Thank you for your question. You’re asking if a necklift under a local
anesthesia would give a significant result even without a facelift being done at the
same time. Of course, you did not submit a question with a photo but I can certainly
help you understand how these procedures, what roles they have in helping people improve
their jawline. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve
been in practice in Manhattan and Long Island for over 20 years. Face and neck lifting has
been a very big part of my practice and certainly there have been so many variations and evolutions
and one of the things that you can certainly get as many answers as you could possibly
want is by asking groups of doctors who perform this surgery what is the best way to do it.
So, I’ll share with you first some basic principles to help you understand how I think
through when a patient comes and wants a neck lift.
Very often, when people look at themselves and they catch themselves on a side view or
happen to catch themselves on a 3-way mirror or have a photo taken, they notice extra skin
on their neck. And so what they will do is they will do some kind of a mirror lifting.
They lift the face, lift the neck or push back and they will say to me, “Doc, can
you just get rid of this for me?” And when I try to help people understand is first,
understanding basic principles of facial aging.
What is facial aging? Facial aging are two significant things: one is volume loss, loss
of bone, muscle, fat and soft tissues. And then, it is also sagging and descent. There’s
sagging and descent of the skin as well as the underlying muscular structure referred
to as the SMAS or superficial musculo aponeurotic system and platysma so that tissue also has
to be addressed.
So to differentiate a neck lift from a facelift, well an isolated neck lift typically involves
a combination of an incision that is in front of the earlobe and then behind the ear and
to whatever level the extension of the incision has to be in order to create a flap that pulls
the neck back as well as an incision under the chin to address either the platysmal muscle
or as well as to do liposuction or to do something called a platysmaplasty or to do some kind
of under the chin neck definition. So that is an isolated neck lift.
Now, in my experience, one very important variable is of course is the, in terms of
the evaluation of the jawline, is to understand how much of the sagging of the skin is caused
by the face descending and how much is due to loose tissue that’s best addressed by
directing the skin back and upward. So I would generally say that to maximize the jawline
and improve the angle of the neck, generally speaking, the same individual has a degree
of facial descent which means they would benefit from some type of facelift procedure. So the
facelift which elevates things more vertically is then really takes, I think, the majority
of the significant amount of skin and then the necklift, the area behind, will actually
finish the rest.
Now one other major component of this is of course volume loss. So you have to also understand
that even though things can be re-draped and tightened, you still need volume to make up
for loss and to maximize definitions such as in the cheekbone area and the jawline and
the chin. Sometimes, that is best handled by placement of a chin implant or placement
of fillers after the surgery.
So, as far as the local anesthesia question is concerned, facelifts can be done under
local anesthesia. This is one of the things I’ve always advocated since the very beginning
is that you can do full face and neck lift surgery with local anesthesia. In our practice,
we typically do it with LITE™ sedation. We do it in our facilities that are certified
by the Joint Commission so that we get the benefits of the hospital level care in terms
of protocol process, sterility etc. and at the same time the convenience of an office.
But my point is that you really should get a better understanding or a good understanding
I should say, of what component of the jawline improves when you lift upwards and don’t
lift to aggressively, just slightly, and how much works from lifting back. So generally
speaking, I tend to recommend to my patients that you do a combination of a face and neck
lift or a lot of times just a facelift alone. So, speak to your doctor if you have chosen
one or if you are evaluating your options and learn about what choices they would recommend
and you can be prepared to get a lot of different opinions.
So I hope that was helpful, I wish you the best of luck and thank you for your question.