The terms neck lift and facelift can refer to the same procedure, since correcting or rejuvenating the neck generally involves lifting sagging neck tissues back where they belong on the face, so adequate correction of the neck usually requires a facelift.
Variations exist, like a mini-facelift or a lower facelift, that may be more limited.
An isolated incision under the chin is only useful in cases where the neck (under the chin) has fullness but minimal skin looseness.
For most patients, tissues need to be lifted upwards using facelift incisions hidden by the ears. The ideal procedure for each patient is tailored to the patient’s individual needs and physical characteristics.
Let’s look at how they differ, their similarities, and which one you should get.
What is a Facelift?
There are many facelift variations, but contemporary techniques achieve dramatic but natural results by lifting and tightening the SMAS, a layer of connective tissue between the skin and the facial muscles.
Modern facelifts tighten and smooth the jaw-line and neck by lifting the SMAS; then the skin can be lifted and smoothed, removing excess skin without tension, so no distortion is produced and scars can be hidden. Sagging neck skin can be lifted; jowls can be smoothed; loose skin can be tightened; cheeks can be reshaped; neck bands can be released.
A facelift and SMAS lift generally takes 3 to 4 hours, although timing is less for mini-lift and can be more if additional procedures like laser resurfacing of fat injection are performed.
Facelifts are outpatient procedures performed under general anesthesia or, less commonly, conscious sedation. Most patients return to week in 2-3 weeks and are out of the house in 3-4 days. Patients can shower in 48 hours and exercise 2 weeks after surgery.
Facelifts are most commonly performed on patients in their 50s and 60s, but a wide age range of patients may be good candidates.
Types of Facelifts
There are many facelift variations, and the nomenclature can be confusing because terms like facelift and neck lift can be applied to the same procedures or represent different procedures in different surgeon’s hands. Several general terms are commonly used:
A mini-facelift involves limited incisions and limited lifting of the skin and underlying tissues. The results tend to be subtle. Mini-facelift generally are used on younger patients. Patients with significant neck looseness are generally not candidates for mini-lifts.
A lower facelift focuses on the jaw-line and neck, with less change to the cheeks. Many surgeons use this as their basic facelift and utilize eyelid surgery, fat injection, and other techniques to address the upper face.
Full facelifts can be very similar to lower facelifts because both can aggressively treat the jaw-line and neck. Older full facelift techniques use incisions carried into the scalp at the temples, but contemporary techniques avoid temporal scalp incisions because these can shift the sideburns and distort the eyes in ways that can be noticeable; so these techniques have come into disfavor. Now, many full facelifts do not involve temple incisions.
What is the difference between a lower facelift, a neck lift, and an isolated neck lift?
Many surgeons use the terms lower facelift and neck lift interchangeably because, as noted, the common goal is to smooth the jaw-line (eliminate jowls) and lift the neck. The term isolated neck lift refers to tightening the neck using an incision under the chin. This incision is used to remove fat from under the chin and tighten the muscles in the midline.
Can a neck lift be performed by itself?
An isolated neck lift, using only an incision under the chin without a facelift, can be used in some young patients with heavy necks and minimal skin looseness to deepen and define the neck.
An isolated neck lift is more commonly used in conjunction with a facelift, which lifts and tightens from the cheeks, from the face, to create a hammock effect across the neck, under the chin. In appropriately selected patients, this creates a sharper, more well-defined neckline than the facelift alone. The midline neck lift is also used to tighten and release vertical bands in the neck.
The terms neck lift, open neck lift, and midline neck lift can all be used to refer to tightening the neck with an incision under the chin.
Is surgery the only option to tighten the neck or rejuvenate the face?
There are many non-surgical options that can be used to compliment the facelift and sometimes may be used as an alternative to surgery. Medical grade skin care with retinol, retinoic acid, antioxidants, and other topical creams can improve skin texture, minimizing fine wrinkles and sun damage. Most facelift patients benefit from improvement in skin texture, but patients can also use skincare, even if they don’t have surgery.
Resurfacing lasers, in particular fractionated CO2 lasers, can more aggressively improve skin texture than skin care does, but do involve additional cost and recovery time.
Botulinum toxin (Botox) can relax the facial muscle and injectable fillers (like Restylane and Juvederm) can be used to fill deeper skin creases and folds.
Non-surgical skin tightening procedures like Ulthera and Profound can tighten the skin when there is early, mild facial aging, but are not equivalent to surgery.
Are there other surgical options besides a facelift and neck lift?
Eyelid surgery (blepharoplasty) can tighten loose skin, smooth lower eyelid bags, and tighten the upper cheeks.
Fat injection can provide additional volume to the face, including the lips. Brow lifts can lift the brows and improve the upper eyelid esthetics.
Most often, a combination of surgical and non-surgical techniques are used to create the ideal individualized result for a specific patients’ goals and characteristics. Consultation with a board-certified plastic surgeon familiar with the broad range of modern surgical and non-surgical technologies is essential to achieve success with a dramatic and natural result.
Preparing for Safe and Effective Procedures
First, take the time and do the research to find a surgeon with whom you are comfortable, who thoroughly examines you and helps you determine the best surgical plan for you. Take the time to understand the risks and benefits of the procedure, and to have a realistic idea of the expected, typical results.
Medical clearance, including appropriate laboratory studies, may be necessary depending on your age and medical status. Make sure your surgeon is aware of all medications, allergies, medical history, and previous surgeries. Medications, like aspirin and blood thinners, and supplements, like vitamin E, can increase bleeding risk. Estrogen-containing medications should be stopped a month before surgery because they increase the risk of blood clots. Smoking should ideally be stopped many weeks before surgery because it increases the risk of heart attacks, pneumonia, blood clots, wound healing problems, and other issues. Regular exercise may decrease the risk of anesthetic complications.
Risks of Neck Lifts and Face Lifts
All surgical procedures entail certain risks like bleeding, infection, and anesthetic complications, like heart issues and blood clots. Face and neck lifts specifically to carry the risks skin necrosis (a patch of skin dying from blood flow changes, which leaves a scar), hematoma (bleeding under the skin), visible scarring, and facial nerve injury (which can cause asymmetry of facial muscles).
Review the risks with your surgeon before surgery to make sure they are acceptable to you. Also, make sure that your surgeon is board-certified and that the surgical facility is accredited. Also, remember that there are no guarantees in medicine; results may not be what you expect or hope for. Make sure you have realistic goals.
Terminology can be confusing, but you can have a thorough understanding of the best options for you through consultation with a board-certified surgeon deeply familiar with these techniques.