Dr. Mulholland: Welcome to Plastic Surgery Talk with Dr. Stephen Mulholland, brought to you by SpaMedica.
Dr. Mulholland: Hello and welcome. Dr. Mulholland in Toronto, Canada on Plastic Surgery Talk. Welcome to our podcast series. This podcast today is on neck lift, one of my favorite topics on one of the most requested surgical procedures in the face and the neck. If you’re interested and you find these entertaining, educational, enjoyable, please subscribe, share, and comment.
Dr. Mulholland: So, what is a neck lift? A neck lift is a surgical and or minimum invasive procedure on the neck itself. The tissue below the jawline and the mandible that incorporates and usually encompasses sculpting of the skin, the subcutaneous fat, the underlying muscle called the platisma, sometimes the hyoid bone, the submandibular glands, and creating a nice, strong jawline, where the jowls are minimized and a nice, right angle, or cervical mental angle that’s strong. Generally, we want the quality of that skin to be smooth to minimize the risks and the appearance of vertical crepey lines and wrinkles and horizontal necklace lines. So a good neck lift surgeon needs to address all layers of the aging neck; the skin, fat, the muscle, and the supportive tissues.
Dr. Mulholland: A neck lift can be as simple as liposuction under the chin, the injection of Kybella in fat under the chin, the application of energy through the skin, such as Alphera, Morpheus, Profound, the removal of submental fat, the contouring and shaping of muscles and the removal of skin. It can encompass all layers of tissue rehabilitation. Often, it can be done under local anesthesia and the results can be quite profound. It really gives you a youthful contour to the neck and cervical mental region.
Dr. Mulholland: Who is a neck lift candidate? Good neck lift candidates are those patients who have one or more aberrant pathological aging changes of their neck. Too much fat, too much skin, too much skin and fat, wrinkles, loose, weak neck muscles, flacid, loose, weak neck muscles, a low lying hyoid bone, prominent submandibular glands or combinations of all of the above. And often, that’s the case. Many patients will have two, three, or four of those problems and we address all layers of the aging neck in a therapeutic plan.
Dr. Mulholland: I would divide neck lift surgery into three broad categories. The minimally invasive neck lift, the in between mini neck lift, and a standard neck lift. In the non-invasive or minimum invasive realm, we have a lot of energy based devices that can smooth in and tighten skin. Both [inaudible 00:02:54] radio frequency devices such as the Forma, the Pelovay, the Venus Freeze that heat neck skin and tighten it. Non-invasive, a series of six treatments once a week.
Dr. Mulholland: Who’s a good candidate for that? Early laxity of the neck. One can combine that then with patients who have subcutaneous fat or double chin. And we can inject Kybella into that double chin and melt the fat chemically. We can also laser that fat from the outside with sculpture sub mentum, a laser device or a body effects, a radio frequency device, or we can freeze the fat with a cool sculpt mini.
Dr. Mulholland: So we have a lot of the energy-based devices that can kill fat, tighten skin. We can smooth in loose skin, improve fine lines and wrinkles and even add Botox to submandibular glands and very dynamic neck muscles. Those combination treatments, energy-based devices, fat melting chemicals and Botox form the nucleus of minimal invasive neck contouring.
Dr. Mulholland: The next rung up the ladder of opportunity is putting something under the skin. Elegant new devices like face tight, neck tight, accu tight, putting radio frequency heat right into the fat, right into the subcutaneous tissue, tightening and coagulating that neck skin to get 35, 40% contraction. And then heating from the outside in with new devices like the Morpheus or older devices like the Profound and the Althera to tighten the skin while we’re heating the inside neck tissue and getting nice contour improvements. Those are all the non excisional but under the skin energy based devices that improve the contour of the fat. Then we can tweak the skin without removing it using suture support threads and suspension thread lifting of the neck.
Dr. Mulholland: And then finally, the last rung on the ladder, the most significant outcome you’re going to get is from a traditional neck lift, where we make an incision, a crease under the chin, behind the ear, and we actually expose the neck tissue under local anesthesia, remove the fat under direct vision, tighten the muscles under direct vision, recontour and shape the skin and then add Morpheus and energy-based devices on top of the skin. That will give you the best possible neck result.
