What can be done for the aging neck?
Treatment of the aging neck can be one of the more challenging aspects of managing the aging face. Age-related changes in the neck can appear relatively early in life. It is important to understand that the structure and support of the neck is complex, with five different layers affecting the shape, structure and appearance of the neck. Any or all of these layers may be involved for a particular patient so diagnosing the problems and appropriately treating with the right combination of approaches is critical for consistently excellent results.
The skin is the most superficial structure and ages both from physiologic changes and from environmental exposures. As we get older, collagen and elastin production decrease and the skin becomes thinner, less compliant, and more prone to wrinkles. The compliance (stretchiness) of the skin affects how much must be removed in a neck procedure, ranging from none at all to several centimeters. This will impact the length and location of incisions for the neck procedure. Sun damage and surface wrinkles should also be addressed, keeping in mind that neck skin has relatively few hair follicles and heals slowly, so resurfacing procedures are more conservative for this area.
The next layer beneath the skin is the pre-platysmal fat. This fat layer lies immediately under the skin and when excessive can contribute to fullness and bulk in the submental area. This layer of fat can be reached in multiple ways including liposuction, CoolSculpting, Profound RF and direct removal. Most of these procedures can be performed in the office if this is all that is needed, through small incisions or without incisions at all in some cases. Reduction of pre-platysmal fat is also a frequent part of lifting and tightening procedures in the neck.
Beneath the pre-platysmal fat is the platysma muscle which is a thin sheet of muscle extending over the front of the neck on each side with an attachment in the midline. This muscle layer provides the shape of the basic supportive contour of the neck. As we age, the platysma may begin to sag, may have loosening of the midline attachment or may develop bands. To significantly change the shape of the platysma usually requires surgery to reposition and resupport the muscle and restore its natural midline attachment. In some cases there is excess lax muscle which must be removed to restore a more youthful neck contour.
Beneath the platysma lies another layer of fatty tissue called the sub-platysmal fat. When this is present the platysma muscle must be elevated to access and remove the excessive amount of fat. Once surgical work proceeds at this level the procedure is termed a deep neck lift. Many of the failures we see in necklift surgery are from lack of treatment of the subplatysmal fat and/or platysma muscle, resulting in residual neck fullness and sagging.
The deepest layer of the neck contains the deep neck muscles, hyoid bone, larynx, and submandibular glands. In some cases where the position of these structures contributes to the cosmetic concern, they must be tightened, modified, or partially removed. This is a more extensive deep neck lift procedure and is not routinely necessary though some patients require such treatment to obtain their desired result.
The starting point for treatment of the deep neck is a detailed consultation with a facial plastic surgeon highly experienced in evaluation and treatment of the neck. At Beaty Facial Plastic Surgery each patient’s goals and anatomy are carefully evaluated and considered to develop the most effective surgical plan for that person.