November 19, 2024 • 23 mins
Because the neck tends to reveal your age more clearly—and age faster—than your face, it is a key area to address when talking about facial aging.
Some people catch the early signs, like skin texture changes, and horizontal lines across the neck. For these concerns, skin treatments, like chemical peels, energy treatments for skin and dermal stimulating filler treatments can help. For minimal sagging or excess fat is approached with liposuction, or muscle tightening through small incisions. As skin laxity worsens, energy-based lifting treatments come into play.
But once you reach the point where there’s noticeable sagging or that “turkey neck” look, surgery is needed for real improvement.
The neck is just as visible as the face, so it’s crucial to include it in any rejuvenation plan. Don’t focus only on the face and neglect the neck—it’s on display every day, too.
Find out why the neck is so tricky to treat, how to pick the right surgeon for a neck lift, and why it’s often paired with a face lift. Learn what causes neck aging and how to prevent it and treat it.
Links
Learn more about neck lift and skin quality treatments
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
Welcome to Park AvenuePlastic Surgery Class,
the podcast where we explore controversiesand breaking issues in plastic
surgery. I'm your co-host, Summer Hardy,
a clinical assistant at BassPlastic Surgery in New York City.
I'm excited to be here with Dr. LawrenceBass, Park Avenue plastic surgeon,
educator, and technology innovator.
The title of today's episode is NoMore Turkey Gobbler: All Things Neck.
(00:25):
I get the idea herefrom the title Dr. Bass,
but what is the scope of the topicand why is the neck so important?
Well, the neck tends to showyour decade of age even more
clearly than your face andage a little more quickly
than the face.
So it's a very important areawhen we talk about facial
(00:48):
aging. And if you havethat hanging wattle of
skin under the chin,
that definitively pegs youin a certain decade of life.
So typically in your sixties,maybe in your fifties,
but everyone's going to know forsure you're not in forties or
(01:08):
thirties. And the neck is a zone under the
jawline,
including that area underthe chin that's horizontal,
but also the area fromthe Adam's apple down,
that includes the Adam's appleand the neck skin going down
(01:29):
to the collarbone or claviclesand the top of the chest.
And it generally includes the areawhere the sternocleidomastoid muscle
is, the strong muscle on eitherside of the neck that creates a
V or demarcation line for the front of the
neck in the back of theneck. It's behind that,
(01:51):
but most people don't see the backparts of your neck when you're
talking to them or whenyou're walking around.
Okay, that makes sense. And thengiven the title of this episode,
can you tell me what is aturkey gobbler Dr. Bass?
So as I mentioned,
it's that hanging wattle of skinthat hangs down from underneath the
(02:13):
chin to just above the Adam's apple.
Some people have vertical bandingeven when they're very young.
That's not a turkey gobbler,
but when you really start tohave that hanging band of skin
and fat,
that's not muscle tenting up and that
(02:36):
represents substantial excess of skin.
That's a turkey gobbler thatputs you in your sixties,
maybe in your later fifties,
except for folks who havelost massive amounts of weight
that defines your decade.
And most people reallyhate it and feel it makes
(02:59):
them look considerably less attractive.
It's typically associated witha bunch of other aging changes,
and so it's something people reallywant to chase and get rid of.
Got it. What is the treatmentfor a turkey gobbler?
Are there nonsurgical options?
So by the time you reach thestage where you have that
(03:21):
actual hanging band of skin and fat,
you are past the stage where there'sany meaningful treatment using
nonsurgical methods.
And I do a lot of research and I'm very
interested in new technologiesand I've tried all kinds of
(03:41):
technologies on these thingsand I've succeeded in taking
a component, a percentage if you will,
of the turkey wattle out.
But if you have that hangingturkey gobbler and I take
20% of it away,
which would be a really good result andI've succeeded in doing that in some
(04:04):
folks, you still have 80% of it present.
You still have an obviousvisible turkey gobbler.
You're still obviously in your sixties,
you're not in that adult indeterminatestage that we're trying to create with
facial rejuvenation. So inmy view, that's a failure.
