Rapid Recovery Neck Lift
Treating the neck is one of the most difficult aspects of facial plastic surgery. Many revisions that we see are difficult cases. Dr. Rizk, a New York facelift and necklift specialist, specializes in revision facelift and necklift surgery.
So what makes a good neck or an attractive jaw line? We see a number of unnaturally pulled vectors or directions in the neck so the vector or direction of elevation is very important. Dr. Sam Rizk, a New York necklift specialist believes that definition along the jaw line is one of the most important aspects to an excellent result while avoiding the pulled tight look. Dr. Sam Rizk explains further that the vector of elevation should be parallel to the jaw line in the front and at a slight angle towards the ear in the back to avoid puckering at the post-ear and achieve the most natural outcome.
The platysma muscle is one of the most important aspects of achieving this natural contour. Some diagrams show the platysma meshing together in the middle, which is only present in about 20% of patients. Usually, the platysma comprises two separate cords. Dr. Sam Rizk believes that thinking of the mid-line neck in the same way as a hernia will help patients understand the problem. You want to put the platysma together in a natural way to get a natural result. This angle becomes very important — around 110˚ between the anterior chin and the posterior hyoid depression.
So your aim should be to get a distinct inferior mandibular border, a sub-hyoid depression and a reasonable distance from the anterior mandible into this area. The area may be filled with subplatysmal fat, which may not be amenable to liposuction. Dr. Sam Rizk would then use a three dimensional, high definition telescope to go deep in the neck, under the muscle, to clean some of this deeper fat with precision and good visualization.
The patients who present for an isolated neck lift are typically in their forties. They have already had fillers and Botox but their neck is ageing because no amount of fillers will improve platysmal muscle laxity. They could also be patients who have had previous facelift or necklift surgeries and have had a recurrent looseness in their neck, or male patients who don’t want a facelift. Dr. Sam Rizk who is a New York facelift surgeon, states that male patients do not usually want the word face lift mentioned. They want either a necklift or a minimally invasive procedure because they associate a facelift with a fake appearance. Dr. Sam Rizk explains the need to achieve a natural appearance in facelift and necklift surgery by following proper vectors or directions of pull and by being conservative in the pull in a male facelift patient.
Dr. Sam Rizk, further explains that pre-operative evaluation is very important. Dr. Rizk looks at the submental area or area under the chin for specific anatomical characteristics. Does the patient have a thin neck? If so, can you see the middle of the platysmal border? Is there central fat under the chin? If so, is it below or above the platysma? What is the distance between the anterior chin and the subhyoid depression? Is there skin laxity? Dr. Rizk looks for skin laxity by asking the patient to tighten their neck muscles, then grabs the skin and move it around — if it’s mobile, it’s not just the platysma, there is excess skin. In those cases, Dr. Sam Rizk does a lateral neck lift plus a submentoplasty or platysmaplasty in the middle.
Dr Rizk, a NYC facelift and necklift surgeon, further explains that significant jowling will not improve with an isolated neck lift, so that patient may require a minimally-invasive lower face lift. Mimetic banding should be addressed not only by putting the bands together, but the patient may require some Botox in the neck to prevent the bands from recurring.
These bands are typically asymmetrical. This must be pointed out to the patient before surgery. Also Dr. Rizk checks the chin’s bone structure — is there significant chin protrusion or does the patient need a chin implant? A chin implant sometimes is necessary to achieve a more natural result and to extend a retruded chin forward.
Fat is usually present in the deeper structures of the neck, up to the thyroid cartilage. The platysma extends above the jaw line and it becomes very important to raise a posterior flap in the platysma and attach it to the mastoid periosteum behind the ear from a post-auricular approach.
Dr. Sam Rizk, a NYC facelift surgeon, addresses the loose platysma by binding the platysma in the midline down to the hyoid after removing subplatysmal fat and removing a strip of redundant platysma which eliminates the tensile area of the bend below the hyoid level. This allows Dr. Rizk to perform a lateral lift and get some mobility in the lateral platysma. If Dr. Sam Rizk has a patient with a very large and fatty neck then he will bind the midline platysma all the way to the hyoid and much lower than the hyoid.
Dr. Sam Rizk explains: “You’re aiming for a slight concavity when you’re finished. My sutures are placed in a horizontal mattress fashion. So following removal of platysmal fat, the platysma gets attached together and the wedge is then excised. I raise the posterior platysmal border, after raising a flap, all the way to mastoid periosteum. Make sure you watch out for the marginal mandibular nerve. After reviewing my revision cases, I found that I didn’t raise this flap — when I didn’t, those patients tended to herniate more and the neck loosened more quickly. So I find it’s necessary to raise at least a 2–3cm flap, and mobilise the posterior platysmal border.
To prevent the flap becoming loose, it is best to attach it to the mastoid periosteum, where you will get the most strength in the posterior pull. My incision in the isolated neck lift will sometimes curve around the ear lobe if I’m doing a lateral pull for redundant skin. If I’m not doing a lateral pull because the patient has no redundant skin, I will do it from an isolated submental approach.”
According to Dr. Sam Rizk, most patients requiring necklift surgery benefit from the combined central platysmaplasty with the 3d high definition telescopes (minimally invasive) and lateral neck lifts (from behind the ears). About 10% of patients requesting necklift surgery require only a central neck lift — those patients tended to be younger with no skin laxity or skin looseness — and 5% of the patients had just a lateral neck lift. Those patients tended to be thin with not very apparent midline platysma.
Dr. Sam Rizk, a NYC facelift surgeon and necklift expert, states that the lateral necklift entails a constant pull on the posterior platysma, the mastoid periosteum. The anterior neck lift varied between plicating the platysma and cutting it at the hyoid or plicating much lower than the hyoid in obese patients or those with obese necks.
Dr. Sam Rizk first performs liposuction in a closed fashion above the platysma and then he opens the submental incision further and performs the submental contouring.
There are two main types of tissue glues: platelet-rich plasma (PRP) and Tisseel. Dr Rizk prefers Tisseel because it’s extremely sticky. There has been no incidence of viral transmissions and it adheres to all surfaces. It is sprayed under the flap prior to closure, hold pressure for three minutes and that’s it. The flap really has to be fixed in the position that Dr. Rizk wants it prior to spraying the Tisseel, unlike PRP.
Patients who are not good candidates for an isolated neck lift are those with extreme skin redundancy, who would probably require a face lift, and those with significant jowling — these patients would benefit from submentoplasty face and neck lifts.
So the rapid recovery customised neck lift is a procedure that Dr. Sam Rizk performs frequently in his practice. Dr Rizk does a central platysmaplasty in almost every man and a significant number of women to achieve a better outcome with the 3d high definition telescope. Dr. Rizk always uses the Tisseel tissue glue, which decreases haematoma and seroma rate. Dr. Sam Rizk, a New York facelift surgeon, always use the high-definition telescope system to get a superior visualisation lower down in the neck, from a very small submental incision. This rapid recovery system will allow a low rate of revisions and low complication rate.