Neck and décolletage lift: technique of the operation

Plastic surgery is performed on virtually any area of the body, including the neck. For example, such a popular surgical procedure as a neck lift allows people to get rid of such an aesthetic problem as sagging skin under the chin. Other ways to eliminate this defect is not possible, so platysmoplasty (as neck lift is called in surgery) is considered a fairly common set of surgical interventions.

Indications for the procedure

There is relatively little fatty tissue in the neck area. Sagging of the skin is formed with age, and in many respects it is "to blame" for the small fat layer and the structure of the subcutaneous musculature, called "platysma", which is a thin muscular element located directly under the skin and fused with the dermis. In many people, the platysma does not have a continuous surface, but is marked by separate muscle clusters, which dehydrate with age and lose their functional capabilities.

Anatomically, the platysma is classified as a mimic muscle, so it does not participate in the motor activity of the neck, but is engaged only against the background of certain emotional states - for example, when a person is experiencing severe pain, or is very frightened or angry. Since we experience such emotions, frankly speaking, not often, the platysma is almost always in a relaxed state. As we age, blood circulation in the tissues of the neck slows down, the muscles become less elastic and flabby. This results in sagging of the skin under the chin, drooping of the corners of the mouth, etc.

In what cases can a patient be recommended to have a neck lift? First of all, the indication is considered to be age-related defects, as well as those formed due to individual features of the neck structure, or due to a certain lifestyle. Most often, women aged over 25-30 years old seek the help of a surgeon for a neck lift. Older patients undergo a neck lift to correct such problems as "turkey neck", "Venus rings", double chin.

Turkey neck is a defect that forms in absolutely all people with age, as it is associated with the natural loss of elasticity of skin and muscle tissue.

Venus rings are a common aesthetic flaw caused by excessive accumulation of fatty tissue in the neck area. This, in turn, is associated with a gradual weakening of blood circulation and slowing down of metabolic processes. Externally, the problem looks like the formation of peculiar ring-shaped thickenings on the cervical circumference.

Double chin is an equally common problem associated not only with excess weight, but also with age-related thickening of tissues in the neck area.

Any of the above flaws can be corrected with a competent neck lift.

Preparation

Before referring a patient for a neck lift, the doctor will necessarily conduct a preliminary assessment consultation: it is necessary to determine the degree of age or other tissue changes, to assume the scale of the upcoming intervention, to choose the most appropriate type of surgery. The doctor will ask the patient about the problems that bother him, about possible contraindications to neck lift, about the defects that need to be eliminated and corrected. In addition, the patient will be informed about how the neck lift will be performed, how long the procedure will last. The doctor will definitely provide information about the further period of rehabilitation and possible consequences and complications.

In preparation for a neck lift, the patient will undergo a diagnostic examination. Preoperative scans will also be taken in order to analyze any changes later.

Two weeks before the neck lift, the patient must refuse to take medications that affect blood clotting - we are talking about acetylsalicylic acid and other drugs with similar effects. If any medications a person has to take constantly, it is necessary to warn the operating doctor in advance.

14 days before the procedure, the patient should stop smoking (or at least significantly reduce the number of cigarettes smoked). The fact is that smoking provokes spasm of blood vessels, which can lead to deterioration of blood flow in tissues, both during the intervention and during the rehabilitation period.

A week before the neck lift, the patient should remove from the diet any fats and spicy dishes, as well as exclude the consumption of alcoholic beverages.

8-10 hours before the procedure, you should not eat or drink: at the time of intervention, the stomach should be empty.

The surgery itself usually lasts about 30-40 minutes, after which the patient is sent for inpatient observation.

Technique of the neck lifts

Various methods of neck lift are known: surgeons choose the optimal one based on the individual characteristics of the patient. These are the following methods:

• cervical liposuction;
• isolated neck lift;
• comprehensive neck and face lift;
• cervicoplasty;
• radical platysmaplasty.

Cervical liposuction is performed through a small incision (about 3.5 cm) through which excess fatty tissue is removed. This technique is optimal for the removal of the second chin.

Isolated neck lift involves local plasty and shift of skin flaps: this method is more gentle, but does not give a strongly pronounced rejuvenating effect. [1]

A complex lift is a combined technique that combines neck and facial skin correction. The method may include a lifting procedure, liposuction and contour plastic surgery.

