Dr. Mohamed Ahmed El Rouby

                   Consultant and Assistant Professor of Plastic Surgery
                   Ain shams University - Cairo - EGYPT

 

Neck Rejuvenation, Aging Neck Management (Cervicoplasty) Neck Rejuvenation

What is Neck Rejuvenation?
neck rejuvenation
Many people are pleased with the appearance of their neck, but others, both young and old, are very self-conscious about the appearance of their neck. Some complain their neck looks too fleshly, or that it lacks definition. Most refer to the problem as a “turkey neck” or "double chin".

This unattractive neck can result from a variety of conditions. Overweight is one condition that can cause the neck to appear obtuse. Other causes may be a genetic predisposition to having a significant amount of fat in the jaw. Age can also cause the skin to droop and make the jaw-line appear jowly. Then there are those suffering from a condition known as retrognathia, where the jaw recedes and makes it look as if the person has no chin or jaw-line.

A neck lift provides a solution to people searching to improve the appearance of the neck and under the jaw line. This is designed to reduce the look of loose, sagging skin. Keep in mind that this procedure will not rejuvenate the facial area.
A neck lift can be performed alone, or in conjunction with other procedures including face lift and chin augmentation. Combined, these procedures can provide a complete facial makeover. A neck lift can even give some people the appearance of lost weight.

Neck rejuvenation treatments come in many forms:
- Surgical procedures: such as neck lift, endoscopic neck lift, neck liposuction or contour threadlift.
- Non-surgical procedures: such as chemical peels, laser skin resurfacing and cosmetic injectable fillers.

All of these procedures determine how much the procedure will cost, the type of anesthesia used (if any), downtime, recovery time, and its own share of risks and benefits
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The main feature of Aging face and neck is Wrinkles. So,What is the Wrinkles?

Four Types Of Wrinkles And How to Get Rid Of Them?!
wrinkles
Cosmetics companies don’t usually do a good job of explaining the problems they claim to solve. Take anti-wrinkle creams for example. Can someone just please tell me what causes wrinkles in the first place?

1. Atrophic Crinkling Rhytids:
What they are: Fine lines on the face that are almost parallel to each other.
Where they occur: They show up in different areas of the face and body but they tend to disappear when skin is stretched transversally. (that means they shift when your body posture changes.) These wrinkles are associated with loss of elasticity.
What you can do: Since these wrinkles are due to underlying loss of collagen, you need to protect your skin using sun block agents. You can also use moisturizers to temporarily plump the skin and diminish the appearance of these fine lines.

2. Permanent Elastic Creases:
What they are: These are crease lines in the skin that become increasingly permanent over time, especially with sun exposure.
Where they occur: They show up most frequently on on the cheek, the upper lip, and the base of the neck.
What you can do: Sun exposure makes this type of wrinkle worse. So unless you’re blessed with naturally dark skin, you should avoid sun exposure or use a sunscreen on these areas to prevent this kind of wrinkling.
 
3. Dynamic Expression Lines:
What they are: Wrinkles that are caused by facial muscle movement.
Where they occur: Frown lines and crows-feet.
What you can do: These wrinkles respond to Botox treatments.

4. Gravitational Folds:
What they are: As the name implies, these lines are from the effects of gravity and they become increasingly obvious as skin begins to fold and sag. As we noted in a recent post, skin research on the International Space Station might shed some light on the mechanisms of gravity-induced wrinkles.
Where they occur: The location of these wrinkles is related to the thickness of skin. While we would have thought this means that thicker skin shows more folds, surprisingly the researchers said that a fat face may show fewer gravity folds than a lean face.
What you can do: Skin-lifting procedures are effective at removing these kinds of wrinkles.


Ideal Neck features:

Youthful neck: Minimal laxity, No rhytids, and No fatty deposits. (Type I in Dedo's classification)
The aging neck has common characteristics: Descent of the floor of the mouth, fatty, wrinkles and platysma muscle lines. (Type II - VI in Dedo's classification)

DEDO classification


Who would best represent an Ideal Candidate for Neck Lift?

A neck lift can improve upon the appearance of the neck by creating more definition of the angle of the jaw. Undergoing this procedure can provide a boost to one’s self-confidence and self-esteem.
- A neck lift can be performed on individuals above 18 years of age who feel the need to improve their necks.
- Typical patients range between the ages of 30 and 70.
- A neck lift can address various cosmetic issues, including: Turkey neck, Excess fat and/or skin in the neck, Retrognathia.
- Who have realistic goals and expectations as well as be physically and mentally stable.
People must remember that cosmetic surgery is meant for improvement, not perfection.


Where do I begin?

After deciding upon a cosmetic surgeon, it is important to meet with the doctor for a consultation visit. During consultations, doctors can learn more about the patients and vice versa. This visit gives the doctor a chance to evaluate the current state of the patient’s neck and discuss options that will help the patient achieve a desired look. Consultation visits also give patients the opportunity to address their reasons for wanting surgery and to ask any questions they might have. These visits also allow the doctors to inform the patient of the benefits, precautions, treatment response, adverse reactions, method of administration and other important information.


How is a neck lift performed?

