An anterior cervicoplasty is a niche type of neck lift offered exclusively to men, who have a favorable history of scarring and who refuse a more extensive procedure. This procedure is not the open neck lift approach where incisions are placed in front and behind the ears. It involves the creation of a Z-plasty (flap) along the front of the neck, whereby the skin flaps can be elevated off the muscle, excess fat resected, neck muscle bands tightened and the excess skin trimmed. The scars will hide in the relaxed skin tension lines and allows surgeons to take out some of the fat that lies below the chin as well as tighten up the muscle bands. Disadvantages: inability to improve mandibular jowls, and possible ingrown hairs in the line of the scars.
A limited cervicoplasty is a more extensive operation favored by individuals who do not want to have visible scars and who desire improvement of their jawline. “U” incisions originate at the sideburns; follow along the curve of the ear, traveling inferiorly around and behind the earlobes. The neck and lower jaw is then elevated off the underlying neck muscles from the right and left sides, uniting in the midline. Excess fat can be trimmed, splayed muscles corrected, a small chin implant may be placed and the redundant skin re-draped and inset. Advantages: improved ability to comprehensively rejuvenate the lower jaw and neck, scar appearance generally superior. Disadvantages: may be associated with greater swelling and the short-term (24 hour) use of drains.
WHY PATIENTS DISLIKE THEIR NECK
Aging brings changes many individuals do not like and did not expect. In the jaw and neck, tissue may fall producing “jowls”, fatty deposits accumulate under the chin and platysmal bands splay apart, resulting in cords.
People also do not like the horizontal lines that span from side to side along the neck called relaxed skin tension lines and sun induced pigmentary (red and brown) changes. Those can be addressed at the time of cervicoplasty with either lasers or chemical peels. The appearance of a ‘turkey gobbler’ is definitely undesirable in this age of selfies and high density.
The ideal candidate for a necklift is one who is dissatisfied with the physical findings of mandibular jowls, “double chins”, turkey gobblers, loose muscle bands, and an overall weathered appearance. They should be aware that all medical conditions, including smoking should be well controlled as active smokers are at higher risk for skin loss or slough. Any medications, which can interfere with clotting, such as Aspirin, nonsteroidal anti-inflammatory drugs, Plavix & Coumadin should be suspended to avoid bleeding (hematoma), which mandates reoperation.
It is vital that patients understand the type of complications which are specific to this procedure. Minor complications such as ingrown hairs, stitch abscesses, bruising, temporary discoloration and pain are expected by all. Major complications include hematoma (collection of blood under the skin), skin necrosis (tissue death), nerve and/or salivary gland injury are rare provided the patient’s medical conditions have been optimized pre-op and they follow post-op instructions carefully. Disappointment with aesthetic outcome can be avoided by fully discussing with the patient their objectives, reviewing old photos and proposing the “correct” operation should be understood and agreed upon by both patient and Plastic Surgeon, prior to scheduling a date.
Detailed instructions are given on wound care, activity schedule, medications to take and avoid. Bruising is generally limited but swelling can persist and be reduced with lymphatic drainage. Patients are pleasantly surprised that there is relatively little pain. Bathing, including shampooing can be resumed 2 days post-op but men should wait at least 4-5 days before shaving. Male patients are advised that their beard may display “ingrown hairs”, during the immediate 2-3 month post op course; thereafter, the hair follicles are able to grow straighter through the scars.
We urge caution during the first month, in order to avoid complications and ensure a speedy recover. Heavy exercise, including bending or ranging their necks, should be postponed for at least 4 weeks.
It is important to set the expectation that nothing lasts forever. Assuming that the cervicoplasty patient enjoys good health, maintains stable weight, does not adopt vices such as excess sunbathing and/or smoking, then the improvement can last 10-15 years; remembering there is individual variation. Staying out of the sun is important since excessive sun tends to cause collagen degeneration. Living a healthy lifestyle and not having too many vices like gaining and losing weight are also helpful in maintaining results. It is encouraged to use sunscreens and cosmeceuticals to enhance the appearance of the neck skin, especially in women who are more subject to laxity, compared to age matched males, whose neck skin is thicker because of the effect of testosterone.
The decision to have an isolated cervicoplasty often depends on whether or not the patient minds having a long scar down the front of the neck. In general, men tend to be more open to the scar as it can be hidden by growing a beard. In order to determine whether cervicoplasty is the “right” procedure, it is important to consult with several Board Certified Plastic Surgeons, bring older photos to demonstrate the patient has aged, review their Before/After images, and ask to speak with patients who have had similar procedures.