And my experience with patients hasbeen that they're still unhappy with
(04:27):
their appearance because they werereally looking to minimize that.
We never get rid of a hundred percent,
but if we got rid of 80or 90% of what's there or
95% if we were really lucky,
you look definitively better andthe future is mild rather than
(04:48):
being obvious.But if you only take 10, 20, 30% away,
the future is still obviously there andyou're still obviously in that later
stage of life.
I didn't realize that onceyou can really see it,
surgery is one of the main options then.
So what kinds of aging changesare typical in the neck?
(05:11):
So even though we titledthe episode about the
turkey gobbler, we're really,as we said in the subtitle,
talking about all thingsneck. So just like the face,
the neck is an area anatomicallythat that has a lot of
complexity.
There are a lot of different structuresunder there in a very small amount of
(05:35):
space.
A lot of those structures arereally important things for your
life and well being.
So someone who works in the neck needsto be intimately familiar with all of
that anatomy and likethe face, unfortunately,
there's not a single thingthat ages in the neck,
(05:57):
a single anatomic structurethat needs to be addressed.
But there are multiple componentsand those components include
skin quality things.
So skin quality talksabout redness and vascular
changes,
pigmentary changes like agespots and sort of bronzing of the
(06:18):
skin,
the turgor of the skin. Doesit look floppy and parchment like or is it firm and
springy like youthful skin?And texture, wrinkles and
crepiness has that skin texture
declines.
You show more and more alignswrinkles and irregularity.
(06:39):
So those are skin qualityissues. Then there's skin laxity,
which starts out as a little bit ofhanginess and progresses to the point
where you really have the turkey gobbler.
There are muscle changes like separationof some of the platysma muscle,
which is really a paired muscle andthat can show some vertical banding and
(07:01):
other kinds of lines and alsocontribute to dissent and blunting
of the cervicomental angle. The anglebetween the horizontal and the vertical
glands in the neck can also show,
so glands like the submandibulargland that sit under the jaw,
tucked up behind the jaw when we're young,
(07:24):
start to sag and droop downand they can show on the
side of the neck just under the jawline.
And finally fat,
which can be excessivein the neck, building up,
contributing to fullness,
contributing to blunting ofthe demarcation between the
(07:45):
jawline and the neckand fullness of the area
under the jawline and under the chin.So those are a
long laundry list of all ofthe small things that can go
together to create an agingappearance in the neck.
Wow, there are a lot of smalldetails that's really interesting.
(08:09):
When do they show and what arethe big factors in this area?
So of course aging is variable,
so there's no single age where agiven feature is going to show,
but we do age based on some
controllable factors and some thatare not currently controllable.
So sun exposure is abig factor in skin aging
(08:35):
and neck skin is reallyaffected by that as well
as smoking. Those are ourtwo big controllable factors.
And then there's also timing ofskin aging based on your skin type
fair thin skin tends stagemore quickly than thicker,
darker skin. So thoseare some of the factors.
(08:57):
But most people by the timethey're in their forties,
will start to have some texturechanges in the skin of their neck,
often even in the thirtiesand some fair skin,
people who get a lot of sun canstart to see these changes in their
late twenties.
There we're mostly talkingabout skin laxity changes and
(09:18):
laxity starts to creep inand most patients in their
fifties accelerate in the sixties.
And for women menopauseis a watershed where
again, skin laxity and otherskin aging changes can speed up.
Okay. So we've heard abouta few of the problems.
(09:39):
What is the approach to treatment?
Well, this depends on what isreally showing and predominates
in the appearance of the neckand on when the patient shows
up asking for help. So somepeople come very early,
they're starting to seesome skin quality changes,
some lines going side to sideacross the bottom of the neck,
(10:03):
a little bit of sagging of skin or alittle bit of fullness or banding of
skin. So at that point,
skin quality treatments are goingto be the focus and sometimes
liposuction or a little muscletightening just done through small
incisions under the chin.
