Question:
I have a turkey gobbler type neck and I’ve heard that this is not as much related to excess skin as it is to the platysma muscle. If this is true, what is done during surgery to fix this muscle?

Answer:
You are correct that the bands hanging down from one’s neck are typically not just skin but the front edge of the platysma muscle.  Treatments can include a neck lift that is performed in and around the ears where the back side of the platysma muscle is elevated and thus the front edge of the platysma muscle is also elevated at the same time or in a more aggressive fashion we can actually perform a direct platysmaplasty through an incision under the chin where excess platysma muscle is resected and then the platysma muscle edges are actually sutured together.  This is most commonly performed in conjunction with the facelift and in my hands I prefer the extended SMAS deep plane facelift in conjunction with this platysmaplasty and frequently I will even be contouring the fat under the platysma to give a patient a very high, elegant neckline.  With this technique rejuvenation can be extremely significant and yet the overall effect is very natural appearing.

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Question:
I recently heard of something called a Botox neck lift. What kind of results could I expect from this compared to a traditional surgical neck lift?

Answer:
A Botox neck lift involves placement of Botox in the platysma muscle to try to reduce dynamic platysmal bands, which are lines between the chin and the lower neck.  Though it can help slightly, the overall effect is rather minimal and compared to a surgical neck lift is essentially miniscule.  

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Question:
How is submentoplasty different from a neck lift?

Answer:
Submentoplasty could be considered a form of a neck lift in that the muscles underneath the chin are tightened directly through a small submental incision as opposed to a mini lift where the SMAS is lifted on each side which lifts the jowls and some of the laxity under the chin and this is performed through incisions in and around the ear.  Typically a submentoplasty is performed in younger patients that have no jowling but have excessive fullness under the chin whereas a neck lift is typically performed in patients that have aging features including some early jowling along with the laxity under the chin.

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Question:
I’m 39 but I feel like my neck is very saggy prematurely and that this really ages me. The sag started a few years ago when I lost about 40 lbs. Even though I feel pretty young for this, could a neck lift help?

Answer:
I have treated many patients in their 30s with a neck lift or mini lift and several of them had had a significant amount of weight loss in the past contributing to their laxity.  This is a procedure that is performed in the office setting using strictly local anesthetic.  The scars are extremely well hidden in and around the eyes.  It is very effective at completely rejuvenating this area and at your young age should last an extremely long time.

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Question:
How do you treat a hematoma following neck lift surgery?

Answer:
If it is a small hematoma, I will simply evacuate it using a small suction and then place another pressure dressing for an additional 24 hours.  If it is an enlarging hematoma then we need to remove the sutures, evacuate the clot, find the area of bleeding and cauterize it and then close again with sutures prior to placing the pressure dressing.  Occasionally someone will come back days after a facelift with a small hematoma and in that particular circumstance we will simply observe it and as it softens we will literally aspirate it with a needle evacuating the additional fluid.  In all of these circumstances additional bruising will be created and obviously then it will take longer for this to resolve, but the patient can wear cover makeup over these areas and their downtime is typically no more significant than a patient who did not have a hematoma.

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