FACIAL PLASTIC SURGERY. Neck lift

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1 FACIAL PLASTIC SURGERY Neck lift Mr Jonathan Hayter FRCS, FDSRCS Consultant Maxillofacial Surgeon Spire Leicester Hospital Gartree Road Oadby Leicester LE2 2FF Nuffield Health Leicester Hospital Scraptoft Lane Leicester LE5 1HY BMI Meriden Hospital University Hospital Site Clifford Bridge Road Coventry CV2 2LQ Telephone: / kim.ward@spirehealthcare.com Website:

2 Mr Jonathan Hayter FRCS, FDSRCS Consultant Maxillofacial Surgeon Spire Leicester Hospital Secretary: Kim Ward Gartree Road Tel: /3687 Oadby Leicester LE2 2FF NECK LIFT INFORMATION Age changes around the neck include fat accumulation and loss of elasticity in the soft tissues and muscles resulting in wrinkle and fold formation. The aim of a neck lift is to restore a more youthful, slimmer and smoother appearance. What causes these age changes? It is a natural part of ageing for skin to become less elastic and the muscles underneath the skin to slacken. Weight change, sun exposure and regular smoking can accelerate some of these changes. In addition, accumulations of fat may occur. How do these changes affect the neck? As the soft tissues slacken they droop causing folds of skin around the neck. Loss of elasticity in the skin allows wrinkles to form. The muscle layer at the front of the neck often slackens and separates resulting in the typical vertical folds running from under the chin down into the neck. Fat accumulation is variable and may be limited and just contribute to the slackening of the soft tissues. However, considerable deposits may occur resulting in fullness of the neck. How can a neck lift help? A neck lift addresses each of the causes of neck ageing. Liposuction helps reduce the fatty deposits. Repair and tightening of the muscle layer reduces the slackness of the soft tissues especially at the front of the neck. Smoothing and removing excess skin improves the contour and reduces wrinkles. Overall, a slimmer and smoother rejuvenated appearance is restored to the neck. What about other areas of the face? Similar age changes may affect other areas of the face. Upper eyelids can develop skin folds and lower eyelids can bulge to form bags under the eyes. Eyelid reshaping (blepharoplasty) can improve the appearance of the eyes. 2

3 The mid face can be affected with deepening lines around the mouth, jowl formation and skin folds around the upper neck. A facelift repositions the skin and underlying tissues to restore a more youthful appearance. As part of the slackening of neck tissues is a result of slack facial tissues descending, a facelift is usually the best procedure to improve the neck as it raises the soft tissues effectively as well as incorporating the liposuction and muscle repair elements of a neck lift. What if more than one area of the face could be improved? If there is more than one area of concern, it is possible to have the appropriate operations one at a time or combined together. A typical combination would be a neck lift with eyelid reshaping. How do you find out if a neck lift is suitable? One of the most important parts of facial cosmetic surgery is the consultation. The initial consultation visit has several purposes. Firstly, it will help establish what your concerns are, what you hope to gain from a neck lift and whether this is the correct treatment for you. As described above, a facelift is usually the best procedure to improve the appearance of the neck. A detailed discussion of your concerns and aims will help to determine the best procedure for you. Secondly, it allows discussion of your medical details and a full facial assessment to help treatment planning. Finally, it allows you to be informed about treatment possibilities and answer any questions arising at this stage. What if you want to go ahead with a neck lift? The information discussed at the initial consultation needs to be carefully considered. If you wish to proceed, a second consultation two or three weeks later is essential to make sure that this is the right treatment plan and to answer any remaining questions. If no photographs were taken at the initial consultation, they will be obtained at this consultation for medical records. Further visits may be required to clarify any details and answer any further questions. What preparations are required before the operation? If you intend to lose weight this should be done before the operation. Smoking can interfere with the healing process and smokers should cut down or preferably stop smoking months before the operation, this will be discussed in detail. Certain medicines, such as aspirin or anticoagulants, may interfere with healing. It may be necessary to adjust these medications or change the timing of the operation; this would be fully discussed in the preoperative visits. 3

4 What happens during a neck lift? An incision under the chin allows liposuction to the front of the neck and under the chin and any muscle repair at the front of the neck that is required. Incisions behind the ear and into the hairline allow tightening of the muscle layers. The skin is smoothed out and any excess behind the ears is removed. Stitches are placed in the incision lines. What is it like immediately after the operation? It is likely that there will be some discomfort that will be treated with painkillers. There will be dressing bandages around the head and neck for the first day and there will be some swelling and bruising. How do you reduce the swelling and bruising? Some swelling and bruising will always occur after a neck lift operation. There will be a surgical drain on either side to reduce the chance of a blood clot collecting and these drains are removed after one or two days. The dressing bandages limit swelling and are removed after one day. It is important to sleep with the head and shoulders raised on pillows to help limit further swelling and bruising. Pillows should definitely be used for the first two weeks and it is a good idea to continue this for the first two months. How long will the swelling and bruising last? Most of the swelling and bruising will subside after two weeks. All swelling, particularly puffiness on waking, may take two or three months to settle. If you are prone to bruising then fading bruises may take another week to settle. When do you return to work? Stitches behind the ear and under the chin will be removed after about seven days and stitches in the hairline after about ten to fourteen days. It takes about two weeks to recuperate after the operation and general anaesthetic. After two to three weeks most of the bruising and swelling will have subsided. Therefore, it is sensible to allow at least two weeks for the main post-operative effects to settle down before returning to work. Are there any side effects following a neck lift? All operations carry some risk of side effect. Branches of the nerve that move the lower lip could be bruised and this may cause some weakness. This is uncommon and if it occurs it tends to be temporary and normal facial movements are usually restored within the first few weeks. Rarely, a small area of 4