As skin laxity progresses,
(10:27):
we can come in with energybased treatments for the skin,
and these are ideally for peoplein their forties and some people in
their fifties who don't yetneed a surgical neck lift or a
surgical facelift,
if they just have a little laxity,
those energy-based treatmentscan give them what they need,
(10:50):
which is just a little bit of tighten up.
But if there's significant laxityor the obvious turkey gobbler,
those technologies are not going tobe able to contribute enough change to
make a meaningful difference.
I've heard that the neck is harder totreat. Is this true? And if so, why?
(11:11):
The neck skin is significantlydifferent from our
face skin,
even though the neck skin is onlya few inches away from the face,
blood supply is different, thethickness of the skin is different.
And most importantly,
there are things calledadnexal structures in the skin.
(11:31):
So these are sweat glands,oil glands, hair follicles,
things that are in theskin that are not skin
material, skin fabric themselves.
And that's a source ofhealing and regeneration in
part for skin when it's wounded.
And just in terms of itsregeneration and turnover,
(11:57):
skin turnover declines as we age and
our neck skin has a thousand fold fewer
adnexal structures than our face skin.
So that skin is going toshow aging changes first.
And it also tells us why it's goingto be harder to treat because its
(12:19):
ability to heal andregenerate is significantly
less than that of face skin.
That's really interesting. Here'ssomething I've always wondered about,
what is the difference betweena facelift and a neck lift?
So that difference meansa lot more to patients
semantically than itdoes to plastic surgeons.
(12:44):
There are some proceduresthat focus on addressing
lax skin in the neck or addressingdeeper structures in the neck.
And these are sometimes done in earlystage of aging where we make an incision
just in front of the earor just behind the ear
to lift the skin just in the neck in a
(13:09):
more focused fashion.
But most of the time we'remaking a more extensive
incision that's both in front ofand behind the ear and back into the
posterior hairline.
And we're generally resetting in harmony,
a lot of the tissues inthe face and neck because a
(13:32):
key element of what botha facelift or a neck
lift are aiming to correctis hanging skin in the
neck and a sharpening of the jawline.
And the jawline is that demarcationbetween the face and the neck.
So in either a facelift or a neck lift,
(13:53):
that has to be made as sharp,
defined and youthfulas it possibly can be.
And that means that all the adjacentstructures both above and below are going
to require a little bit oftinkering so that everything
remains in harmony.
So there are just faceliftsand just neck lifts,
(14:16):
but most techniques are going toinvolve at least some work in all or
both of those areas.
And that doesn't reallymodulate the recovery,
which is part of the reason why somepeople are focused on getting just a neck
lift or just a facelift because they don'twant to mess with more than they have
(14:37):
to.
And you get more or less the same recovery
if you have a properneck lift or facelift.
Just the area where that bruisingor swelling may occur is slightly
larger,
but it doesn't necessarilylast any longer.
(14:58):
If you're adding a bunch of otherprocedures, it may last a little longer,
but not between thefacelift and the neck lift.
Okay, that makes a lot ofsense. Thanks for explaining.
So then more recently, I've heard theterm deep plane neck lift mentioned.
What does this mean and how is itdifferent from traditional neck lifts?
(15:20):
So deep plane techniques,
which is really a better wayof putting it than neck lift,
is sort of a marketing term thata lot of people who are promoting
deep plane facelift are using,
but it does have somesignificant medical meaning to
most of us in plastic surgery.
(15:41):
And the important thing here isthat there are a bunch of structures
in the neck that need to be addressedin a patient who has a significant
amount of aging besides just the skin.
And so deep techniques,
deep plane techniques in the neck meanaddressing things that are under the
(16:04):
skin and under the platysma muscle.
So in addition to takingout subcutaneous fat,
often there is fat underthe platysma and that
fat needs to be reducedto create the shape in the
submental area or the areaunder the chin that we want.
(16:24):
Some patients, if you justtake the subcutaneous fat,
they'll still have somebulging under the chin
that has to be done in proper measurebecause if that's over aggressively done,
you can get concavity and hollownessunder there what's called the cobrah neck
deformity, which is undesirable.There are also muscles there,
(16:47):
the anterior gastric muscles thatsometimes contribute to fullness,
and sometimes these areat least the anterior
leg of that muscle is debulked.