Cervicoplasty involves removal of sagging tissues that have lost elasticity: excess skin in the neck and chin area is excised.

If a radical platysmoplasty is performed, a neck lift can be performed in one of these ways:

• lateral;
• medial.

In the lateral lift, the platysma is peeled off and the excess fatty tissue is removed. After that, incisions are made in the temple area, wrapping around the ears and ending behind them. Thanks to the method, the platysma is tightened, tone returns, contours become clearer (tissues are pulled up and fixed behind the ears). The procedure is often combined with SMAS-lifting, correcting the lower half of the face and neck.

In medial lifting, the divergence of the medial muscle edges is corrected - a so-called corset neck lift is performed. Tissues are cut under the chin, the subcutaneous muscles are stretched to the center, and a marked neck-chin angle is formed. The platysma is sutured, sutures are placed over the skin.

Neck lift with a back incision is a relatively new technique, which has been used in the world of plastic surgery for only 7-8 years. In the post-Soviet countries, this surgery is not particularly widespread, primarily due to its novelty and lack of practice among specialists.

Neck lift with mesonites is a minimally invasive procedure with a relatively short recovery period. Thanks to mesonites, consisting of polydioxanone, a kind of framework is created, which is gradually resorbed in the tissues. At the same time, mesonites stimulate the production of skin collagen, so the lifting effect is retained even after the framework is dissolved. There are other frame threads - Aptos. Their composition is represented by caprolactone, so the lifting effect is more powerful. [2], [3]

Endoscopic neck lift belongs to the category of low-traumatic techniques, because it is performed with the help of an endoscope. This lift does not require large incisions and significant tissue peeling. Nevertheless, the effect of endoscopic lifting is not less than that of traditional neckplasty. Punctures for the endoscope are made in the folds behind the ears. General anesthesia is used, and the whole course of the operation the doctor sees on the monitor: the surgeon redistributes soft tissue, fixes the muscles and tightens the skin in the desired direction. Endoscopic neck elevator is almost always performed simultaneously with chin liposuction and facelift. [4]

Laser neck lift refers to non-surgical methods: the session is painless and relatively easy to perform, and the effect lasts for up to 2 years. The essence of the method is the impact of the laser beam on the skin, as a result of which collagen production is stimulated, and the skin begins to rejuvenate itself. For a sustained effect should be at least three sessions of laser lifting. CO2 laser fractional neck rejuvenation is an effective treatment option with long-term efficacy for patients who mainly have skin laxity and wrinkles along with skin surface pigmentation. [5]

Radiofrequency liposuction (RFAL) for neck and facial contouring. It is a safe procedure to achieve a significant reduction in skin laxity and fat deposits in the neck, jawline and cheeks. [6]

Hollywood neck lift is a unique technique Hollywood neck lift, developed by New York plastic surgery specialists. This technique provides effective tightening of the chin and neck, getting rid of sagging skin, restoring youthful features of the neck and face. This neck lift was given the Hollywood name because of its high popularity among Hollywood actors. After the procedure, patients quickly returned to work, and the scars remained invisible to others. Hollywood neck lift is done not only in the United States, but also in our country, as the technique has become widespread among most of the world's plastic surgery clinics.

Combined use of ultrasonic liposuction and limited incision platysmoplasty to correct fading neck skin. This combination therapy is minimally painful and invariably results in significant improvement of the cervical chin angle. [7]

Contraindications to the procedure

The surgeon will not perform a neck lift if the patient has these contraindications:

• acute infectious-inflammatory processes, periods of exacerbation of chronic inflammatory pathologies;
• malignant and benign tumors and autoimmune processes;
• impaired blood clotting;
• absolute loss of elasticity and turgor of the skin;
• diabetes;
• decompensated heart and vascular diseases;
• allergic mood of the body, acute periods of allergic reactions;
• insufficient renal and/or hepatic function;
• damage and diseases of the skin in the area of the proposed operation.

