While the face in theory ages evenly, one’s concerns about different facial changes is not. Besides the eyes, the neck is a frequent target of aging dissatisfaction. While the neck is composed of various tissues, one wants see is loose and hanging skin. This makes one yearn for the days when the skin between the chin and neck was firm and taut and a more defined neck angle existed. While styles and fashion have changed over the years, a sharp and clean neckline has always been a youthful image.

While the neck has always been a physical disdain of aging, what has changed is the age at which these concerns arise. Turkey necks and wattles are understandable neck concerns, but they represent older patients often in the sixth, seventh and eighth decades of life.  Ever since Nora Ephron’s book ‘I Hate My Neck’ was published, it was like a light bulb when off for many younger people.  Younger people, women and men alike, now appear in the fourth and fifth decades, to do something about their loosening neck skin. The reality is that the publication of the book was merely coincidental to this interest. The wide spread use of Botox and fillers has filled many a plastic surgeon’s office with early aging patients where the opportunity to discuss these concerns can easily happen.

The interest in addressing the earlier changes in neck aging has led to a variety of surgical and non-surgical treatments. A host of energy-driven devices exist for neck tightening, like Exilis and Ultherapy, but these are really bridging therapies until the time comes when one is ready for a more definitive surgical approach. Some fat shrinkage and skin tightening may work well for more minor neck droops, but really significant and and longer-lasting results requires tightening the muscle and skin to resist the never-ending effects of gravity.

Necklifting options today range from under the chin approaches (submental incisions) that use skin tightening caused by fat removal and/or muscle tightening and more traditional approaches (facelift) that use skin shifting and excision by incisions around the ears. Most younger aging neck patients are going to usually benefit by submental approaches and these are of the greatest interest because they are ‘less’ surgery with a quicker recovery. By definition a submental approach involves a small and inconspicuous incision right under the chin. It can be just a few millimeters when only liposuction is used. The heat created by the use of Smartlipo is a reall complement to the any fat removal done. For someone with a full neck but good thick skin, this could be all that is needed to create a better neck contour.

The most unknown necklift is that of the submentoplasty or platysmaplasty. Through a slightly larger submental incision, fat is first removed from under the skin but the cornerstone of the procedure is the muscle tightening. The sagging platysma muscles are sewn either back together or folded onto themselves in an up and down fashion creating an effect like a corset on the waistline. (which is why this procedure is also known as a corset platymaplasty) This shortens the vertical length of the muscle, pulling the neck angle upward  and with that the overlying skin as well. Other muscle innovations create slings from one side of the neck to the other using permanent sutures to create a hammock-like effect with special instrumentation for passing these sutures into the correction position.

While not as common, a few will have a neck problem that is not primarily fat but just loose skin. Skin laxity is a less frequent cause of younger patients but definitely becomes more of an issue as one crosses the half century mark. Loose skin in the neck, if not too severe, is managed by a smaller neck-jowl tuck-up or one of the many variations of short scar or limited facelifts. While less skin is removed than in a traditional facelift, the tightened on both sides of the jawline creates a hammock-like effect across the midline of the neck pulling it tighter.

The revolution in sagging necks is that more and more younger patients are turning to necklifts as stand alone procedures…changing for some the title of their own book ‘I Love My Neck!’

Dr. Barry Eppley

Indianapolis, Indiana

One of the defining facial features that casts an impression about one’s appearance is the neck, or more specifically the neck angle or neck profile. Whether one is young or old, an obtuse or poorly defined neck angle is not aesthetically desireable. If one is young with a full neck, liposuction alone will increase the neck angle as the skin retracts upward. When one is older, however, a dropping or poor neck angle is associated with muscle and other tissue changes. This is why a facelift, or some variation of it, is needed to make a significant change in the neck angle through a suspension effect of ear to ear skin flaps.

Short of an open facelift approach, there has not been any other method to help tighten the neck and jowl SMAS. The SMAS is an acronym for a layer of tissue above the muscle which most confuse as a facial muscle which it is not. But tightening the loose SMAS can help improve the neck angle. 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 soft tissue approximation and elevation of subdermis and muscle. 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 elevation of neck skin flaps, the swelling and bruising is much less and the need for the skin to ‘stick back down’ is eliminated.

The iGuide allows soft tissue to be elevated and defined by essentially creating a ‘neck trampoline’ using dissolveable sutures. Through a series of needle punctures placed along the jawline, a dissolveable 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 elevated the skin, muscle and the SMAS as a combined soft tissue unit. This suture is not to be confused with different facial rejuvenation techniques in the past that have have used barbed sutures.