The submandibular gland, whichwe talked about previously,
which can start to sag down,
(17:08):
can either be tugged up in sometechniques or more commonly debulked.
And there's a lot ofdifferent kind of effort,
more extensive effort beingexpended on how the platysma muscle
itself is handled separatefrom the skin draping that
(17:29):
takes place in the neckto tailor out the laxity.
So controversial which techniques work
best for the platysma and It's probablydifferent in different patients
depending on what theirneck shape is like.
And so examination andcustomization of the for any
(17:49):
patient is importantwhen you're chasing more
advanced techniques aspart of an neck lift.
Can you tell me a bit more aboutthe approach to procedure selection?
What is the best optionand how should I choose?
So in terms of which procedure for skin
(18:10):
lifting, as I was just explaining,
we need to customize based on the shapeof the neck, the shape of the jawline.
Some people have a very longjaw, a very projecting jaw,
other people do not.
Some people have a jaw that's angulatedvery much up and other people have a
much more horizontal jaw.
That's all going toaffect how things drape
(18:34):
with the skin, the fat, theother structures in the neck,
people have differentpositioning to the hyoid bone.
It's a little bone that sits againat the cervical mental angle.
The intersection between thehorizontal and the vertical
above the Adam's apple andhow low or high that bone
(18:58):
sits is going to affect the shapeof the neck, how much fat is there,
how much skin laxity.
So what all of that means as a bottomline is there's no one procedure
that's the right procedure.And
also different surgeons havedifferent approaches using
(19:19):
the same basic techniques.
So what's most useful is to workwith someone who's an experienced
plastic surgeon, knows whatworks well in their hands,
looks closely at whichfeatures and what layout is
present in your neck,
listens carefully to whichfeatures bother you the
(19:42):
most and make sure that theywork that into the plan.
So that's in terms ofskin laxity and surgery.
In terms of skin quality treatments,
there's really a big range of treatmentsand there are a lot of different ways
to push the skin qualityand get it to improve.
These treatments are goingto vary depending on how
(20:06):
extensive the findingis, how severe it is.
So even if you pick the exactsame laser or the exact same PRP
treatment,
you're going to do it differentlybased on what the stage of aging is,
what the skin type is,how severe the finding is,
what other associated findings are there,
and how many treatmentsyou're willing to have,
(20:29):
and how much recovery timeyou're willing to have.
So you pick something that's agood intersection of all of those
factors and it should be prettyclear from that discussion. Again,
there's no one right answeror one best technique,
but it depends bothering you andhow much effort you're planning to
(20:50):
expend to chase that featureand get it corrected.
Got it. And what areyour takeaways, Dr. Bass?
So the neck is a reallyimportant area to include in
any rejuvenation plan.
It's just as important as the facebecause people see it all day every day.
(21:11):
It's not an area ofthe body that's hidden.
So don't chase away aging changeson the face and forget to treat the
neck. That's really important as a first
step. Recognize that it's goingto take more treatments to get
a given amount of correctionon the neck than on the face,
(21:34):
so it's more treatments.
It's a slower and more limitedresponse when you treat the
neck. because of thatdifference in the skin biology,
that means you really ought toplan early and get a jumpstart on
things before they're reallyset in cement and difficult to
(21:56):
undo. So working on skin quality early,
certainly with sunscreen in yourtwenties and starting to look at skin
products and protection andmoisturizing in your thirties and
maybe even some in-officetreatments is really important,
(22:16):
especially skin quality things.
The laxity comes later,typically late forties,
the second half of forties,fifties, and sixties.
But skin quality is going tostart to show problems earlier
in most folks. Finally,
(22:37):
probably the best results are obtainedwith a multimodality approach that
addresses all of the little agingchanges in at least some measure,
and that also allows you to usethings for what they're good for,
use things in a moderate amountrather than trying to take one
modality and pushing it too hard,
(22:58):
which gives you diminishing returnsand potentially more risk of
complications.
