The Neck Lift procedure begins with a tightening of your neck muscles in the under-the-chin area. This is usually called a platysmaplasty and there are different types of platysmaplasty. Dr. Moelleken prefers the Neck-Lace platysmaplasty, which is an interweaving method of tightening the muscles, rather than tightening them down the center. This is just the first step and you should not be misled into believing that this procedure alone will make you look good (without laser, tightening muscles, cutting muscles, etc.). This is simply the first step.
Next, the deep tissues of your face will be restructured and there are many ways of doing this. Every possible direction of pull and small change in the anatomic layer where this is performed has a name and an “artistic genius” attached to its development. Composite Lift, Deep Plane Lift, PSP, Skin Only, SMASectomy, and SMAS are only a few techniques available. SMAS is an abbreviation for Sub-Muscular Aponeurotic System, which is a layer of tissue that covers, surrounds, and attaches to the deeper tissues and structures of your face and neck, including your entire cheek area. It also attaches to the platysma which is the superficial muscle covering your lower face. Dr. Moelleken prefers 100% volume retention through a SMAS lift rather than SMASectomy or the removal of the very valuable deep layer. He also prefers a purely vertical lift to the SMAS, therefore considered a biplanar facelift. In most patients, a facelift alone with no deep restructuring (i.e. a min-lift) is not adequate. Your skin might look good but the blockiness of your face with the bog jowl tissue collection is still there. He says to remember that the less surgery you have, the more temporary the result so the way to avoid years of rejuvenation is to choose the correct and most effective procedure the first time.
Finally, your skin is widely undermined and tightened, again in highly debated directions. Dr. Moelleken prefers the slightly up and slightly back method. He realizes that the incisions must be artistically closed so that your ear and hairline look as though no procedure was performed and the direction of pull on your skin will determine how authentic your Neck Lift will look. This is especially important for patients with small signs of aging because with Dr. Moelleken, when finished, there is no evidence of anything being done. If any of these steps are omitted however, your results will be lessened.
Many patients consider ancillary procedures first including volume replacement of the hollowing areas of your lips, smile lines, frown lines, cheeks, eyelid rejuvenation, endoscopic brow elevations, and the laser resurfacings of your neck. You should realize that studies indicate that noninvasive techniques contribute 10% of the results you want however if you are satisfied with a 10% solution, noninvasive techniques are acceptable. If instead, you are seeking a result to make you look your best for approximately 10-15 years, you should consider a Face and Neck Lift with ancillary procedures instead of choosing small parts of the entire course of action. Anesthetics are typically light general anesthetics for the Neck Lift although intravenous sedation with local anesthesia is available for the right patient.
In order to undergo a Neck Lift, you must be in good general health, both mentally and physically. You and Dr. Moelleken will discuss what type of anesthesia to use, depending on your level of comfort, and with most patients this is local anesthesia with sedation. During your consultation, Dr. Moelleken will instruct you on what medications to avoid prior to your surgery as certain medications, vitamins, and herbal preparations thin your blood, which can cause increased bleeding. If you are a smoker, you will need to stop all forms of nicotine (including gum and patches) at least two weeks before your surgery and two weeks after to ensure proper healing. On the day of your surgery, you should wear comfortable clothing including a button-down shirt that does not have to be pulled over your head and neck. You should expect swelling and bruising that can last for several days after your Neck Lift and you may feel different sensations including tightness, tingling, pulling, and sometimes numbness. These are very normal reactions and should not be a cause for concern, as they typically subside during the first few weeks. As with any surgery, there is always a risk of infection so you should keep a watchful eye on your temperature and at the first sign of a fever, call Dr. Moelleken immediately. Many significant factors are considered for each patient’s outcome and healing process including your age, health factors, diet, lifestyle, and family history.
For patients with more fat and muscle looseness than can be handled with a corset platysmaplasty, Neck-Lace procedure is performed. This procedure involves extensive tightening of the muscle with no volume reduction and no cutting of the platysma, which Dr. Moelleken says occurs from premature aging. Liposculpture is performed on the submental and jowl regions, as well. The incision is usually about one inch or less placed under your chin and recovery is five to seven days. You should be able to return to your normal actives after two weeks depending on your healing rate
With the more extensive tightening of the platysma muscle and the tissues above the glands, this procedure is exceptionally powerful at rejuvenating your neck without removing any volume from the platysma muscle. Liposculpture of the submental and jowl region and upper neck is performed before the Neck-Lace Procedure. Dr. Moelleken believes this will be the new “platinum standard” with superiority over corset platysmaplasty and a Neck Lift alone.
This procedure is for patients who want a complete rejuvenation of their face. It combines Dr. Moelleken’s signature LiveFill® graft insertion into your lips, nasolabial folds, marionette lines, and other customized areas; his signature Neck-Lace procedure for additional neck tightening; his signature USCI (Ultrashort Incision Superficial Cheek Lift) procedure for under your eyes and cheeks using fat preservation, redistribution of lower eyelid fat, or LiveFill® grafts in patients with lower eyelid hollowness; a complete Bidirectional Face and Neck Lift procedure with 100% volume retention and no SMAS removal; cheek augmentation with superior vector SMAS transfer; an upper Lip Lift (gull wing); subcutaneous minimally invasive Brow Lift; central minimally invasive nerve-sparing brow muscle reduction, upper blepharoplasty, and conservative laser resurfacing when required.
Additional options to rejuvenate your face and neck include:
Minimally invasive devices such as radiofrequency (RF) like the Accent, Venus Freeze and Vela Smooth in addition to Thermage, Polaris, and Re-Firme can be used to heat your skin, produce new collagen, and tighten your skin.
Some individuals have ‘sagging’ necks primarily due to fat accumulation below their jawbone (mandible). In this case, when fat reduction is needed, liposuction or liposculpture of the area beneath your chin (submental region) or the jowls can be performed to significantly improve your neck appearance. Liposuction is also frequently combined with surgical neck rejuvenation, and in selected cases some direct excision of fat (through a hidden incision below your chin) is performed. The incision is small (usually ¼ inch or less) and made under your chin with healing time approximately three days of wearing a dressing. The reduction of fat in the area below the jawline and in the anterior neck almost always makes the neck appear longer and makes your profile appear more elegant or refined.
Fat reduction and sculpting is performed through a small ¼ inch or less incision below your chin in the submental, jowl, and neck region. Recovery usually takes five days before you can resume your normal activities. You should make arrangements to have someone drive you home after your surgery.
This technique, often combined with liposuction or liposculpture, involves suturing together the plastysmal muscles. This smooths the neck and this technique is stronger than liposuction or liposculpture alone. However, it works best in patients who do not have a significant amount of skin laxity. The incision is usually placed one inch or less underneath your chin and recovery is typically five to seven day. All patients heal differently but most return to their normal activists in approximately two weeks.
This is a more powerful treatment for your neck and jawline, achieving smoothing of your neck and jawline. Incisions are placed behind the tragus (bump in front of your ear), below your earlobe, behind the ear itself, and finally into your hairline. Recovery is typically 10 days and two to three weeks before you can resume your normal routines. This is currently the gold standard for the rejuvenation of the face and neck.