This advanced technique, when done properly, results in high patient satisfaction.
Several techniques for performing neck lifts are described in the literature.1,2 In last month’s issue of Plastic Surgery Products, an algorithm was presented for deciding which procedure to recommend to the patient who wants neck rejuvenation: liposuction, a suture-suspension neck lift, or both.3
Now, we are going a step further and will discuss the subtle nuances of neck lifts from the initial consultation to fine surgical details that can make the difference between a happy patient and an unhappy one. We will concentrate on a specific neck-lift procedure: the suture-suspension neck lift with fibrin sealant.4
Preparing the Patient
The initial consultation is the cornerstone of an excellent physician–patient relationship. Expectations are set, and realistic goals are carefully delineated. It is essential to explain what a neck lift is (it’s still commonly called a “chin lift”) and what it can accomplish for the patient.
Usually, a patient comes in because she caught a glimpse of her profile in a photograph or was told by a friend that her neck was sagging. She wants to improve her neck, but she does not want a full facelift. The indication for a suture-suspension neck lift, in general, is a poorly defined cervicomental angle and mandibular border, which are common manifestations of the neck that result from aging or weight gain.
The surgeon who will be performing the operation—not an assistant or nurse—should describe the procedure in comparison to a facelift. We suggest a verbal description of where the incisions would be—behind the ear, in the postauricular sulcus, and under the chin in the submental area—as well as the variance in the quality of the scars and possible “southward” migration. It is also important to discuss the amount of skin resected, the suture-suspension technique with permanent sutures, and the purpose of the fibrin sealant.
Stress how a neck lift differs from a facelift. Both will theoretically rejuvenate the neck. However, a facelift will improve the mandibular border, the labiomandibular region, and the midface, whereas a neck lift will not. We ask the patient to sit in front of a mirror, and, with a long cotton swab, press against the neckline to show the depth of the cervicomental angle and the amount of realistic improvement a neck lift will yield. Then, we pull on the neck skin posteriorly with both hands to show the anterior effect of a neck lift.
Immediately after that, we pull on the facial skin and neck skin posteriorly to show what a facelift would accomplish. This may seem like a trivial exercise, but it establishes the difference between the procedures in the patient’s mind and makes it less likely for her to confuse the results expected from each one.
This is also a good opportunity to stress to the patient that the neck laxity will be significantly improved, but it is not going to be 100% better. If the patient has severe neck laxity, it is important to tell her that if she chooses to have a neck lift rather than a facelift, she may need to resect more skin in a future revision or touch-up procedure.
Discussing the Complications
There is a fine line between being realistic with a patient and making her afraid to have the surgery. Honesty is always the best policy. It is very important to discuss in detail the risks of a neck lift and compare them to those of a facelift.