A neck lift may be performed in the cosmetic outpatient surgery center, or at a hospital. This procedure is usually performed under general anesthesia, allowing the patient to sleep during the operation.

The neck lift takes about two to three hours. If multiple procedures are performed, it takes longer.

The neck lift is actually a combination of procedures and each could be done separately:
- The first is cervicoplasty, where excess skin is removed.
- The Second is platysmaplasty, where neck muscles are removed or altered.
- We may also perform liposuction on the neck to remove fat deposits from the neck.
- Adjuvant procedures.

Cervicoplasty:
- During cervicoplasty, two incisions are made either under or behind the ear. When combined with a platysmaplasty, a small incision is made under the chin.
- Sections of skin are trimmed, lifted into place and sutured.
- Then, a section of fat and muscle is removed and the ends are sutured together at the mid-anterior (front) section of the neck.
- The skin can be brought together under or behind the ear to further firm up appearance of the neck.

face left techniques



Platysmaplasty:
It is Shortening of the redundant platysma muscle to eliminate platysmal bands. It could be done by many techniques, like plication, reaproximation, imbrications or Z-plasty.

neck lift



Neck Liposuction:
Removing fat alone can improve problems in the neck. However this is only available to patients who have little excess skin in the neck region. If they do not have excess, droopy skin, neck liposuction will present a beautiful result.

neck rejuvenation



Adjuvant procedures:
Facelift: This procedure can tighten a jawline that grows slack and jowly and those with folds and fat deposits around the neck. This is more beneficial to those wanting to improve upon signs of aging in their face as well as the neck. For more details click here!.

Chin implant:
This is for people who have a weak chin and, as result, the neck looks overly fleshy. Chin implants can also help those with retrognathia "the jaw is receding". For more details click here!.

According to Dedo's classification we can sum up Neck lift procedures:
- Type II:
(SMAS Rhytidectomy) SMAS plication or imbrication, Deep plane and subperiosteal lifts.
- Type III “double chin”
(Submental liposuction) Better than direct excision, however is it Beneficial alone? + platysmal banding.
- Type IV
(Submentoplasty) Sharp supraplatysmal dissection, Platysma manipulation (reaproximation or imbrication).
- Type V, VI “Turkey Gobbler deformity"
(Mentoplasty) Direct skin excision then Z, A-T, T-Z closure. For Males only as it cause Submental scar.


How Much Pain is Associated with Neck lift?

There will be some discomfort after undergoing neck lift surgery, which can be lessened with prescribed pain medication. Some degree of swelling and possibly bruising can be expected, but this is only temporary. It is recommended that you stay home for at least a week after surgery and take it easy for the first three weeks following surgery.


What happens after undergoing a Neck Lift operation?

During the recovery period, patients should wear a compression garment for several days. This garment helps improve blood circulation and minimize swelling. The compression garment can allow the patient to heal from their necklift faster and minimize the amount of downtime while providing comfort and support to the neck.

Even though swelling takes a few weeks to subside, patients should be able to start seeing the results of their neck lift within a week following surgery. Patients will notice more definition in their neck and under the jaw line.

The duration of the results depend on the type of procedures used. The neck lift procedure can last about five to ten years, but this varies from patient to patient. However, liposuction permanently removes fat deposits from the neck.


What Are the Risks and Limitations of Neck lift?

With any cosmetic procedure, there is always the possibility of risks. A neck lift may involve multiple procedures, so, there is an increased risk. The most common risk for any cosmetic procedure is allergic reaction to the anesthesia and infection. Another potential complication is accumulation of blood under the skin (hematoma). Yet another risk is injury to the nerves that control muscles in the treated area.

These risks can be reduced when the procedure is performed by a qualified surgeon, with extensive experience in performing neck lifts and if patients follow pre-operative and post-operative instructions. Smokers should stop smoking two weeks before surgery because this contributes to poor healing of the skin.


What Are The Typical Costs Associated With Neck Lift?

Although price is a factor when deciding on surgery, the most important factor is that you feel you are getting a good quality, natural-looking result from the procedure.

When dealing with necklift costs, you also need to take into consideration the fact that adjuvant procedures may be needed. Costs for neck rejuvenation vary depending on the type of treatment ranging from 2000 – 3500 U.S. dollars. However, Liposuction alone averages 1500 U.S. dollars. Medical insurance providers do not cover the Facial Rejuvenation procedure.

N.B. Keep in mind that a necklift may improve the appearance of wrinkles but it will not remove them entirely from the facial region. Additional facial treatments such as chemical peeling and laser resurfacing, along with Botox and filler injections may used to help treat laugh lines, wrinkles, furrows and other skin blemishes such as age spots and acne scars.

Endoscopic necklift (platysmaplasty)neck thread lift
A technique using an instrument known as an endoscope, a tiny fiberoptic lens inserted through half-inch incisions placed inconspicuously in your chin and temple. The lens is attached to a camera connected to a television monitor, which allows the doctor to see where he is operating by watching the monitor and manipulating the tiny instruments externally. The endoscope also contains small tools.
During treatment, we can remove any fat bags and jowls and treat lines and dynamic wrinkles but not excess skin.

