November Newsletter 2021

During their consultations, nearly every patient I see over the age of 50 and many patients in their 40’s at some point will mention that they wished their necks looked better.  In fact, for many of my patients, it’s the most important issue they want to address. Even though other areas, such as sagging or puffy eyelids, midface volume loss, or lip lines, are, in my opinion, more of an aesthetic opportunity, the owner of the neck is fixated on the changes they see and want them remedied.
Well, now that I am approaching 60, I get it! I can also add that along with neck sagging, we often lose jawline definition and develop jowls and marionette lines. Basically, it is all a function of reduced skin elasticity and gravity. Now, that’s not to say that lost cheek fullness doesn’t exacerbate the issue, it does. But, regardless, the neck will sag with age. There are also a couple of anatomic features worth mentioning. A weak chin and a naturally low hyoid bone in the neck (the higher the hyoid bone, the better the jaw-neck angle), can each contribute to early neck sagging and an unflattering neck contour which will worsen with age. In fact, we actually lose bone in our jaw, and chin projection weakens with age, resulting in less forward support as we get older. So, what can we do about lower face, jawline, and neck sagging?
To start with, I will ask you if you are okay with aesthetic improvement, or does your lower face and neck have to be “great.” How old are you? What is your general health? Are you on blood thinners? Do you smoke? Are you okay with a surgical procedure or are you looking for a non-surgical solution? Keep in mind that when I perform a surgical procedure, such as a lower face & neck lift, commonly referred to as a “facelift,” I have ultimate artistic control and dramatic improvement is often achievable immediately. We hide the scars in the contours of the ears and in the hair, but we knowingly leave the most inelastic central neck skin in place. Therefore, in some patients, due to their severely inelastic central neck skin, keeping their neck tight for many years may not be achievable. With a direct neck lift, the most inelastic central neck skin and fat are removed, with results that can last for decades. However, there will be a midline neck scar, so this procedure is typically recommended only for fair-skinned, older individuals. However, with energy devices such as ProfoundRF, there is no scar. I perform the procedure, but your body gradually generates new elastin, which over time causes the skin to tighten and the texture to improve. Since I don’t control the outcome to the same degree as surgery, results are therefore more unpredictable. Some patients are thrilled with their improvement and others, not so much. That is reality.
Are you squeamish and definitely want general anesthesia, or perhaps you want to avoid going to sleep and definitely don’t want general anesthesia? Do you have a low hyoid bone and/or a weak chin? Will you need either chin filler or an implant? What is the quality of your neck skin? Is it very inelastic? How much excess fat are you carrying in your neck? Are you willing to lose weight before surgery? If so, what is a realistic target weight that you can achieve? Generally, if you are planning on losing 15% or more of your body weight, you should do it before face and neck surgery. Do your scars generally heal well? Keep in mind that surgery corrects sagging but trades scars for laxity. How much bruising, swelling, and downtime are you willing to tolerate? What about cost? $5,000, $10,000, $20,000. What are you willing to spend to get the results that you want? Lastly, are your expectations realistic based on the procedure(s) that were chosen?
As you can now see, there are a number of issues to consider. Every patient has their own answers to these important questions and therefore, the best procedure is different for each individual. As of today, the procedures I currently perform to improve the lower face, jawline, and neck include lower face and neck lift (I perform a modified deep plane facelift), direct neck lift, neck liposuction with or without neck muscle tightening, Profound RF, Injectable collagen stimulators, platelet-rich plasma (PRP), chin and jawline fillers and, chin implants. I want to add that techniques and technologies are always evolving and I evaluate them on an ongoing basis. If there is something new that I determine to be safe, effective, and brings additional value to my patients, I will add it to my toolkit.
If you want to figure out what is best for you to achieve your aesthetic goals, please call to schedule a consultation with me. There is no one correct answer, but I promise to take the time to discuss all the options with you and help you decide how we can help you to look naturally more beautiful.
Seth A. Yellin, MD, FACS
Founder & Director, Marietta Facial Plastic Surgery, Laser & Aesthetics Center