Treatment of the Aging Neck, Neck Liposuction and Platysma Repair

Surgical treatment of the aging face and neck has historically been thought of as going in for a facelift and coming out with a new look. But the downside to the traditional facelift was always its cost, recovery time, and the risk of coming out of surgery with a pulled, unnatural look. New therapies in cosmetic surgery have pushed the envelope of minimally invasive surgery, and nowhere is that more evident than in treating the neck and jaw line. While it is true that some patients benefit most from a full facelift, many will achieve superb results with treatment of the neck alone, or in combination with easier and less invasive procedures than a facelift.

The minimally invasive procedure most talked about in medical circles for treating the aging face and neck is liposuction. Through a series of small incisions, fat can be removed and the neck and jaw line sculpted to produce a smoother, more natural and youthful appearance. In many cases, tightening of the neck muscles further refines and shapes the neck, restoring the natural angles and symmetry of this important aesthetic unit. The beauty of all this is that it is performed as an outpatient procedure with a few small incisions instead of the large, sometimes unsightly facelift incision.

The neck and jaw line are critically important features of the adult face, and telltale signs of advancing age are often first noticed in these areas. For this reason, the uniquely elegant procedures discussed below are targeted to produce a more youthful and natural look with minimally invasive, targeted therapy.

Neck Liposuction

As people age, gravity and time can cause the skin and underlying fat to sag, leading to the formation of jowls and slack skin around the neck. Neck liposuction can dramatically reduce this prominent sign of aging by creating a more youthful neck and jaw line. Since skin retains much of its elasticity as we age, the neck and jaw can be reshaped by removing excess fat from the neck and cheeks through small incisions under the chin. The skin then re-drapes itself along the jaw line for a more youthful and aesthetically pleasing appearance. In many cases, Thermage is used as an adjunct to neck liposuction to significantly enhance skin tightening.

Platysma Repair

Some individuals, particularly women, will develop linear vertical ridges on the neck that are known as platysma bands. The platysma is a thin muscular sheet located just under the skin of the neck. With time, the fibers of this muscle can weaken, causing prominent midline bands as well as the appearance of a loose, shapeless neck. Repair of the platysma muscle can dramatically improve the contour and shape of the neck. At the conclusion of the liposuction procedure, the platysma muscle can be tightened through a small incision that is hidden under the chin. A few well-placed sutures under the skin help to tighten the muscle, and the shape of the neck is restored to a more youthful appearance.

The concept of repairing and tightening the platysma muscle is central to the surgeon's ability to shape and contour the aging neck. There are a variety of muscle repair techniques used by physicians around the world, but the novel platysma repair procedures performed at SkinCare Physicians are renowned for producing smooth and eye-pleasing contours of the neck, and refining the jaw line and jowls.

Using a Combination Approach to Produce the Best Results

These procedures are very effective ways to treat changes to the lower part of the face caused by aging. Because so many people develop changes to the jaw line as one of the first signs of aging, neck liposuction and platysma repair can produce dramatic changes in a patient's appearance. Since we target the source of the problem, the need for a full facelift and its potential complications is eliminated. Ancillary procedures such as Botox® injections, Contour Threads, Thermage®, or soft tissue augmentation with Collagen, Restylane or fat transplants can help to enhance the results of neck liposuction and platysma repair.

Your surgeon will help you to choose the proper procedure, depending on your goals, complexion, skin type, and skin elasticity.

Before the Procedure

Laboratory tests will be done to ensure you are in good health. Pre- and post-operative antibiotics are given for infection control, and products containing aspirin are discontinued at least two weeks prior to surgery. Use of vitamin E must also be discontinued.

The Procedure

Local anesthesia is obtained with the tumescent technique, which has revolutionized the field of liposuction. We are now able to precisely remove fat cells without the need for an anesthesiologist in an extremely safe and effective procedure. Several small 3 to 4 millimeter incisions are made under the chin and along the jaw line to precisely remove the fat contributing to a sagging neck and jowl formation. Our physicians have helped to pioneer neck liposuction and reshaping techniques, delivered talks at national conventions, and written books and medical journal articles about the procedures used to perform safe and effective neck contouring.

Platysma repair is performed through a small, 1-2 inch incision under the chin. The surgeon carefully brings the muscle back into its natural position under direct visualization and sutures it into place. The incision heals almost imperceptibly within a few weeks.

After the Procedure

You will be asked to continue the antibiotics you began before surgery. Pain is minimal, as is post-operative discomfort. A compression garment is used continuously for the first week, then eight to ten hours a day for the next three to four weeks. If sutures are placed (platysma repair), they are removed one week after surgery.