This procedure benefits are: minimal wound and scarring, less bleeding and less possibility for swelling. However, it is time consuming (4 to 5 hours); it could not remove excess skin and should be done by well trained and certified consultant of plastic surgery.

Contour Threads™ facelift:
Permanent threads hung up the sagging neck skin and muscles to temple region.


II- Non-Surgical procedures:

The following are some of the more common minimally-invasive or non-surgical facial rejuvenation procedures:

A- Microdermabrasion:
This is a superficial skin polishing procedure that involves sanding off the first layer of skin with tiny crystals. (For more information Click here)

B- Chemical Peel:
When certain chemicals are applied to the skin, they cause age spots to disappear while tissue appears less transparent.(For more information Click here)

C- Laser Skin Resurfacing:
Through short bursts of laser light, unsightly veins and dark “age” spots are gently removed the skin.(For more information Click here)

D- Meso-sonic Rejuvenation:
Meso-sonic rejuvenation is designed to reduce redness, flushing and wrinkle size. This leaves the skin with a more even tone that looks and feels smoother.(For more information Click here)

E- Spider Veins Treatment (Sclerotherapy):
The injection of a chemical, known as a sclerosing solution, into unsightly veins which causes them to turn white and gradually disappear.(For more information Click here)

F- Botox Injections:
Botox is a botulinum toxin that is injected to prevent the contraction of muscles that form wrinkles, thus reducing them.(For more information Click here)

G- Injection of Lipolysis materials:youth
This method is alternative to neck liposuction. The idea is injection of certain materials that lyses or break cell wall of fat cells make it easy to remove the fluidly fat by blood. It could be done in 3 to 4 sessions with 3 days intervals.

These neck rejuvenation procedures are just some of the many ways cosmetic surgery can help enhance one’s appearance.


How long do these Non-Surgical neck rejuvenation procedures last?
The following is a listing of the average duration of the results, which can vary from patient to patient:

Botox Injections: 6 Up to 18 months according to type and concentration.
Chemical Peel: Variable depending on the chemical used.
Sclerotherapy, Dermabrasion, Microdermabrasion, Laser Skin Resurfacing, Photo Rejuvenation and lipokill injection: The results of these procedures are permanent as it removes age spots, wrinkles, and other skin conditions or submental fat.
However, the skin can still age and new wrinkles and other blemishes can still appear.


FAQ from patients when considering undergoing neck rejuvenation?!

Q - What is the type of anesthesia, and when I can return to normal life?
A - According to your age and the procedures. General anesthesia for surgical procedures, Local anesthesia or without for non-surgical procedures, and you can practice your normal life 2 hours up to 2 days according to type of procedures.

Q - What are the symptoms that may occur in the first five days after neck rejuvenation procedures?
A - Soreness which could be managed by pain killer’s medications and there may be edema or swelling of the face and neck.

Q - What are the guarantees that the success of the process?
A - There is no doubt that the followers of the medical instructions and close follow up visits are the main factors for the success of any surgical procedure. If not, the process to achieve the agreed outcomes before, the process repeats at reduced cost. Some procedures as filers and Botox injection need refine touch after 2 weeks.

Q - When can we get the final results?
A - For Non-surgical facial rejuvenation the results appear immediately, for surgical procedures the final results is achieved after the first three weeks.

Q - Is the rejuvenated neck seems naturally?
A - Yes.

Q - What is ideal age for neck rejuvenation?
A - It could be done at any age.

Q - If you are not Egyptian, What is the minimum period for follow up?
A - For Non-surgical necklift, just one day. for surgical procedures, five days.

Q - What are the contraindications of surgical neck lift procedures?
A - There are no absolute contraindications but the patients should inform their surgeons about any allergies, serious medical conditions, and medications they may be taking. Smokers should stop smoking 2 weeks before surgical procedures to promote the healing process.

Q - Where will the neck rejuvenation procedures be performed?
A - In hospital if general anesthesia is needed (surgical procedures) or in outpatient bases (clinic) if local anesthesia will be used (Non-surgical procedures).

Q - In my case, what technique is most appropriate in helping me achieve my cosmetic goal?
A - It depend on the your age and your preference.

Q - How much does neck rejuvenation procedures cost and what elements factor into that cost like hospital fees, anesthesia, and so on?
A - Ranging from 500 to 3500 U.S. dollars. Medical insurance dose not cover facial rejuvenation procedures.

Q - What is the surgeon’s level of experience in performing neck rejuvenation procedures?
A - Consultant or Doctoral in Plastic surgery.

Q - What percentage of patients experience complications with neck rejuvenation procedures?
A - 8 - 10%


Summary of Neck Rejuvenation Procedures:

The time of the procedure: from half to five hours.
Type of anesthesia:
local anesthesia +/- sedation or General.
Location:
hospital or clinic with or without postoperative hospital stay.
Expected Side effects:
Temporary swelling and pain.
Recovery time:
return to work after 2 hours and the final outcome immediately for Non-surgical procedures and within 3 weeks for surgical procedures.
Cost:
according to procedure ranging from 500 to 3500 U.S. dollars.
Results: according to procedure ranging from months to years and sometimes permanent results.