Thank you Dr. Bass for getting me upto speed on all things neck with this
fascinating look at a critical area.
Thank you for listening to the ParkAvenue Plastic Surgery Class Podcast.
Follow us on ApplePodcasts, write a review,
(23:19):
and share the show with your friends.
Be sure to join us next time to avoidmissing all the great content that is
coming your way. If you want tocontact us with comments or questions,
we'd love to hear from you,
send us an email at podcast@drbass.net or
DM us on Instagram at @drbassnyc.
Welcome to Park AvenuePlastic Surgery Class,
the podcast where we explore controversiesand breaking issues in plastic
surgery. I'm your co-host, Summer Hardy,
a clinical assistant at BassPlastic Surgery in New York City.
I'm excited to be here with Dr. LawrenceBass, Park Avenue plastic surgeon,
educator, and technology innovator.
The title of today's episode is NoMore Turkey Gobbler: All Things Neck.
(00:25):
I get the idea herefrom the title Dr. Bass,
but what is the scope of the topicand why is the neck so important?
Well, the neck tends to showyour decade of age even more
clearly than your face andage a little more quickly
than the face.
So it's a very important areawhen we talk about facial
(00:48):
aging. And if you havethat hanging wattle of
skin under the chin,
that definitively pegs youin a certain decade of life.
So typically in your sixties,maybe in your fifties,
but everyone's going to know forsure you're not in forties or
(01:08):
thirties. And the neck is a zone under the
jawline,
including that area underthe chin that's horizontal,
but also the area fromthe Adam's apple down,
that includes the Adam's appleand the neck skin going down
(01:29):
to the collarbone or claviclesand the top of the chest.
And it generally includes the areawhere the sternocleidomastoid muscle
is, the strong muscle on eitherside of the neck that creates a
V or demarcation line for the front of the
neck in the back of theneck. It's behind that,
(01:51):
but most people don't see the backparts of your neck when you're
talking to them or whenyou're walking around.
Okay, that makes sense. And thengiven the title of this episode,
can you tell me what is aturkey gobbler Dr. Bass?
So as I mentioned,
it's that hanging wattle of skinthat hangs down from underneath the
(02:13):
chin to just above the Adam's apple.
Some people have vertical bandingeven when they're very young.
That's not a turkey gobbler,
but when you really start tohave that hanging band of skin
and fat,
that's not muscle tenting up and that
(02:36):
represents substantial excess of skin.
That's a turkey gobbler thatputs you in your sixties,
maybe in your later fifties,
except for folks who havelost massive amounts of weight
that defines your decade.
And most people reallyhate it and feel it makes
(02:59):
them look considerably less attractive.
It's typically associated witha bunch of other aging changes,
and so it's something people reallywant to chase and get rid of.
Got it. What is the treatmentfor a turkey gobbler?
Are there nonsurgical options?
So by the time you reach thestage where you have that
(03:21):
actual hanging band of skin and fat,
you are past the stage where there'sany meaningful treatment using
nonsurgical methods.
And I do a lot of research and I'm very
interested in new technologiesand I've tried all kinds of
(03:41):
technologies on these thingsand I've succeeded in taking
a component, a percentage if you will,
of the turkey wattle out.
But if you have that hangingturkey gobbler and I take
20% of it away,
which would be a really good result andI've succeeded in doing that in some
(04:04):
folks, you still have 80% of it present.
You still have an obviousvisible turkey gobbler.
You're still obviously in your sixties,
you're not in that adult indeterminatestage that we're trying to create with
facial rejuvenation. So inmy view, that's a failure.
And my experience with patients hasbeen that they're still unhappy with
(04:27):
their appearance because they werereally looking to minimize that.
We never get rid of a hundred percent,
but if we got rid of 80or 90% of what's there or
95% if we were really lucky,
you look definitively better andthe future is mild rather than
(04:48):
being obvious.But if you only take 10, 20, 30% away,
the future is still obviously there andyou're still obviously in that later
stage of life.
I didn't realize that onceyou can really see it,
surgery is one of the main options then.