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 upgrades the surgical outcome.

The iGuide neck contouring system is touted as being able to be done under local anesthesia and that is most certainly true. But that would only be relevant if one was doing an isolated neck procedure which often is not the case. But for those patients interested in a most minimalistic approach, an office procedure under local anesthesia with oral sedation is easily done. Neither the tiny incisions nor the weaving of the sutures requires the use of any sharp needles.

The iGuide provides a clever minimally invasive approach to redefining one’s neckline. As its tagline states, it is ‘The Neck’s Big Thing’. Time will tell whether this technique will find its way into the standard repertoire of successful neck contouring procedures or go the way of the barbed suture.  

Dr. Barry Eppley

Indianapolis, Indiana

The neck wattle is one of the most bothersome of aging facial features, particularly for the older male. Men are often much more concerned about their turkeyneck than they are about the bags and hanging skin around their eyes. That neck wattle not only flops around but really stands out in a shirt and tie as it hangs down onto the collar. It is an unfortunate sign of a man’s age.

The traditional and most effective correction for the neck wattle, at any age, is a facelift. While highly successful, some men seek out a less invasive approach with a quicker recovery. The direct necklift may be an attractive alternative provided one is willing to accept a central neck scar. Such a necklift scar usually does better in a male than a female due the improved scar results that occur in bearded skin.

While the direct necklift involves the simplistic concept of a vertical cutout of central neck skin, the operation is actually more sophisticated and involves numerous nuances in technique. Not only is skin removed but the attached underlying fat down to the platysma muscle is removed as well. With a very wide diastasis of the platysma muscle, all subplatysmal fat down to the strap muscles can also be removed from under the chin down to the thyroid cartilage. The intramuscular platysmal gap is then closed by a vertical row of muscle plication sutures. These maneuvers help to compliment the skin closure in getting a much improved and often dramatic change in the neck angle that not even a full facelift can approximate.

Despite the striking improvement in the neck angle with these deeper tissue steps, the outward appearance of the neck scar is also critically important. While there may be some horizontal scars from the closure under the chin and in a lower horizontal skin crease above the sternal notch, the most important and visible scar is the vertical one. Historically, the vertical necklift scar is done as either a straight line or a straight line with a central z in the middle of it.

The problem with a vertical neck scar is that it runs perpendicular to the horizontal skin tension lines in the neck and is under tension. This poses the risk of hypertrophic scar formation. This is why in some cases a z-plasty is made in the central area of the scar. An alternative option that I have explored for vertical necklift closure management is a running broken line closure of a symmetrical fashion. Known as a running w-plasty, this is a common scar revision technique that can also be called a ‘zipper line’. This breaks up the tension along the scar line and reduces the risk of poor scar outcomes.

In the cutout design of a vertical necklift, the edges of the excision are marked and then a running w-plasty pattern drawn on the outside of it. The skin is then incised along the marks and the deeper portions of the necklift carried out in the usual fashion. This creates a saw tooth-edge appearance along the skin margins.

At closure, the limbs of the skin edges is interdigitated to create the zipper line closure. This requires a meticulous closure with fine sutures done under loupe magnification.

The zipper necklift is another option for direct neck wattle removals. It appears to be a good choice when the skin excess is not significant enough to require horizontal excision and closure extensions under the chin and in a low skin crease…if only a completely vertical excision is needed. It could also serve as an option for hypertrophic neck scar management should that be necessary from a previous direct necklift.

Dr. Barry Eppley

Indianapolis, Indiana

Background:Changes in the neck is one of the most bothersome facial changes that occurs as one ages. A sagging neck can ‘grow’ into a really significant neck wattle by the time one reaches their sixties and seventies. When the neck sags to this degree, it literally flops from side to side and hangs down from the chin all the way to below the thyroid cartilage. (adam’s apple) This neck wattle is often referred to as a ‘turkeyneck’.

The traditional treatment for any sagging neck problem is that of a facelift. The benefits to the neck in a facelift is that the hanging skin is freed and chased back to the ears where it can be removed and the resultant scars placed in the hidden crevices and skin folds of the ear. While this is a highly successful operation, certain patients may seek an alternative approach that is less extensive , more cost effective and has a quicker recovery.

