As we age, the skin, fatty tissue, muscle, and glands under the jaw line begin to sag downwards. This process results in the loss of a youthful jaw line, its definition and sculpted contour.

Many people believe that simple, non-surgical facial procedures can correct these signs of aging and provide the lasting, youthful appearance. The truth is, however, that the correction of facial and neck aging often requires significant structural modifications and robust structural suspension that non-surgical techniques simply cannot provide. Filling in of wrinkles and fine lines on the face and neck won’t give you the appearance you want if your jowls are sagging and you have a double chin or present with prominent vertical bands along the front of the neck.

Face and neck are often considered as one functional unit, so in many patients the typical ageing changes in the face are accompanied with slack of the skin in the neck too and vice versa. Although it is occasionally appropriate to operate only on the neck, in most instances, the neck is addressed in combination with at least lower or entire face skin and muscles area. This offers the opportunity to deal with the jowls and jawline, tighten wide and super thin muscle on the front of the neck resulting in dramatic aesthetic improvement. In selected group of patients, neck can and should be rejuvenated on its own, but in vast majority of patients, the best results are achieved if face and neck are tackled at the same time.

It always helps to plan things in advance of surgery and adjust work and life activities accordingly. Therefore, please consider the following issues prior to your operation:

• All of my patients are strongly advised to stop smoking prior to surgery as smoking significantly increases the complication rates and can create devastating problems, especially after this type of surgery
• Anticoagulation medication (Aspirin, Brufen, Warfarin, Clopidrogel) should ideally be stopped few days before the operation to reduce the risk of bleeding, but advise from the clinician who prescribed them is wise beforehand.
• Please make sure that you arrange to be collected from the hospital as you will not be able to drive after the surgery
• Plan your time off school / work / sports

There are many procedures utilized to rejuvenate the neck. In some patients, liposuction alone can improve neck contour. Probably the majority of patients require liposuction combined with neck muscle tightening and/or muscle repositioning. In selected, but minority of people, ‘less invasive’, neck lift based on suture suspension (also known as ‘Trampoline or Shoelace neck lift’) will suffice. I prefer to perform conventional neck lifts under general anaesthesia with at least, one night stay in hospital. Occasionally, it is possible to arrange day care surgery, but in my practice, this is usually an exception, rather then a rule.

Neck Liposuction – Fat along the jaw line and under the chin is often removed first by fine liposuction. This is achieved by inserting fine, liposuction cannulas through incisions under the chin and/or under the ear lobule. These scars will be tiny, 2-3mm long, hidden within the chin creases and several months after surgery, almost unnoticeable. Liposuction not only removes localised fat deposits, but causes deeper scarring and subsequent tightening as skin heals over emptied fat pockets.

Skin and Muscle tightening/redraping – Common sign of the underlying structural changes associated with facial aging is the separation of the broad and thin neck (platysma) muscles from the midline of the neck. When we are young, these muscles are joined at the center of the neck. Muscle separation results in unsightly vertical cords (bands) which become increasingly prominent along the length of the neck as we get older. During a traditional neck lift, skin excess is removed and these muscles corrected i.e. resuspended against each other resulting in tightened and redraped neck line.

Incisions are made around the lower half of the ear and off into the lower scalp. Occasionally it may be necessary to make a small incision under the chin too. These incisions allow access to the deeper layers of the neck i.e. muscle, fascia and fat which can then be manipulated, tightened, reinforced etc.

In most instances, I insert drains under the operated area, pending degree of tissue oozing during operation. These are removed on the first postoperative day whilst you are on the ward.

Suture Based (‘Trampoline/Shoelace’) Neck Lift – Over the last 2 decades, neck lifting based on tightening of the suture slings inserted under the jaw line skin has been introduced as less (minimally) invasive modification of conventional neck lift (described above). Procedure entails making a series of pinpricks across the jaw line. A thin surgical thread (suture) is weaved through these tiny holes, before being tied together like a shoelace, tightening up loose skin around the neck and chin. Two sides of the neck muscle and interwoven together in a broad fashion, distributing the tension to a larger surface area. Creation of lateral traction on the neck muscle creates a “sling,” which elevates the soft tissues below the jaw and significantly improves the angle of the neck. This tautening effect can resemble stretching of a trampoline, hence the name ‘Trampoline or Shoelace Neck Lift”.

Whether performed as a stand-alone procedure, or in conjunction with other facial rejuvenation techniques, suture based neck lift can radically improve overall appearance and permanently restore a more youthful, lifted neckline, but is, in my opinion limited only to small group of patients whose skin quality and features would respond to above.

If performed in isolation, the trampoline neck lift can be performed on an outpatient basis, either using general anaesthesia or occasionally, intravenous sedation. Recovery after this operation is perhaps a bit faster then after traditional surgery, but it still requires several downtime days and rest. The initial results will be immediately apparent after surgery, but will continue to gradually improve over the next 6-9 months as scarring matures and healing.

You should expect to be will in the hospital for 1-2 nights. The wounds will be taped and any sutures in front of the ear removed at one week. Any further sutures (in the hairline) will be removed at 10 days post-operatively. You will be able to shower the day after you leave hospital and then use a hairdryer on a warm setting to dry the tape off. Bandages stay for 3-4 days, whereas the sutures are removed between 7-10 days.

You will be able to shower the day after you leave hospital and then use a hairdryer on a warm setting to dry the tape off. It is important to minimize your activities in the first few weeks. Bending or lifting should be avoided as well as strenuous exercise for 6 weeks. You will usually need to take 3 weeks off work and will return to normal within 6-8 weeks.

You are likely to be provided with a specialised necklift compression garment postoperatively. The aim of this supplementary dressing is to support adherence of surgically raised skin flaps to the underlying muscles and minimise the large raw plane created by surgery. Compression garment is particularly important during the first week after surgery when the risk of bleeding and seroma (tissue fluid collection) is the greatest. Garment is usually abandoned 3 weeks after operation.

Unfortunately, complications can occur following any surgery and patients need to be fully aware of this. I always tend to carry out surgery in a safe manner and take all sensible measures to minimise risks and complication rate. As with any surgical procedure, there are general and procedure (facelift/necklift) specific risks which patients must be aware of:

General Risks (especially if operation is carried out under general anaesthetic):

• Adverse reaction to general anaesthetic
• Clots in the legs/lungs
• Vein trombosis (DVT) / inflammation (trombophlebitis)
• Bruising and swelling in the operated area (especially in patients on aspirin or anti-inflammatory drugs)
• Bleeding and haematoma (including need to return to theatre to evacuate large blood clot in approximately 3-4% of patients)
• Scarring
• Infection (3% of patients)
• Skin/scar irregularities
• Hypertrophic (lumpy and itchy) scars
• Delayed healing
• Numbness, alteration in sensation around operated area

Procedure Specific Risks:

• Skin numbness and necrosis of facial and neck flaps
• Asymmetry between two sides of the neck
• Earlobe numbness and altered positioning of earlobes
• Damage to the facial nerve and its branches (weakness of the corner of the mouth and/or lower lip)
• Alopecia (bold patches of skin)
• Mild facial asymmetry
• Need for a revisional surgery several years later (in response to ongoing ageing and gravity)

It can take few weeks for swelling to disappear, scars fade and soften. The scars are initially pink, can be a bit lumpy and/or itchy, but over the course of 3-6 months, they mature nicely and become hardly noticeable white lines. Although scars are permanent and quite extensive, in my experience, they rarely pose problems in the long term. Postoperative infections can delay healing process and prolong remodelling of the scar tissue.