So what kinds of aging changesare typical in the neck?
(05:11):
So even though we titledthe episode about the
turkey gobbler, we're really,as we said in the subtitle,
talking about all thingsneck. So just like the face,
the neck is an area anatomicallythat that has a lot of
complexity.
There are a lot of different structuresunder there in a very small amount of
(05:35):
space.
A lot of those structures arereally important things for your
life and well being.
So someone who works in the neck needsto be intimately familiar with all of
that anatomy and likethe face, unfortunately,
there's not a single thingthat ages in the neck,
(05:57):
a single anatomic structurethat needs to be addressed.
But there are multiple componentsand those components include
skin quality things.
So skin quality talksabout redness and vascular
changes,
pigmentary changes like agespots and sort of bronzing of the
(06:18):
skin,
the turgor of the skin. Doesit look floppy and parchment like or is it firm and
springy like youthful skin?And texture, wrinkles and
crepiness has that skin texture
declines.
You show more and more alignswrinkles and irregularity.
(06:39):
So those are skin qualityissues. Then there's skin laxity,
which starts out as a little bit ofhanginess and progresses to the point
where you really have the turkey gobbler.
There are muscle changes like separationof some of the platysma muscle,
which is really a paired muscle andthat can show some vertical banding and
(07:01):
other kinds of lines and alsocontribute to dissent and blunting
of the cervicomental angle. The anglebetween the horizontal and the vertical
glands in the neck can also show,
so glands like the submandibulargland that sit under the jaw,
tucked up behind the jaw when we're young,
(07:24):
start to sag and droop downand they can show on the
side of the neck just under the jawline.
And finally fat,
which can be excessivein the neck, building up,
contributing to fullness,
contributing to blunting ofthe demarcation between the
(07:45):
jawline and the neckand fullness of the area
under the jawline and under the chin.So those are a
long laundry list of all ofthe small things that can go
together to create an agingappearance in the neck.
Wow, there are a lot of smalldetails that's really interesting.
(08:09):
When do they show and what arethe big factors in this area?
So of course aging is variable,
so there's no single age where agiven feature is going to show,
but we do age based on some
controllable factors and some thatare not currently controllable.
So sun exposure is abig factor in skin aging
(08:35):
and neck skin is reallyaffected by that as well
as smoking. Those are ourtwo big controllable factors.
And then there's also timing ofskin aging based on your skin type
fair thin skin tends stagemore quickly than thicker,
darker skin. So thoseare some of the factors.
(08:57):
But most people by the timethey're in their forties,
will start to have some texturechanges in the skin of their neck,
often even in the thirtiesand some fair skin,
people who get a lot of sun canstart to see these changes in their
late twenties.
There we're mostly talkingabout skin laxity changes and
(09:18):
laxity starts to creep inand most patients in their
fifties accelerate in the sixties.
And for women menopauseis a watershed where
again, skin laxity and otherskin aging changes can speed up.
Okay. So we've heard abouta few of the problems.
(09:39):
What is the approach to treatment?
Well, this depends on what isreally showing and predominates
in the appearance of the neckand on when the patient shows
up asking for help. So somepeople come very early,
they're starting to seesome skin quality changes,
some lines going side to sideacross the bottom of the neck,
(10:03):
a little bit of sagging of skin or alittle bit of fullness or banding of
skin. So at that point,
skin quality treatments are goingto be the focus and sometimes
liposuction or a little muscletightening just done through small
incisions under the chin.
As skin laxity progresses,
(10:27):
we can come in with energybased treatments for the skin,
and these are ideally for peoplein their forties and some people in
their fifties who don't yetneed a surgical neck lift or a
surgical facelift,
if they just have a little laxity,
those energy-based treatmentscan give them what they need,
(10:50):
which is just a little bit of tighten up.
But if there's significant laxityor the obvious turkey gobbler,
those technologies are not going tobe able to contribute enough change to
make a meaningful difference.
I've heard that the neck is harder totreat. Is this true? And if so, why?