This alternative approach is the direct necklift. While uncommonly done, it removes the neck wattle by directly cutting it out. The tradeoff for this more simpler neck solution is that of a scar running down the center of the neck. This scar in the older male usually does quite well because of its location in bearded skin. The hair follicles in the skin and the daily use of shaving (microdermabrasion) leads to good scar outcomes. Women, however, have a different quality of neck skin that is usually thinner and the creation of a neck scar is more of a potential concern.

Case: This 63 year-old female could no longer stand the hanging skin from her neck as it gradually became bigger. She was offered a traditional facelift but declined and wanted a direct necklift instead. She was also offered a chin augmentation to complement her necklift but she declined.

The markings for a direct neck lift is more than just a simple vertical elliptical excision pattern. This would create skin redundancies or dogears under the neck and below the adam’s apple. Smaller horizontal excisions are needed at both ends of the vertical wattle removal, creating more of a candelabra excision pattern.

The neck wattle is removed along the combined vertical and horizontal excision skin pattern, taking all of the underlying fat. This exposes the widely split platysmal muscle edges which are then tightened with individual sutures to create and support a sharper neck angle. This exposure provides a unique view of the deeper muscle anatomy of the aging neck.

The skin edges from the sides of the neck are then brought together in the midline after first bringing together the horizontal areas under the chin and low in the neck above the sternal notch. The deeper layers are closed with resorbable sutures while the skin is closed with sutures that will need to be removed a week later. The only dressing that is used are small tapes which are glued on over the stitches. There are no restrictions after surgery including showering the very next day.

She had a near painless recovery other than some tightness of the neck when trying to look up. She had her tapes and sutures removed a week later. This photo shows her appearance at the time of her suture removal ten days after surgery.

Case Highlights:

1) The direct necklift is a good option for the older woman with a significant neck wattle if one can accept the trade-off of amidline neck scar.

2) The direct necklift provides a dramatic tightening of the neck angle through platysmal muscle tightening and generous removal of the hanging neck wattle.

3) Widening and tightness of the central position of the midline neck scar may require revision through a simple z-plasty or steroid injections.

Dr. Barry Eppley

Indianapolis Indiana

Background: The most troubling facial feature in many older males is that of the neck. The development of a neck wattle is bothersome in many ways. It interferes and looks worse in buttoned shirts as it hangs over the collar. It moves and swings unflatteringly as one moves the head from side to side. While many of the aging male features may be perceived as distinguished, the hanging neck wattle is not one of them and seems disproportionately ‘aged’ compared to the rest of the face.

The classic treatment for the aging neck in men is that of a facelift. This is a procedure with a long history of neck improvement that relocates the loose skin from the central neck up and back to the jowl area and side of the face. It does so to place scars in a less conspicuous area around the ears. But for some men this operation has some concerning issues. The hair pattern around the ears for many men can make the concept of hidden scars more difficult. The heavy and thick skin of the male neck is not as easy in which to get a real significant neck change and is very prone to postoperative relaxation. There is also the reality that some older men simply do not want to go through a facelift operation and the recovery that is involved.

Case: This is a 68 year-old male who found that his growing neck wattle was increasingly bothersome. He was not bothered by the rest of his aging face, the neck was his only concern. While his entire face showed the effects of a life well lived, the size of the hanging neck wattle was hard to miss. While he wanted it removed, he was emphatic about not having a facelift. He was an avid golfer and wanted to return to the links as soon as possible after surgery. As a medical confounding factor, he was on Coumadin for the treatment of atrial fibrillation.

He underwent an excisional necklift through a vertical cutout approach. Under the chin and at the lowest neck skin crease at the adam’s apple area, the vertical excision was combined with horizontal skin removals to avoid unsightly skin redundancies. (dogears) With this skin excision is the removal of full thickness fat down to the split platysma muscle. With the platysma muscle fully exposed, it is sutures together in the midline as part of the direct necklift procedure. Under IV sedation, the procedure was performed in around one hour. The skin was closed with small sutures and covered with small tapes. No drains or other dressings were used. He could shower and shave the next day. His only restriction was not to extend his head backwards for several weeks. He reported at his suture removal a week later that he never had any pain or significant swelling.

The most important question from a patient’s perspective about the direct necklift is the scar. While men accept that there will be a scar, they want to know how ‘bad’ it will be. As seen in his postoperative results, the scar is not particularly visible. This is a mature scar and there is a period of redness until it gets to this point. On average, it is about three to four months until it fades. Beard skin heals better than skin without hair. The effects of daily shaving (microdermabrasion)may also be of scar benefit.

Case Highlights:

1) The direct necklift in the older man is a simple and very effective operation that has very little recovery.