Dr. Mulholland: So the candidate for the third and most invasive procedure, the neck lift, older patients, multiple aging factors in their neck. Perhaps, in their 60s and 70s looking to have a neck rejuvenation. It looks 15 or 20 years younger. The middle option, those patients who are candidates for internal heating techniques and suture suspension techniques, often in their 50s and 60s, modi-staging neck findings and are quite happy doing a non-invasive treatment with no scalpel, no scars. The entry level neck procedures often for those patients in their early to mid 40s that have extra fat, extra skin, not ready for a minimum invasive internal radio frequency heating but external devices alone.
Dr. Mulholland: So those are the candidates, three broad categories. If you select the candidates well and you manage their expectations, all three groups will be happy with their outcomes.
Dr. Mulholland: The most common question I get asked, Dr. Mulholland, how is a surgical neck lift performed? Well first, it’s performed under local anesthesia. You typically don’t need to have a general anesthetic, which makes it much safer. We do use some sedative medications such as Propofol and Lorazepam, Nitrous Oxide. We freeze the neck with local anesthesia like a dentist would and once it’s frozen, you don’t feel anything. Then, we make access to the subcutaneous compartment, a small incision. The skin is undermined and we remove under direct vision any extra fat. That then exposes the muscles under the fat. We tighten the muscles like a corset. It’s called a corset platisma plasty and gives you a nice hammock of support.
Dr. Mulholland: We re suspend any lax or taut bones such as the hyoid bone. Any extra sub glandular tissue like the submandibular gland may be trimmed. And then we re suspend the neck skin. And we take away the excess behind the ear so the scar’s not visible. And that’s an elegant neck lift procedure. It takes about two and a half hours to do. Patients need two to three weeks to recover. And it literally can take 15-20 years off the appearance of your neck.
Dr. Mulholland: What’s the recovery like? In general, most patients need about three weeks to recover from an open neck lift. Two weeks from energy base neck contouring such as neck tight, face tight and submental smart lypo. And about three or four days from an energy based device such as cool sculpting, sculpture, box effects mini and Kybella.
Dr. Mulholland: In that three weeks, they’re going to be swollen, some bruising. There’s not a lot of pain or discomfort. The small stitches under the skin come out in about five or six days behind the ear, about eight to 10 days. Generally, the contour’s going to look pretty good by about six weeks. If you have a big event, you’re having a wedding, you’re going to another’s wedding or you have a reunion or some family event where looking your best is important, give yourself a good three months to recover to get the kind of neck contour you’re looking for.
Dr. Mulholland: By about six months, the sensation’s coming back, it looks much more natural. And most neck lifts are going to last you eight to ten years. Whereupon, you would have aged a little bit from the original one year result but it still looks way better having done it than having not done it. And you’re always going to look about 10 years younger than your neck would have looked had you not done the surgery in the first place.
Dr. Mulholland: Would this be a painful procedure? The energy based devices like Sculpture, Cool Sculpting, body effects mini, Kybella, there’s not much pain or discomfort, a little risk or bruising and generally, the swelling goes away and you look pretty good within a few weeks. But you have a modest improvement, three or four days of recovery.
Dr. Mulholland: With the intermediate procedure such as neck tight, face tight, sub [inaudible 00:08:35], submental lypo, you’re asking for about a week of recovery. It’s like a bruised discomfort like you struck your thigh in a coffee table, a little bit of a submental bruise. But it tends to be gone by about one week and your contour looks good after that week.
Dr. Mulholland: A neck lift is much more sore, especially when muscle work is done. And that’s going to take two or three weeks of modest five, six out of pain, a 10 type of pain. And you might need some narcotics for that first four or five days. Generally a [inaudible 00:09:04] anti inflammatory after four or five days. And most patients describe the recovery as being uncomfortable but tolerable. And given that’s a life-long improvement, more than worth it.
Dr. Mulholland: Neck rejuvenation procedures generally have very inconspicuous, if any, scars. The non-invasive have no scars at all. Cool sculpting, sculpture, body effects mini, Kybella, there’s no scar. The minimal invasive treatments like neck tight, face tight, submental lypo, these have minimal active scars, tiny little abcess pores with no visible scarring once you’ve healed. The trans cutaneous devices like Morpheus and Fractora Profound can leave little needle marks but they tend to resolve and disappear over about a week.
Dr. Mulholland: It’s only the surgical neck lift where there are potential scars but one of the secrets of plastic surgery is to place the scars inconspicuously, make sure they heal beautifully. So small little submental or under the chin incision, right where we’ve all fallen as a kid, we have a little scar there. We follow that crease. We also place an incision behind the ear, not in front, but behind, right where the bone meets the crease. So someone really would have to look very closely to ever discern you had any neck lift scar whatsoever.
