A well-defined neckline is integral to creating harmony between the face and neck, contributing to an attractive and balanced facial appearance. However, aging, genetics, and lifestyle habits can lead to cosmetic changes in the neck, such as sagging skin, the appearance of platysmal bands, and the accumulation of excess fat. While traditional neck lift procedures focused primarily on tightening the skin, advancements in our understanding of neck anatomy have led to more comprehensive and layered surgical interventions. This modern method, known as deep neck contouring, addresses the underlying structures responsible for age-related changes, providing longer lasting results.
The Importance of Neck Aesthetics
The neck plays a crucial role in overall facial harmony. Ideal neck aesthetics include specific parameters:
- Distinct Inferior Mandibular Border: A clear separation between the face and neck enhances facial definition.
- Cervicomental Angle Between 105 and 120 Degrees: This angle contributes to an attractive neck profile.
- Visible Landmarks: Features like the subhyoid depression and thyroid cartilage bulge create a graceful curve.
In women, these characteristics are universally recognized as attractive. In men, a stronger jawline and square facial shape contribute to a masculine and youthful neck appearance.
Factors Contributing to Neck Aging
Aging affects everyone differently, but certain changes in the neck are common due to both intrinsic factors (like genetics) and extrinsic factors (such as sun exposure and smoking), these changes include:
- Skin Quality and Elasticity: Over time, the skin loses collagen and elastin, leading to thinning, wrinkles, and sagging.
- Fat Distribution: Accumulation of fat in the submental (under the chin) area can create the appearance of a “double chin.”
- Muscle Laxity: The platysma muscle, which extends from the chest up to the jawline, can become lax and form vertical bands known as platysmal bands.
- Bone Structure Changes: Bone resorption in the jaw can lead to a less defined mandibular border, exacerbating the appearance of sagging skin and tissues.
Anatomy of the Neck: A Layered Perspective
Understanding the neck’s anatomy is essential for effective rejuvenation. The neck can be conceptualized in three layers:
Superficial Layer
- Skin: The outermost layer affected by environmental damage and intrinsic aging.
- Subcutaneous Fat: Lies just beneath the skin and can contribute to fullness or sagging.
Intermediate Layer
- Platysma Muscle: A superficial muscle that can become lax, leading to banding.
- Inter-platysmal Fat: Fat located between the layers of the platysma muscle.
Deep Layer
- Subplatysmal Structures: Includes deeper fat deposits, the digastric muscles, and submandibular glands.
- Skeletal Support: The mandible (jawbone), hyoid bone, and cervical vertebrae provide structural support.
A Layered Approach to Neck Rejuvenation
At Dr Turner’s clinic in Sydney, we specialize in a comprehensive, layered approach to neck rejuvenation. By addressing each anatomical layer, we can correct the underlying structural changes contributing to neck deformities and provide more lasting and natural results.
Superficial Layer Interventions
The skin of the neck loses collagen and elastin with age, leading to sagging, wrinkling, and the development of deep transverse lines. In addition, subcutaneous fat, located between the skin and the platysma muscle, can accumulate with age, particularly under the chin. This results in submental fullness, often referred to as a double chin.
For patients with isolated submental fullness but minimal skin laxity, non-surgical treatments may be appropriate. However, neck liposuction remains the most effective procedure for precise fat removal, especially when deeper structures are involved. Liposuction can be performed through small incisions and is particularly effective when combined with a neck lift procedure to remove excess fat and contour the neck.
Intermediate Layer Interventions
The platysma muscle, responsible for much of the dynamic movement in the neck, also undergoes changes with age. As the muscle becomes lax, vertical platysmal bands may form, contributing to the appearance of an aging neck. These bands can be present at rest (static bands) or appear with facial movement (dynamic bands).
To address platysmal bands, surgeons typically employ a technique known as anterior platysmaplasty, where the muscle edges are tightened, often referred to as a “corset platysmaplasty.” In cases where inter-platysmal fat accumulates between the muscle edges, surgical excision may be necessary to restore a smooth neck contour. Non-surgical treatments can temporarily weaken the platysma muscle to reduce dynamic bands, but these results are short-lived and require ongoing maintenance.
Deep Layer Interventions
The deep structures of the neck, including subplatysmal fat, digastric muscles, and submandibular glands, often become more prominent with age, contributing to a bulky or sagging neck appearance. The subplatysmal fat, located beneath the platysma muscle, can be surgically resected to prevent it from protruding through weakened tissues.
Hypertrophied digastric muscles, which can contribute to neck fullness, may also be reduced surgically, either through partial excision or plication (tightening). One of the more controversial areas of deep neck surgery involves the submandibular glands. In patients where these glands become prominent due to ptosis or hypertrophy, partial gland resection may be necessary to achieve optimal results. Although this procedure carries some risks, including nerve injury and potential dry mouth, it is a highly effective solution for patients with significant gland prominence.
Preoperative Assessment and Tailored Surgical Approach
A thorough preoperative assessment is crucial for determining the best surgical plan. Dr Turner evaluates not only the neck but also the lower third of the face, as aging-related changes in the face often contribute to neck deformities. For example, patients who request a neck lift may also require a facelift to address sagging jowls and achieve a balanced aesthetic outcome.
Modern neck rejuvenation focuses on recontouring these layers to restore a youthful appearance. The approach is highly individualized, depending on the specific anatomical issues present.
Non-Surgical Options
- Skin Resurfacing: Chemical peels and laser treatments can improve skin texture and reduce wrinkles.
- Injectables: Neuromodulators can temporarily reduce platysmal banding, while injectable fillers can enhance jawline definition.
- Energy-Based Devices: Radiofrequency, ultrasound, and cryolipolysis can tighten skin and reduce subcutaneous fat.
Surgical Options
- Liposuction: Removes excess subcutaneous fat to improve neck contour.
- Platysmaplasty: Tightens the platysma muscle to eliminate banding and define the neck profile.
- Neck Lift (Cervicoplasty): Involves removing excess skin and tightening underlying muscles and tissues.
- Deep Neck Contouring: Addresses deeper structures like subplatysmal fat, digastric muscles, and submandibular glands for a more comprehensive rejuvenation.
- Chin Augmentation: Enhances the mandibular projection, which can significantly improve the cervicofacial balance.
Next Steps
At Dr Turner’s clinic, we specialize in personalized neck rejuvenation strategies that cater to your unique needs. If you’re considering a neck lift or want to explore your options for neck contouring, Dr Turner, a Specialist Plastic Surgeon in Sydney, is here to help you achieve your aesthetic goals.
- Schedule a Consultation: Contact us at 1300 437758 or visit drturner.com.au to book your appointment.
- Prepare for Surgery: Follow any preoperative guidelines provided, such as avoiding certain medications and arranging for post-surgery care.
- Plan for Recovery: Set aside time for rest and healing and arrange for assistance during your initial recovery phase if needed.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Consult with a qualified healthcare professional to determine the best treatment options for your individual needs.
References
- Andrew L. Weinstein AL, Nahai F. A layered approach to neck lift. Plast Aesthet Res2021;8:11.
- Ellenbogen R, Karlin JV. Visual criteria for success in restoring the youthful neck. Plast Reconstr Surg1980;66:826-37.
- Ramírez OM. Advanced considerations determining procedure selection in cervicoplasty. Part one: anatomy and aesthetics. Clin Plast Surg2008;35:679-90. viii