Dr. Andres Bustillo is a board certified facial plastic surgeon that limits his practice to cosmetic surgery of the face and neck. Fifty percent of his practice is focused on facial rejuvenation surgery. He has been in practice for over ten years and is well known for his natural and conservative results.
Necklift Before and After Photos
Apart from his private practice, Dr. Bustillo takes time to teach his innovative techniques to other physicians. He has traveled to Asia, the Caribbean, and Central and South America to instruct other surgeons his surgical techniques. Dr. Bustillo wrote the following to help educate the public about the aging neck and the necklift surgery.
What is a Necklift?
The necklift is a surgical procedure that rejuvenates the neck. The necklift helps to improve the sagging neck in certain patients that may not need the comprehensive facial rejuvenation that a facelift provides. While a necklift improves the appearance of the neck, it cannot change or improve the quality of the neck skin.
What is the Difference between and Necklift and a Facelift?
This is a very common question. A necklift addresses only the neck while a facelift addresses the neck and the face. Many patients in their late forties and on may want to have only their neck lifted. Unfortunately, they may not be candidates for the necklift procedure. After the late forties, the amount of sagging skin in the neck may be too much for a necklift. These patients will need to have a facelift.
Why is my Neck Sagging?
The aging seen in the neck begins in the late twenties. However, visible changes usually become apparent in the late thirties. These changes are due to the aging processes that occur in the skin, fat, and muscles of the neck.
The skin is one of the first components that begin to age. The amount and quality of the collagen and elastin, both important structural proteins in the skin, begin to decrease. This allows for weakening and thinning of the skin. The skin looses elasticity and increases in laxity (Figure 1). You can test your skin’s laxity by pinching the area under the chin; pulling it and then letting it go. Skin that is lax will not snap back.
The platysma muscle originates in the lower face and runs down the entire neck. This muscle descends, in both the face and neck, with age. It can sometimes cause the bands that appear in the front of the neck.
One of the most difficult areas to treat is the aging neck. As the patient ages, certain changes occur in all three layers of the neck. These are the skin, fat, and the platysma neck muscles.
The first component of the aging neck is muscle descent. This refers to the separation and descent of the platysma muscle in the neck. There are two platysma muscles, one on each side, which begin in the lower face and run down to the clavicle on each side. With age, these two muscles separate and descend downward. As they do this, they create what are known as “platysmal bands.” (Figures 2,3). The necklift procedure includes a platysmaplasty. A platymasplasty tightens the neck muscles through the small incision in the neck. The platysma is also pulled from the sides to further define and tighten the neck.
The submental area, just underneath the chin, is an area where the accumulation of fat can cause inflation in the neck. Fat removal should be performed judiciously in order to sculpt the neck adequately, yet maintain a natural appearance. Too much fat removal in this area can skeletonize the neck and allow the underlying neck structures to be visible through the skin.
Skin, the third component, looses elasticity and begins sag. You can see this first in the area just above your Adam’s apple. As the sagging continues, the redundant skin accumulates in the area below the chin. This is the one area that the necklift procedure cannot fully correct. Because the necklift procedure does not improve the quality of the skin, patients with very lax skin may not achieve maximum correction. (Figure 4).
The person with excessive skin laxity may have a less then ideal result in the neck as a consequence. This patient may benefit from a facelift surgery, since more skin can be removed with that procedure. It is a well-known fact that necklifts may not satisfy all patients in the neck area. The reason is usually excessive skin laxity, which surgery cannot completely address.
The necklift procedure treats the aging neck by removing the fat accumulation under the neck, tightening the neck muscles and then removing the excess skin. The procedure is performed through three small incisions. The first incision is below the chin, hidden in the small crease that lies just behind the chin. Through this incision, the fat is removed and the platysmaplasty is performed. A platysmaplasty tightens the neck muscles. The other two incisions are placed one behind each ear. These are used to tighten the neck muscles laterally and to remove the excess skin. By tightening the platysma centrally and laterally, maximum tightening of the underlying tissues is achieved. The incisions are all placed in hidden areas. Once healed, they are will not be visible.
Most people that have a necklift do so in their early forties. (Figures 5, 6). Sometimes people that have lost a substantial amount of weight will have a necklift at an earlier age. Older patients that may have had a previous facelift and are not happy with their necks may be good candidates for a necklift (Figures 7, 8).
