One of the common sequelae in the massive weight loss patient after bariatric surgery is the development of a very saggy neck. What was once a very full neck for some patients becomes a hanging waddle after bariatric surgery for some. Unlike many of the body changes after bariatric surgery, the development of a sagging neck does not occur in everyone. For many, the loose skin in the neck is not a top priority over many other body areas such as the arms, abdomen, buttocks, and thighs. Often addressing the neck problem is done done until a second or third stage bariatric plastic surgery correction.
When it is important, the saggy bariatic neck can be dealt with through a very conventional approach. The typical full facelift (a facelift is a necklift….it does nothing for the face above the jowls unless other procedures are done with it), with the incisions in front and behind the ear, can lift and tighten a large amount of jowl and neck skin. When the excess is considerable, a perfectly sharp neck angle is not possible to obtain. In some rare patients, I have dealt with the neck skin by cutting it out directly (known as a direct neck lift). This is less of a procedure to go through but does leave a scar running down the middle of the neck from the chin to the adam’s apple. While many of these sscar can look quite good, you have to be prepared to bear with the scar as it goes through its maturing phases over many months. This type of scar always looks much better on men than it does in women.
Either way, a facelift or a direct neck lift are relatively easy to go through. There is virtually no pain, and much less swelling and bruising that you would think. I only keep my patients in a neck dressing for one day after surgery. Even with some swelling and bruising, the appearance is less full than before surgery. Do not confuse an isolated facelift or direct necklift with images you have seen on TV or the internet where patients are swollen and bandaged from the top of their heads to the neck. These patients are getting other facial procedures as well as perhaps including eyelifts, browlifts, nosejobs, etc. which causes a lot of mid- and upper facial swelling.
Dr Barry Eppley