(11:11):
The neck skin is significantlydifferent from our
face skin,
even though the neck skin is onlya few inches away from the face,
blood supply is different, thethickness of the skin is different.
And most importantly,
there are things calledadnexal structures in the skin.
(11:31):
So these are sweat glands,oil glands, hair follicles,
things that are in theskin that are not skin
material, skin fabric themselves.
And that's a source ofhealing and regeneration in
part for skin when it's wounded.
And just in terms of itsregeneration and turnover,
(11:57):
skin turnover declines as we age and
our neck skin has a thousand fold fewer
adnexal structures than our face skin.
So that skin is going toshow aging changes first.
And it also tells us why it's goingto be harder to treat because its
(12:19):
ability to heal andregenerate is significantly
less than that of face skin.
That's really interesting. Here'ssomething I've always wondered about,
what is the difference betweena facelift and a neck lift?
So that difference meansa lot more to patients
semantically than itdoes to plastic surgeons.
(12:44):
There are some proceduresthat focus on addressing
lax skin in the neck or addressingdeeper structures in the neck.
And these are sometimes done in earlystage of aging where we make an incision
just in front of the earor just behind the ear
to lift the skin just in the neck in a
(13:09):
more focused fashion.
But most of the time we'remaking a more extensive
incision that's both in front ofand behind the ear and back into the
posterior hairline.
And we're generally resetting in harmony,
a lot of the tissues inthe face and neck because a
(13:32):
key element of what botha facelift or a neck
lift are aiming to correctis hanging skin in the
neck and a sharpening of the jawline.
And the jawline is that demarcationbetween the face and the neck.
So in either a facelift or a neck lift,
(13:53):
that has to be made as sharp,
defined and youthfulas it possibly can be.
And that means that all the adjacentstructures both above and below are going
to require a little bit oftinkering so that everything
remains in harmony.
So there are just faceliftsand just neck lifts,
(14:16):
but most techniques are going toinvolve at least some work in all or
both of those areas.
And that doesn't reallymodulate the recovery,
which is part of the reason why somepeople are focused on getting just a neck
lift or just a facelift because they don'twant to mess with more than they have
(14:37):
to.
And you get more or less the same recovery
if you have a properneck lift or facelift.
Just the area where that bruisingor swelling may occur is slightly
larger,
but it doesn't necessarilylast any longer.
(14:58):
If you're adding a bunch of otherprocedures, it may last a little longer,
but not between thefacelift and the neck lift.
Okay, that makes a lot ofsense. Thanks for explaining.
So then more recently, I've heard theterm deep plane neck lift mentioned.
What does this mean and how is itdifferent from traditional neck lifts?
(15:20):
So deep plane techniques,
which is really a better wayof putting it than neck lift,
is sort of a marketing term thata lot of people who are promoting
deep plane facelift are using,
but it does have somesignificant medical meaning to
most of us in plastic surgery.
(15:41):
And the important thing here isthat there are a bunch of structures
in the neck that need to be addressedin a patient who has a significant
amount of aging besides just the skin.
And so deep techniques,
deep plane techniques in the neck meanaddressing things that are under the
(16:04):
skin and under the platysma muscle.
So in addition to takingout subcutaneous fat,
often there is fat underthe platysma and that
fat needs to be reducedto create the shape in the
submental area or the areaunder the chin that we want.
(16:24):
Some patients, if you justtake the subcutaneous fat,
they'll still have somebulging under the chin
that has to be done in proper measurebecause if that's over aggressively done,
you can get concavity and hollownessunder there what's called the cobrah neck
deformity, which is undesirable.There are also muscles there,
(16:47):
the anterior gastric muscles thatsometimes contribute to fullness,
and sometimes these areat least the anterior
leg of that muscle is debulked.
The submandibular gland, whichwe talked about previously,
which can start to sag down,
(17:08):
can either be tugged up in sometechniques or more commonly debulked.
And there's a lot ofdifferent kind of effort,
more extensive effort beingexpended on how the platysma muscle
itself is handled separatefrom the skin draping that
(17:29):
takes place in the neckto tailor out the laxity.