People are many times confused about what exactly a necklift corrects. The goal of a necklift procedure is to rejuvenate the neck. The face and jowls are not rejuvenated with a necklift. The facelift is the procedure of choice for rejuvenation of the face and jowls.
A patient must have the proper expectation before having the necklift procedure. The necklift can improve the neck in patients with mild to moderate neck aging. If the neck condition is severe, then a facelift is recommended.
Dr. Bustillo will personally meet and will listen to the patient’s concerns regarding the neck. It is important to communicate any recent changes in weight. It is important to discuss any plans for weight loss in the future, as the necklift procedure should be scheduled after the weight loss. Dr. Bustillo will then examine the neck. The skin’s elasticity is checked. Muscle descent and fat accumulation are examined.
Dr. Bustillo will then formulate a treatment plan and discuss this with the patient. He will explain exactly what the necklift can and cannot accomplish. In this fashion, the patient can determine if the necklift is a procedure that he or she wishes to proceed with.
How much does a Necklift Cost?
The cost of a necklift procedure varies from city to city, doctor to doctor, and even from patient to patient. The cost of a necklift procedure performed by Dr. Bustillo under local anesthesia with oral sedation is $5,500.00. This includes the operating room charges. The cost of a necklift procedure performed with IV sedation is $6,800.00. Anesthesia is administered by a board certified anesthesiologist (M.D.) from Baptist Hospital Department of Anesthesia.
Before undergoing a necklift, Dr. Bustillo requires that all patients obtain a medical clearance and pre-operative labs. Patients should refrain from taking aspirin, all anti-inflammatory products, vitamin A, and alcohol ten days before surgery. Patients should begin high dose vitamin C (2000 mg a day) one week before and two weeks after surgery, to help promote healing.
The necklift surgery can be performed with different types of anesthesia. If the necklift is being done as a single procedure, it can be done with local anesthesia and oral sedation. It can also be done with IV anesthesia.
If the necklift is being performed with an adjunctive procedure, such as a blepharoplasty or fat transfer, it will be performed with IV sedation.
The necklift is performed in Dr. Bustillo’s state of the art certified surgical suite. When IV anesthesia is used, board certified anesthesiologists (M.D.) from Baptist Hospital will provide the anesthesia services.
The necklift procedure has minimal risks. The highest risk is with smokers. Patients that smoke have skin with very poor blood supply and can have problems healing. For this reason, Dr. Bustillo will not perform a necklift on active smokers or those that use a nicotine patch. Patients that smoke must stop smoking two weeks before the necklift procedure.
A hematoma, or collection of blood, can occur in patients undergoing a necklift procedure. This is a rare occurrence and happens 1% of the time. If it does occur, it can be easily drained in the office. Most patients that have a hematoma after the necklift recover well and have a good result. It is rare to have infections after a necklift. Dr. Bustillo administers antibiotics before, during, and after the necklift.
The patient is allowed to go home or to the hotel room the same day of the surgery. Dr. Bustillo recommends the patient to stay the first night in bed with the head elevated with two pillows. The diet should be liquid for the first twelve to eighteen hours and then progressed to soft diet for a few days.
After surgery, a small bandage is placed around the neck. There should be minimal to no pain. Extra-strength Tylenol is usually sufficient for any discomfort. Stronger pain medication is also prescribed just in case. The patient returns to the office the day after the necklift to have the bandage removed.
The patient then returns to the office on the fifth day after the surgery to have the small stitches under the chin removed. Most patients can return to school or work on the seventh day after the surgery. The patient returns to the office on the tenth day after the necklift to have the stitches behind the ears removed. Exercise can be resumed three weeks after the surgery.
What is Non-Invasive Neck Tightening?
Non-invasive neck tightening refers to one of the many systems that claim to tighten the neck skin. I have tested all of these in my office and have not been impressed enough obtain one and offer it to my patients. For me be able to offer a procedure to one of my patients, I must be convinced it provides reliable and consistent results. None of the machines on the market can meet this simple rule.
They are definitely an “easy sell” since they are labeled “non-invasive.” However many of them are painful and very costly. There will be a time when a machine will be able to tighten the skin reliably, however, the technology is not presently available.