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“Hi I’m Corey S. Maas MDTM, a board certified facial plastic surgeon in San Francisco and an associate clinical professor at the University of California in San Francisco. As a founder and director of The Maas ClinicTM, we have a comprehensive center here that addresses all areas of the face and body as it’s like to cosmetic surgery.
My particular interest is in the areas of the face and facial cosmetic surgery. One area of particular interest and in area that we particularly makes and significant and advance is in the area of brow lifting or brow plasty surgery, elevating the sagging brow and I’d like to tell you a little bit about how we do it, some of the advances and then I’ll show you some pictures of what people can look like before and after that type of surgery.
So, in this example of an attractive woman with a near perfect facial plane and very nice contour to the nose and really nice jawline and I’ve modified her image to show what typically happens with the neck as we age beyond 40 this becomes quite common and this kind of aging where the skin of the neck begins to hang toward the persons chin and down toward the chest really creates a webbing effect and a lot of people are bothered by it. It’s seen in people who have had typically a previous facelift some years before and that’s a chicken neck lift just right at lower facelift really addresses or in younger patients like the example like again i’ve modified this image I’m going to show her actual image in just a moment because its really pretty close to what a neck lift would provide in terms of surgery. But that image is really what we’re addressing, we’re addressing the hanging skin below the jawline when we do a neck lift its really typically a younger patient that’s got a genetic redisposition to having hanging skin or extra fat under the chin along the jawline or a patient whose had a previous lower facelift surgery, a chicken neck lift and subsequently has really redeveloped this. Now there are a couple of factors that also can lead to more significant hanging of this tissue under the chin, one of the more platysmal bands.
Platysmal bands are really bands of muscle that’s a very thin muscle that envelops the necks, it’s grimace muscle and that platysma can actually separate in the mid-line and create almost like a cord that’s underneath the chin and really they’re very commonly on each side and very parallel and when people make facial expressions we see those cords and from the side view it really creates a web reappearance to the neck, in other words chin comes down as the curvilinear line down to the chest rather than a nice sharp angle that’s formed at the point where the chin or the underneath the chin area meets the neck itself. So if we lose that cervical mental angle, that’s the name for it, one of the causes is platysmal bands, another one is excessive fat underneath the chin area and we can use Kybella the non-surgical neck lift procedure to address that, that’s the series of injections that address the fat by making those fat cells rupture and open and when they release those lipids there’s an intense inflammatory response that’s created as those fat cells release their lipids with Triglycerides the fat a substance itself into the tissue, inflammation is created and inflammation actually creates a tightening effect underneath the neck.
Now, some patients are good candidates but if there’s not a [inaudible [00:03:55] of fat under the neck or at least enough to make a substantial difference in terms of reduction and the inflammatory process that wouldn’t be a good candidate. In the case of bands we can often make a small incision under the chin and cut the bands if that’s the only problem, in a younger person that could be the issue but in most patients we address that and the main thing that occurs in most patients is the redundancy excessive skin that occurs underneath the chin and neck, that’s what really a neck lift does.
So there are three components to a neck lift depending on the condition, one is the amount of fat underneath the chin, two are the platysmal bands or the muscles changes that occur with aging and three are the aging skin or hanging skin that occur underneath the neck and if we address those things with the neck lift we address each of those things and if we address them individually there are can be individual procedures for them but the neck lift itself addresses all three.
So first, typically with the aging and even in our mid-30’s the brow with gravity effects begins to sag down and you see heavier brows the eyelid skin begins to hood down over the eyes and people just get a sort of worried or tired look about them. The older techniques of addressing this issue were called coronal brow lifting techniques and they were quite extensive with incision that really sort of went across the entire head and the entire forehead was peeled down or incision for made along the frontal hairline and the way the fashion, some cases those are up important and may still be applicable if they have a high hairline but for the most part, the newer techniques we have may developed allow us to make tiny little incisions back behind the hairline and use what is called an endoscope, a lighted telescope. Through those little incisions with the lighted telescope I can placed that down underneath the sagging tissues and elevate everything through that tiny little incision that’s sagging down, I can identify the muscles that typically are injected with Botox that create the frown line and reduce their strength by simply doing a little bit cutting arises of those muscles, we certainly don’t need them that’s an option for all the patients and then we simply elevate or restore the brow to a more youthful position with an upward and outward vector. That upward and outward vector of pole is maintained with a tiny little drop of biological glue, no drilling in the skull which is done by many centers just a little drop of biological glue that goes away in a very short period of time and that pulls the brow in place untilits totally healed. That healing process really only takes about a week, their swelling in the upper brow can be a little bit of bruising around the eyelid itself but typically people are back doing their normal social functioning things within a couple of weeks after this surgery, the incisions being so small, there’s nothing really to see in terms of the healing process and you can restore a brighter or youthful, more alert and awake look in a very short period of time with an outpatient procedure that doesn’t take much longer than an hour.