Consequences after the procedure

Some consequences after the procedure sometimes cannot be avoided:

• Hemorrhages, hematomas, serous fluid accumulations are associated with tissue damage and can be detected by pain, bruising or small masses in the suture area, and tight ligaments behind the ear flaps. In most cases, this consequence can be noticed within the first 24 hours after the neck lift. If the problem is detected later, it worsens the prognosis and can lead to complications such as tissue necrosis.
• Significant hematomas or seromas due to the escape of large amounts of blood or serous fluid into the tissues require surgical intervention. They are removed through previously made stitches, which are then reapplied.
• Hair loss in the neck lift area (behind the ear flaps or in the temporal area) is due to damage to the hair follicles during the procedure. Typically, hair regrowth occurs without additional doctor involvement, some time after the neck lift. If recovery has not occurred, the doctor may recommend a hair transplant.

Under certain conditions, not just temporary effects, but also quite serious complications can develop after a neck lift. Although, statistically speaking, this is relatively rare.

Complications after the procedure

• Cutaneous necrosis develops due to impaired blood flow caused by tissue thinning or excessive tension to the suture line. After neck lift, necrotic processes are more often fixed in the area behind the auricles.
• Accession of infection is possible against the background of a large-scale hematoma, or necrotic processes. In addition, infection can occur if hair accidentally gets into the incision area during its closure. Such a problem is usually eliminated by a course of antibiotics.
• Excessive accumulation of pigment in the skin, or depigmentation is observed in hypersensitive skin, as well as in the formation of extensive intradermal bruising.
• Facial contour deformation can occur as a result of hematoma formation, displacement of skin areas, damage to the superficial cervical musculature, excessive removal of fatty tissue in the chin area. Often such a problem, which occurred during neck lift, requires repeated surgical intervention.
• The formation of keloid tissue in the area of scarring is often found in patients with a hereditary predisposition to this complication. In normal people, the suture normally heals completely within a maximum of 10-12 months: the result is an ordinary scar. If the healing is disturbed, then keloid tissue grows in the scar. In order to prevent complications, you should identify any predisposition to keloid growths at the planning stage of a neck lift or any other surgery.

Care after the procedure

For several days after the neck lift procedure, the patient will stay under the supervision of a doctor, in hospital conditions. In case of significant pain discomfort, he or she will have to take pain medication. In general, small pulling pains in the neck area can be felt for about 10-14 days, after which they gradually disappear as the wound heals. At the same time as the pain, the bruises disappear and the swelling goes down.

Sutures are removed 1-1.5 weeks after the intervention. To accelerate tissue recovery, the doctor may prescribe physiotherapy - first of all, this method is necessary to restore the function of the neck muscle tissue.

After the neck lift, the doctor applies a modeling bandage to the patient, which is subsequently replaced by a special compression neck brace. It will have to be worn for 3-4 weeks.

Additional physician recommendations may include the following:

• during the period of tissue recovery after a neck lift, you should not go to a bath or sauna;
• Do not take hot showers or baths;
• Do not go to a tanning salon, sunbathe on the beach or go swimming;
• any physical activity should be limited (it is undesirable to run, jump, carry heavy objects, bend over);
• It is advisable to sleep in a semi-reclined position, you can use a high pillow for this purpose.

If you follow all the doctor's advice correctly, the risk of developing complications after a neck lift will be reduced to zero.

Testimonials

Most commonly, plastic surgeons offer patients a neck lift in three variations:

• lateral lift with tissue tightening by horizontal suturing;
• medial lift, which involves vertical stitching of the tissues, up to the center of the neck;
• mixed variant of the lift - lateral-medial type.

According to the reviews of experts, the last of these methods is recognized as more effective, because with its help it is possible to carry out the tightening of all the sagging tissues of the neck, which is noticeably reflected in the expression of neck contours.

As patients themselves say, lateral-medial neck lift helps to literally rejuvenate even women over fifty years old. The main condition is to choose a good clinic and operating surgeon who is qualified and licensed to perform such corrective surgeries. Deciding on the procedure, it is also important to check how modern equipment is involved in the process of intervention. If the patient is dealing with a clinic of the right level, the ideal results of a neck lift will be as follows:

• the angle between your neck and chin will be equalized;
• the skin will be smoother, firmer;
• will show clear cervical contours.

It is better if the neck lift is performed in conjunction with facial rejuvenation. In this case, you can expect optimal rejuvenation results.