
The iGuide neck contouring system, in some cases, may be able to be done under local anesthesia without going to sleep. If all one’s neck needs is some liposuction and a suture weave, this would certainly be possible. Neither the tiny incisions nor the weaving of the suture requires the use of any sharp needles. But when other facial procedures are being done with it, then more than local anesthesia would be needed.
The iGuide provides a clever minimally invasive approach to redefining one’s neckline and is a great adjunct to liposuction and any form of a necklift. As its tagline states, it is ‘The Neck’s Big Thing‘.
Dr. Barry Eppley