The neck lift procedure can be done under local anesthesia with sedation or a light anesthesia if you will can be done under a light sleeping anesthesia but you know either case it’s a very comfortable procedure and has a very low recovery time. The incisions for neck lift are usually small incision underneath the chin to do very small micro liposuction. Now in some patients that’s really with very little fat just to break up some of the smaller platysmal bands that are there. There’s also an incision perform behind the ear that starts really behind the earlobe, it goes high on the back of the ear so that it can’t be seen and then drops down and goes into the hairline back behind the ear. So that incision is all hidden. Now depending on the amount of excess skin in many cases we’ll have to do a little bit of correction in front of the ear to make sure that there’s no redundancy or folding of the tissue around the earlobe, it needs to be nice and smooth in the end.
Once those incisions are made and as the liposuction is performed as needed I’ll address the platysmal bands if they’re present, if they’re not present we done have to do anything about that, if they are we’ll make a single small little incision by lifting the skin over them that will allow the cervical mental angle that’s where the chin meets the neck to be restored and bring that back up and then I elevate the skin underneath the ear and behind the jawline. Once that’s done this is the important part of the technique I use, I used the back edge of that platysmal muscle that’s the thin sheet of muscle that envelops our entire neck the grimace muscle and I use that to place the tension on this with stitches that are buried underneath the skin well on to the tissues and secure to the thick connective tissue behind the ear and in the hairline area. So those are buried sutures, you never see them but it allows a lot of tension without pulling the skin and all giving that sort of weird windswept look as we often see and is inappropriate for a neck or facelift.
Once the facial tissue is restored to its original position we really have reestablishment of the neck angle and then its gentle text tension on the skin going toward the back of the head or post yearly and slightly superiorly that means up behind the ear the little sutures are placed is come out after about 7 days or so, 1 or 2 stitches under the chin often we’ll use dissolvable stitches and I asked people to wear a little compression garment around their face which they can take on and off for about a week after the procedure. So you can take a shower the second day after the procedure, we encourage people to wash and go about their normal life in terms of doing exercise and it really you know only things I ask people to avoid are bending, lifting and straining types of exercises in the days following the surgery. What a neck lift ultimately does is restore them and I’mgoing to show on this attractive women a nice cervical mental angle that’s where the chin again meets the jawline want to see if there’s a regularity to the jawline which we don’t see in the particular example that we used here, that can be addressed with the lower facelift but in the case what we’re describing here we like to see a nice angle between where the chin meets the neck 90 degree angle is great and having contour like this is an optimal outcome. Again, the 90 degree angle where the chin meets the neck, there’s an optimal outcome for neck lift surgery.
The steps to review a neck lift surgery are first a light or slight sleeping anesthesia the local anesthesia is used extensively below the jawline and behind the ear, the incisions are marked and once anesthesia is fully effective we make a small incision underneath the chin for micro-lipo if there’s any fat there, if there’s not this can help to break up some of the smaller platysmal bands that’s the neck bands that we see underneath the chin. If there is a thick platysmal bond we’ll lift the skin slightly from that same incision and cut it so we can restore that portion of that muscle, we certainly don’t need it, it’s the grimace muscle and the cords just make the neck hang, it’s like a close line effect and once that’s done we address the skin by lifting that from behind the ear so the incision can’t be seen elevating the back edge of that same platysmal muscle to restore the contour and finally taking any skin redundancy that’s their way with sutures that removed after approximately 7 days. The beauty of the neck lift procedure are that there are virtually no incisions that can be seen, there’s very little swelling and after neck lift surgery and typically there’s very little bruising so most people with a little scarf can pretty much return to normal social activities although we do restrict exercise to those exercises that involve no bending, lifting or straining.
If you’re interested in more information on this topic or any of our other topics please don’t hesitate to write at @DrMaas.com you can send videos, you can send photographs or just written text with questions and I’m happy to answer them, we’re more than happy to have you visit our website or visit our Facebook page @Facebook.com/MaasClinic. This is Corey S. Maas MDTMon looking your best.”
