NECK LIFTS after Massive Weight Loss

After significant weight loss, either through bariatric surgery or through diet and exercise, the skin often sags because it has been stretched to the point where it has lost its elasticity and is unable to shrink. When getting plastic surgery to tighten this loose skin, most patients concentrate on sagging abdomens and breasts while ignoring another crucial area?the face and neck. The face and neck are the most important visible features of the body, and they convey the way we feel through expression and appearance; an individual who is happy and energetic can appear sad and tired due to sagging in the lower face and neck.

During the weight loss process, all the tissues in the body become loose. The neck is no exception, and it can be one of the most troubling long-term issues for many individuals. Sagging ?turkey gobbler? necks make people look much older and heavier than they really are. In fact, the two areas with the most influence on how others perceive us, either positively or negatively, are the eyes and neck. Fortunately, both of these areas can be corrected with relatively straightforward procedures that can produce a remarkable change.

The neck begins to sag very early in the weight loss process; very rarely does the neck skin shrink adequately. In some individuals, correction of this neck laxity can be achieved through a neck lift alone, whereas others need to have it combined with a full facelift.

The specific procedure required depends on which structures in the neck are responsible for the sagging appearance. The neck is composed of a series of layers, all of which contribute to its appearance. The skin forms the outermost covering, followed by a layer of fat of variable thickness. An aesthetically important thin muscle called the platysma forms the next layer, followed by another layer of fat.

In our youth, the platysma muscle is joined in the center and tight; however, as we gain weight, the muscle and skin become stretched out and the platysma separates in the middle. The stretching causes the skin to hang down, and the muscle separation forms clearly noticeable vertical bands.

In order to individualize the procedure to the patient, a comprehensive aesthetic examination needs to be performed. After massive weight loss, almost everyone will have excess skin and fat. The amount of excess underlying fat is easily determined by pinching the thickness of the neck tissue.

As previously stated, some individuals may require a full face and neck lift; this can be determined by looking at the face to see if there is tissue hanging down over the jawline (jowls). The greater the extent of jowls and hanging cheek skin, the greater the need for a face and neck lift. I have found that when I ask patients to demonstrate their desired post-operative appearance, if they pull back on the skin with both hands, it usually indicates that there is too much downward movement of the skin and a full face and neck lift is required. For those that have sagging skin in the neck but not in the face, an isolated neck lift may be performed. This is fortunately true of many massive weight loss patients.

A full neck lift is actually a combination of three procedures: cervicoplasty, platysmaplasty and liposuction. A cervicoplasty involves removal of the excess skin, while a platysmaplasty alters the position or amount of the platysma muscle.

To perform a neck lift, incisions are made in the crease under the chin and in the hairline behind the ear. The skin is lifted up off the platysma all the way around the neck. Excess fat is removed via liposuction or directly cut out. The platysma is then examined through the incision under the chin and is usually sutured together in the middle and/or partially cut. Other sutures can also be used to suspend the muscle behind the ear and create a sling that will hold the skin and muscle tight against the jawline. Botox can be injected directly into the vertical platysma bands in order to reduce their visual appearance.

The procedure will be tailored to the patient?s needs and wishes and carefully planned by the surgeon. All patients need to be proactive in their treatment and have extensive discussions with their surgeons regarding the expected outcome. It is not usually possible to create a 90-degree angle between the jaw and neck, but it is reasonable to expect a significant improvement in the contour, tighter skin and a more youthful appearance.

A neck lift is usually completed in two or three hours and is usually performed on an outpatient basis. Although the surgery involves a lot of tissue lifting and muscle manipulation, there is relatively little discomfort and most individuals can return to work within a few days. (The recovery time is obviously extended when a facelift is added to the procedure.) A compression neck strap is commonly worn for a period of time to help the skin adhere to the underlying tissue and reduce swelling and bruising. The scars under the chin and in the hairline heal well and are barely noticeable in most situations. The final appearance will not be seen for at least 9-12 months, so some patience is needed, but you will be rewarded with a more youthful, tighter neck.

Plastic surgery after massive weight loss is vastly different from that performed on individuals who have not lost large amounts of weight; thus, patients should seek out board-certified surgeons with extensive experience in the area of massive weight loss. Body contouring surgery can help to restore the normal, natural contours that have been lost with weight gain and allow you to finally realize the fruits of all your hard work.

A neck with the typical massive weight loss appearance. There are vertical muscle bands and excess fat and skin. This individual would need a full face and neck lift. 

A & C: Pre-operative photographs showing obvious vertical platysma muscle bands and mild skin laxity.

B & D: Two days post-operative after muscle repair and liposuction only. Note that even though no skin was removed, it has followed the contour of the underlying tighter muscle. Pre-operative and six months post-operative appearance of a neck lift.

 

Gavin Dry, MD, FRCPS, PLLC, a leading board-certified plastic surgeon in the United States, specializes in surgery after massive weight loss. Please visit www.gavindry.com.

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