Dr. Mulholland: Are there any risks from any of these neck lift procedures? The less invasive the procedure, the lower the risk. Cool sculpting, sculpture, submental body effects mini, Kybella, basically almost no risks, a small risk of bruising, swelling, some risks of ongoing fibrosis or a small risk of a burn. But these burns are generally very, very small. And so the risk essentially is almost zero.
Dr. Mulholland: The biggest risk with those non-invasives, spend quite a bit of money, two or $3,000.00 and don’t see much. The biggest risk is that doesn’t meet your expectations. The second group, the neck tight, the face tight, submental lipo, again, very elegant, thermally controlled radio frequency devices, very low risk of a thermal injury or a burn. We can aspirate the fat. You get skin tightening. So as long as your expectations are for a good result that’s noticeable, you have reasonably good muscle tone, not a lot of skin laxity, those techniques are essentially risk diminished to the point where you could say after a week, it looks great. It’s going to last you a number of years.
Dr. Mulholland: The biggest risk, of course comes from the open procedures, the open neck lift. There’s risk of a scar that can have adverse healing. There’s risk to the facial nerve and some weakness. There’s risk of blood collection called a hematoma, the fluid collection called a seroma. But managed by a busy surgeon like myself and other busy surgeons, these risks are very small when managed properly with proper post-op followup protocol support. And so, the risks become perhaps one or 2% of patients experience some annoyance that we can manage. Most patients, vast majority, over 95% are super happy with their new neck contour. They experience no significant down time or side effect and no complications. And it’s usually a good exchange for risk reward and benefit.
Dr. Mulholland: Can we combine neck lifts with other procedures? And the answer’s absolutely yes. In fact, the vast majority of patients do so. They’ll do a neck lift or cervical mental contour and jawline. They might do a little cheek lift or suture suspension or volumization in the mid-face, upper or lower [inaudible 00:12:23] or brow lift, fractional laser resurfacing. So we can treat the face and neck like a house. We’ve got the basement, the middle floor and the top floor. You can renovate one room and floor at a time or combine different rooms and different floors for a synchronous approach to upper third, middle, third lower, third harmony, beauty and youth.
Dr. Mulholland: So I get this a lot. What is the cost to a neck lift procedure? Well, clearly it falls what category you’re going to explore. If you’re looking at the non-invasive, cool sculpting, sculpture, body effects mini, depending on the clinic in Canada, Kybella and one of those energy based devices might cost you three to $4,000.00. You get a modest improvement but almost no risks and very little recovery.
Dr. Mulholland: The middle group of procedures, the neck tight, face tight, submental lypo, skin tightening, Morpheus, that will run four or 5000, maybe as high as $6,000.00, depending on the clinic. And you can get a nice, noticeable improvement if you have recently good skin tone and you’re properly selected. For the neck lift, which gives you a really amazing life changing result, depending on the surgeon’s experience and the clinic and the city in Canada, it might cost between 15 and $25,000.00.
Dr. Mulholland: But again, when you look at relative value, you’re going to spend less on a full neck lift that will last a decade than you’re going to spend on that Ford Prius or a Ford Escort or a Toyota Tercel or a Corolla. That’s going to cost you 20, 25, $30,000.00. You’re going to drive it for five years and hand the keys back. This is a neck lift for the rest of your life. So, most patients value their neck, their jawline, their face more than their family car. And so the relative value and prices need to be adjusted accordingly.
Dr. Mulholland: But generally, affordable. Remember, many patients finance their surgery just like their car. They don’t pay up front with the cash to get their immediate neck lift. They go to a company like I Finance Canada or Medicard. They pay for it over five or six years. At the end of that five or six years of affordable payments, they own their neck and that neck’s going to last the rest of their life. So affordable way to look 20 years younger.
Dr. Mulholland: So thank you for joining me, Dr. Steven Mulholland here in Toronto, Canada on plastic surgery tuck. For the latest podcast installment neck lift, neck lift procedures, very, very popular because you can look great. You can look in shape. You can look rested and youthful but you can have an old neck, and old granny skin or a double chin. And it just ruins your whole look.
Dr. Mulholland: So a neck procedure’s very common. I hope we’ve covered off on the topic, modest neck, medium neck, more difficult and older neck. So there’s something for everybody. Explore a physician in a clinic close to you that has experience and we’ll see you next time.
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