5 weakness lasts longer and may be permanent. I have not seen this following a neck lift, but it remains a possibility. There is often a feeling of lumpiness around the neck initially, where the deeper tissues have been tightened, and this slowly resolves. It may take several months to completely remodel and smooth out. The incisions usually heal well but healing is sometimes delayed. This is more likely in smokers and patients who suffer from diabetes. The scars are discreet and hidden in skin creases or within the hairline. Occasionally, a small area of scar may become lumpy and require local treatment. No-one s neck is perfectly symmetrical and minor differences between the two sides may persist after a neck lift. These differences are usually too minor to be noticed. How do I care for my neck after a neck lift? In the early days the face and neck should be washed gently with hair washing starting three or four days after the operation. Moisturising cream can be gently applied about two weeks after the operation and this should be continued as part of normal skin care. It is particularly important to avoid sun exposure in the early days and a high factor sun cream and sunglasses are essential on sunny days. This is good general advice to maintain the health of your skin. Finally, it is important to avoid smoking during the healing period. Again, this is good general advice to maintain a healthy skin. What happens in the years after a neck lift? A neck lift helps restore a more youthful appearance and this benefit will persist. However, the normal ageing process continues and features of ageing will return gradually with time. Although previous surgery makes future operations a little more difficult, it is usually possible to repeat a neck lift procedure in the future, if this is appropriate. How do you make an appointment to discuss facial cosmetic surgery? A doctor s letter is helpful, although not essential, for an initial appointment. Please contact Kim Ward to arrange an appointment either by: - Telephone; / 3687 or ; kim.ward@spirehealthcare.com 5

6 Advice about your neck lift operation Before your operation Pre-operative consultations. You will have had at least two consultations prior to a decision to proceed with a neck lift. If you have any outstanding queries or would just like to go over the ground once again, book a further appointment. It is much better to clarify you understanding of the operation well in advance of the procedure. In addition, if your operation is booked for several months ahead, a pre-operative appointment will be arranged shortly before your operation to refresh your memory of the treatment and recovery periods and to answer any further questions that may have cropped up. There is only one outpatient consultation charge and that covers all subsequent appointments. Smoking For smokers, you will have had a discussion about the adverse affects of smoking on healing. Any smoking history can have an effect on healing, the more you have smoked and the more recently you have smoked posing the biggest problem. You will have agreed a no-smoking period before your operation and it is important that this is continued after your operation for at least six weeks during the initial healing period. Ideally, you will be able to stop smoking all together. Weight change If you are planning any weight change, for most people this would be weight loss, this should be completed before your operation. Notable weight loss after a neck lift may lead to slackening of the face and neck tissues, detracting from the effect of the operation. Recuperation arrangements. You need to allow adequate time for recuperation before resuming normal work and social activities. Don t underestimate the effect that an operation will have on your energy levels, most people will take at least two weeks to get back to normal after a neck lift. In addition, normal bruising and swelling may take between two and three weeks to diminish so that you don t look as if you ve had an operation. Because of this, you should allow at least two weeks before going back to work and socializing. After your operation Bruising and swelling Bruising and swelling is normal after an operation and, following a neck lift, will typically last for between two and three weeks. If you bruise easily there may still be some residual bruising present beyond three weeks but this should be faint and usually easily concealed with clothing, such as a neck scarf, or make up. 6

7 Other effects Your neck will feel tight and numb and may feel lumpy where the deeper layers have been tightened. These are effects that you feel rather than others can see. The tightness relaxes over the first month or two as the soft tissues adapt. The numbness gradually resolves as the nerve endings grow back. Most people get full return of sensation but this can take six to twelve months. Sometimes reduced sensation in the earlobes persists. The lumpy feeling gradually diminishes as the soft tissues remodel, again this can take six to twelve months. Bathing You can shower and wash your hair following your operation but dry quickly and reapply the ointment that you have been given to any stitch lines over the first couple of weeks. Prolonged soaking in a bath should be avoided for the first two weeks to allow the incisions to heal. Exercise Light exercise can be recommenced at two weeks, as healing progresses and you get your energy levels back. Heavy exercise and gym workouts should be avoided for the first month. Skin care Applying moisturizing cream to the central face and cheeks can be started immediately. Massage and moisturizing cream to the lower cheeks and neck where the operation has taken place should be avoided for three weeks until healing has progressed. Applying hair colour should be avoided for at least one month or longer if there is slow healing of the incisions within the hairline. Maintenance Your neck lift will improve the appearance of your neck. However, if you have notable facial expression lines across your forehead, such as frown lines, these require Botox to soften the muscle action. Also, if you have lines around your lips or would like your lips to have a fuller or better defined shape then dermal fillers are required to add volume to these areas. In order to make the most of your new appearance both Botox and tissue filler treatments are available at a reduced rate for patients who have had a neck lift. 7