2) The vertical and two horizontallimbs of the direct necklift scar heals extremely well in the bearded skin of the older male. While scar revision of the central part of the neck scar may occasionally be needed, the need for it is not common.

3) The central part of the neck is dramatically changed with this operation. It also provides some secondary improvement in the jowls by tightening them inferiorly.

Dr. Barry Eppley

Indianapolis Indiana

The aging neck is one of the most bothersome features of facial aging, whether it be a man or a woman. This is very evident as patients get older (greater than 55 or 60) and often is the sole focus regardless how the rest of the face is aging. For many men, the sagging neck is often their only facial aging concern.

Often a surprise to many patients is that the traditional facelift is the primary surgery to improve the sagging neck. While many perceive that a facelift is a total facial rejuvenation, they erroneously believe that the neck is treated differently with a ‘necklift’. Understanding that a facelift and a necklift is the same operation is a revelation for many.

For some older patients with severe neck sagging or a ‘turkey neck’, they simply do not want to go through a facelift. In most men in particular, the facelift concept and the lack of significant hair around their ears motivates them to pursue a different option. Rather than try and persuade patients to go through a procedure they don’t really want or can’t afford, I have used in my Indianapolis plastic surgery practice an uncommon option.

The direct neck lift is one limited form of facelift that just deals with the neck only. By cutting out the neck wattle directly, a dramatic change in one’s neck contour is achieved. It would be fair to say that the direct necklift produces a more dramatic neck profile change that is strongly resistant to future aging concerns caused by skin relaxation. Rather than shifting skin back in a traditional facelift, inches of skin and fat are permanently removed and platysmal muscles strongly tightened in the direct neck lift. It is simpler, faster, has next to no pain, and involves very little recovery of any significance.

But the beauty of the direct necklift is marred by one potential concern, which is why it is rarely done, that of neck scarring. That is the price that is to be paid for its simplicity and effectiveness. But how bad is this scarring? Is it slight or is it significant? Many who have never actually performed the procedure believe that the risk of poor scarring makes the direct necklift not a viable treatment option. That has not been my experience.

When speaking about necklift scarring, it is important to point out that the vast majority of patients I have treated are older men, age 65 or older. That is an important point for two reasons. The bearded skin of men allows for the most favorable s exposed scar location. Between the thickness of the skin, the healing potential of hair follicles and sweat and oil glands and the daily shaving (microdermabrasion scar treatment) that most men do, scars are set up to heal favorably. Secondly, this male population is very motivated as the other alternative (facelift) is even less appealing.

The scar pattern from a direct necklift is not a straight line. Vertical excision alone will leave redundant tissue under the chin above and along the thyroid cartilage below. Rather it is a vertical excision pattern that is combined with horizontal ellipses at either end, forming a ‘candlestick’ or ‘fishtail’ pattern. The very center of the closure in the middle of the neck will bear the zone of greatest tension. This is often relieved with a z-plasty to prevent central scar hypertrophy or widening. This is done in about half of the cases. Such an excision pattern has shown to produce remarkable neck changes in profile.

The scars from a direct necklift usually settle quite quickly and the typical early redness of scars fades by three months or so. While a very fine line vertical neck scar can be seen on very close inspection, it is largely inconspicuous in all men. The horizontal submental and low neck line scars become invisible. The redness of the scar persists longer in women and may be more visible which is why it is usually a gender-biased procedure.

While the potential scarring is an appropriate concern in the direct necklift, careful patient selection can make for a very satisfied patient. I have yet to formally revise any neck scars but have injected several raised scars of a cm or so in the tight central neck zone.

Dr. Barry Eppley

Indianapolis, Indiana

The neck wattle is a common sign of facial aging and often one of the most bothersome. Even in the presence of many other facial changes that occur with time, some patients find the sagging neck to be the first and, sometimes only, area they want addressed. This is particularly seen in older men.

While a facelift is the traditional approach to the neck wattle, there are numerous reasons why some patients do not want to undergo that operation. Cost, recovery, and lack of hair or a good hairline in and around the ear are the most common.

An alternative approach to neck wattle reduction is the direct necklift. While uncommonly done, this operation removes the neck wattle by cutting it out right down the middle of the neck. A small but powerful operation, excess skin and fat are removed and the platysmal separation sewed together…directly. While there are a lot of advantages to the direct neck lift (minimal recovery, short operative time, little to no bruising or swelling), it comes with the trade-off of an unnatural location for the resultant scar. Patients must balance that disadvantage with its other advantages.