Patients are able to resume normal activities within a week to ten days of surgery, and the effects and benefits of surgery are apparent almost immediately.

Contour Thread Facelift

The minimally invasive alternative to a facelift

After years of research and scientific progress, doctors finally have a minimally invasive way to lift the face with virtually no scars. This new procedure, the Contour Threadlift, uses tiny incisions and strong sutures to lift and reposition aging skin. This is a remarkable advance in the treatment of facial aging, and allows many patients who did not want to have a facelift to finally achieve the results they are looking for.

The quest for the perfect facelift has been going on for decades. Beginning in the early part of the 20th century, doctors began to seek improvements in technique to lift facial skin back into a more youthful position. The single greatest limiting factor in traditional facelift surgery, until now, has been the noticeable scarring that occurs in front of and around the ears. In addition, other factors such as the risk of an over-pulled look, as well as the inherent risk and recovery of a surgical facelift, have made many patients and doctors reluctant to take the plunge. That has all changed with the introduction of facelifts using suspension suture, or threads.

Why have a facelift?

Although the general trend in cosmetic surgery has been to move away from more aggressive facelift surgery, there is still a significant role for the lifting of tissues back into position for many patients. Patients understandably are reluctant to undergo invasive surgery to achieve this lifting and repositioning of facial tissues, but in many cases this is exactly what the patient needs.

As we age, tissues of the face including skin, fat, and muscle, begin to sag due to the effects of gravity. In addition, there is atrophy and loss of supporting structures such as fat. The goal of facelift surgery is to lift and reposition tissues that have sagged. This simple strategy can be an extremely effective. Many patients will also benefit from ancillary procedures, such as Botox injections to reduce wrinkles, and soft tissue fillers to replace the supporting fat that has been lost. But the essential goal of the facelift is to restore tissue to its more natural, youthful position. Conceptually the facelift is a terrific procedure, but the inherent risks and scarring have limited its utility.

So what is new now?

In a word, what is new are threads. We have used various types of threads for decades in cosmetic surgery, but until recently none of the threads available provided the strength needed to predictably lift tissues. The first materials that proved useful, Contour Threads, were approved by the FDA in 2005. These specially designed threads are made of polypropylene, a suture material we have used in surgery for decades with a superb and proven safety profile. The threads have tiny "barbs" placed along their length, giving the threads their unique ability to lift tissue.

What are the advantages of the Contour Threadlift?

There are several very important advantages to the Contour Threadlift. They include:

• There are no visible scars after the procedure
• The procedure can be performed with only local anesthesia
• Recovery is rapid, with return to activities within a few days
• The amount of lift is actually adjustable for several months

The Contour Threadlift is performed as an outpatient procedure in SkinCare Physician's state-of-the-art procedure rooms. Only local anesthesia is required. A major advantage of the Contour Threadlift is the ease of recovery afterwards and the absence of risk associated with general anesthesia. Tiny 3 to 4 millimeter incisions are made in the hairline, and the Contour Threads are gently slid into place under the skin. Your surgeon will determine just how many threads you will need, and exactly where they should be placed.

Once the threads are in place, your surgeon will gently lift and move the tissues to be repositioned. This part of the procedure is totally painless, and it is remarkable to watch as signs of aging are literally swept away. This movement of tissue is truly where the artistry of your surgeon helps to create the natural results achieved with Contour Threads. After the skin has been repositioned, your doctor will have you look in a hand held mirror so that with your input, the threads can be adjusted to achieve the precise results you were looking for.

Perhaps most amazing, the amount of lift created by the threads can be adjusted for several months after the procedure. This fine-tuning of the result is achieved in a painless five minute office visit without the need for any anesthesia.

What is recovery like after the Contour Threadlift?

Recovery is rapid after the procedure. You will need someone to drive you home, but you will not need any bandages. Pain is minimal after the procedure and usually controlled easily with Tylenol. It takes several weeks for the threads to "lock" into place, so you will need to be careful with sleeping and certain facial movements for 3 to 4 weeks after the procedure. Since the threads contain tiny little hooks or barbs that hold your skin in its new position, your body will take a few weeks to adjust to the presence of the threads. Our staff will give you detailed instructions as to the proper care of your skin after the procedure. The threads themselves cannot be seen or felt under the skin once they have settled into position. Patients report that they feel totally natural and comfortable with the threads in place, and they don't even notice they have them, except for the superb results they have achieved.