So controversial which techniques work
best for the platysma and It's probablydifferent in different patients
depending on what theirneck shape is like.
And so examination andcustomization of the for any
(17:49):
patient is importantwhen you're chasing more
advanced techniques aspart of an neck lift.
Can you tell me a bit more aboutthe approach to procedure selection?
What is the best optionand how should I choose?
So in terms of which procedure for skin
(18:10):
lifting, as I was just explaining,
we need to customize based on the shapeof the neck, the shape of the jawline.
Some people have a very longjaw, a very projecting jaw,
other people do not.
Some people have a jaw that's angulatedvery much up and other people have a
much more horizontal jaw.
That's all going toaffect how things drape
(18:34):
with the skin, the fat, theother structures in the neck,
people have differentpositioning to the hyoid bone.
It's a little bone that sits againat the cervical mental angle.
The intersection between thehorizontal and the vertical
above the Adam's apple andhow low or high that bone
(18:58):
sits is going to affect the shapeof the neck, how much fat is there,
how much skin laxity.
So what all of that means as a bottomline is there's no one procedure
that's the right procedure.And
also different surgeons havedifferent approaches using
(19:19):
the same basic techniques.
So what's most useful is to workwith someone who's an experienced
plastic surgeon, knows whatworks well in their hands,
looks closely at whichfeatures and what layout is
present in your neck,
listens carefully to whichfeatures bother you the
(19:42):
most and make sure that theywork that into the plan.
So that's in terms ofskin laxity and surgery.
In terms of skin quality treatments,
there's really a big range of treatmentsand there are a lot of different ways
to push the skin qualityand get it to improve.
These treatments are goingto vary depending on how
(20:06):
extensive the findingis, how severe it is.
So even if you pick the exactsame laser or the exact same PRP
treatment,
you're going to do it differentlybased on what the stage of aging is,
what the skin type is,how severe the finding is,
what other associated findings are there,
and how many treatmentsyou're willing to have,
(20:29):
and how much recovery timeyou're willing to have.
So you pick something that's agood intersection of all of those
factors and it should be prettyclear from that discussion. Again,
there's no one right answeror one best technique,
but it depends bothering you andhow much effort you're planning to
(20:50):
expend to chase that featureand get it corrected.
Got it. And what areyour takeaways, Dr. Bass?
So the neck is a reallyimportant area to include in
any rejuvenation plan.
It's just as important as the facebecause people see it all day every day.
(21:11):
It's not an area ofthe body that's hidden.
So don't chase away aging changeson the face and forget to treat the
neck. That's really important as a first
step. Recognize that it's goingto take more treatments to get
a given amount of correctionon the neck than on the face,
(21:34):
so it's more treatments.
It's a slower and more limitedresponse when you treat the
neck. because of thatdifference in the skin biology,
that means you really ought toplan early and get a jumpstart on
things before they're reallyset in cement and difficult to
(21:56):
undo. So working on skin quality early,
certainly with sunscreen in yourtwenties and starting to look at skin
products and protection andmoisturizing in your thirties and
maybe even some in-officetreatments is really important,
(22:16):
especially skin quality things.
The laxity comes later,typically late forties,
the second half of forties,fifties, and sixties.
But skin quality is going tostart to show problems earlier
in most folks. Finally,
(22:37):
probably the best results are obtainedwith a multimodality approach that
addresses all of the little agingchanges in at least some measure,
and that also allows you to usethings for what they're good for,
use things in a moderate amountrather than trying to take one
modality and pushing it too hard,
(22:58):
which gives you diminishing returnsand potentially more risk of
complications.
Thank you Dr. Bass for getting me upto speed on all things neck with this
fascinating look at a critical area.
Thank you for listening to the ParkAvenue Plastic Surgery Class Podcast.
Follow us on ApplePodcasts, write a review,
(23:19):
and share the show with your friends.
Be sure to join us next time to avoidmissing all the great content that is
coming your way. If you want tocontact us with comments or questions,
we'd love to hear from you,
send us an email at podcast@drbass.net or
DM us on Instagram at @drbassnyc.
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