To help with that determination, an appreciation of the scar in the direct necklift is critical. The ultimate question is…how does the scar look and is it a bad scar? The scar pattern is really an H-shape that is turned on its side. A small horizontal limb is right under the chin (hidden and is inconsequential), a longer vertical limb that runs between the underside of the chin and a low horizontal skin crease (the scar concern) and a low horizontal scar just under the thyroid cartilage. (adam’s apple, that usually heals imperceptibly in older thin skin)

I have used three types of direct necklift incisional approaches. They differ in how the vertical scar line is placed. The vertical scar can be a straight line, a straight line with a central Z in it (z-plasty), and a running W-pattern. The purpose of the breaking up the straight line with a Z or a lot of W cuts is to prevent scar contracture and tightening at the cervicomental angle. I have seen good scar results with all of them and this probably has a lot to do with patient selection. (older male patients 60 years and up) Currently, I favor the straight line approach for the vertical scar and will usually defer the need for a central z-plasty until later. In some cases, but not all, a hypertrophic scar will develop in the tightest part of the closure (cervicomental angle) with the straight line closure. Depending upon how the closure feels during surgery, a z-plasty may be placed if it is felt to be advantageous and this is usually done in women as opposed to men.

For the well-informed patient, a direct necklift can be a better operation for their neck wattle. The scar does particularly well in men because of their beard skin, daily microdermabrasion treatments that they do (shaving) and the value of a re-established sharp cervicomental angle when wearing shirts. Its value in women lies in its simplicity and minimal recovery, particularly in the face of older age and comproming medical conditions.

Dr. Barry Eppley

Indianapolis, Indiana

As one’s face ages, there is a gradual downward shifting of tissues from the cheek down into the neck area. The combination of time, gravity, and loss of skin’s elasticity and its underlying anchoring ligaments accounts for this inferior movement. Because the jaw (mandible) acts like a ‘fixed fence line’, the falling over of aging tissues creates the appearance of jowling and loss of a once sharp neck-jaw line angle.

But beyond the jawline, other well seen areas are also affected by this tissue migration. Down at the ‘bottom of the well’, the lowest area of the neck can also accumulate excess or rolls of loose skin. These can become particularly evident in patients over 60 years of age and are one of the late signs of facial aging. Just above the sternal notch at the levels of the low end of the thyroid cartilage and across the level of the cricoid cartilages, loose aged skin folds up onto itself extending outward into the sides of the neck. Folds may often hang over into the concave sternal notch area.

While facelift surgery can produce remarkable changes in the central and upper portions of the neck across the jaw line, it does not usually provide significant improvement in the low central neck. This is a simple function of the mechanics of how a facelift works. The greatest impact of tissue movement from a facelift comes from areas closest to where the upward pull is coming from…the ear. As you move further away from the ear, the influence of the pull becomes less. The lowest portions of the central neck are as far as you can get from the ear area and are affected by a facelift little if any at all.

The most powerful procedure to change the bothersome loose rolls of skin in the lower neck is a sternal notch tuck-up or a low horizontal neck lift. Removing skin directly can make a dramatic difference. Using a visible low horizontal neck skin crease that commonly runs across this area, the skin excision uses that line to orient the placement of the final scar. This is a very simple skin excision procedure that often can be done under local anesthesia. There is no swelling, pain and usually little to no bruising afterwards. Dissolveable sutures are placed under the skin so suture removal is not needed.

The sternal notch tuck-up can remove as much as one to two inches of skin which is overlying the low central neck area. This gets rid of that telltale sign of aging which is hard to hide. Even after an excellent facelift result, this area can still not be substantially changed when all the swelling has subsided. Like the appearance of the back of the hands, loose and sagging low neck skin can give away one’s age regardless of how well the jawline and upper face looks.

When should a sternal notch tuck-up be considered? It is a procedure that should not be done at the same time as a facelift. This is not only for vascular and healing considerations but also because a full facelift may well provide enough improvement in this area that the need for it may be unnecessary. It could, however, be done at the same time as a limited or mini-facelift (aka Lifestyle Lift) because neck skin flaps are not raised to any significant degree in this procedure. Liposuction is usually  the only procedure done in the central neck area with this type of facelifting.

Ideally, a sternal notch tuckup is done after a facelift has demonstrated that this area is not adequately improved. The thin aged skin of the lower neck typically heals so well that the scar that is created is negligible.  

Dr. Barry Eppley

Indianapolis, Indiana

The neck, or more properly the neck angle, is a hallmark of both youth and a well defined jaw line. As one ages, the neck angle will change…it is only matter of how much and when. While the aging neck problem is usually addressed by some form of a facelift, this involves incisions around the ears and excision of redraped skin. This requires disturbing tissues somewhat displaced from the neck problem but it is a tried and true solution.

Direct or non-excisional approaches to neck problems do exist. These are known as a submentoplasty or cervicoplasty. They are done by direct manipulation of neck tissues without remote incisions or the need for skin redraping. In young patients with fatty necks but with good bone support, liposuction alone is often adequate. But the fatty neck alone is not to which I refer for these procedures.

The submentoplasty procedure does involve initial liposuction of the neck to defat it. Then a small incision under the chin (submental) is made. Through this incision further cervical manipulation is done. This can involve direct excision of fat underneath the platysma and/or digastric muscles. Such fat is not removeable by liposuction alone. The platysma muscle is then sewn together with resorbable sutures. In some cases, I may place a neck suspension suture from a point behind the ear from one side to the other for optimal neck angle change and support.

While the submentoplasty is obviously appealing because of its more limited approach, it can be a disappointing procedure for improperly selected or underinformed patients. In my Indianapolis plastic surgery practice, I like to stress the following considerations to patients that I feel are good candidates for this operation. First, the procedure should be considered a delaying tactic or a pushback of time  to the eventual need for an excisional type facelift. Second, the submentoplasty can not produce as good as a result in most patients as that of a facelift. Therefore, if one wants a fairly taut neck angle this is not the way to go. Third, for those with simultaneous jowling as well, the submentoplasty can be combined with a very limited tuck-up facelift. This may require some incisions but those can be kept to a small area around the ear. Lastly, chin and jaw line augmentation with an implant can be very helpful in improving the results of the submentoplasty by extending the front position of the jaw. (which creates the mild illusion of a neck angle that is further back)

The submentoplasty will not work for larger necks that have a lot of skin looseness as is often seen in older patients. In thicker ‘bull necks’ as seen in some men, it will not work well either. Speaking of men, I don’t  find that it is a particularly effective for many of them due to the thicker quality of their neck tissues.

The submentoplasty, or non-excisional anterior neck rejuvenation, procedure falls into the contemporary category of ‘minimally-invasive’ surgery. Like any of these anti-aging techniques, however,  patient selection and expectations are the key to a satisfactory result.

Barry L. Eppley, M.D., D.M.D.

Indianapolis, Indiana

Changes in one’s neck are often the single most bothersome facial feature for some men as they age. Loose skin and the development of a neck wattle, all of which creates loss of a more sharply defined neck angle, are more troubling than even the classic signs of periorbital or eye aging. This is particularly true for men as they pass age 55 and beyond.

A traditional facelift for these neck problems, while very effective, is often unappealing for some men. Men are usually more concerned about the recovery from a facelift, where the scars would be, how it may affect their hairline, and the social stigmata of being recognized for having had their ‘faces lifted’.

An alternative plastic surgery solution to these neck issues is to treat it directly…known as a direct neck lift. Rather than chase the extra neck skin back to the ears for its removal, it can be done by removing it from the midline of the neck where the problem actually is. This is a far simpler operation, with very little recovery, no pain other than a little neck tightness, and no change in the hairline or scars around the ears. ]

The downside to a direct neck lift is that there is a midline scar running down the middle of the neck. The pertinent question becomes…what does this scar look like and how noticeable is it?

This is best answered by looking at actual pictures of scars. My Indianapolis plastic surgery practice experience indicates that for most men it can look surprisingly good. Besides good surgical technique and incision placement, the main reason is the unique healing quality of skin with beard hair. Men’s skin is thicker, more vascularized, and heals quicker due to contributions from the hair follicles. (which actually lie below the skin) The hair follicle is responsible for having an increased skin thickness and a better blood supply. Plus, men do a unique daily scar treatment after surgery….they shave. This is like having daily microdermabrasion scar treatments after the incision is fairly well healed. (men usually shave around it for a week or so and then directly over it thereafter)

Here is an example of a direct neck lift scar two weeks after surgery.

Here is an example of a direct neck lift scar three months after surgery.

Most men will develop some thickening of the neck scar just above the adam’s apple (thyroid cartilage) where the tension is greatest several months after surgery. For many men they do not feel that this is a problem. For others I treat it with some steroid injections or perform a small z-plasty in the office to relieve it.

Dr. Barry Eppley

Indianapolis, Indiana