Neck lift (platysmaplasty)

A neck lift is surgery that removes excess skin from the neck, tightens the underlying muscle, and reduces fat deposits under the chin and along the jawline. It is generally considered for loose or sagging neck skin, visible vertical neck banding, or loss of jawline definition following ageing or significant weight change.

Incisions are typically placed behind the ears and under the chin. The platysma muscle is tightened, excess fat and skin removed, and the skin redraped.

The platysma muscle - why the neck ages the way it does

The platysma is a thin, sheet-like muscle running from the collarbones up to the lower face. It is involved in jaw movement and facial expression.

Over time it:

• Weakens and separates in the midline, producing the visible vertical bands that run down the front of the neck
• Loses elasticity, contributing to loose skin
• Pulls downward, blurring the jawline

This is why skin tightening alone often does not fix a neck. If the bands are muscular, tightening skin over them does not remove them - the muscle itself has to be addressed, which is what platysmaplasty means.

Why the neck shows ageing earlier than the face

• The skin is thinner and more prone to laxity and wrinkling
• Platysma weakening produces banding
• Fat accumulates under the chin
• Collagen and elastin decline
• Sun exposure - the neck is frequently missed by sunscreen and is one of the areas where cumulative sun damage shows most clearly

What a neck lift addresses

• Loose, sagging neck skin
• Excess fat under the chin
• Vertical neck bands caused by platysma laxity
• Jawline definition, and the balance between the jawline, neck and lower face

It does not change skin texture, fine wrinkling or pigmentation - those are addressed by resurfacing or skin treatments. And addressing the neck alone while leaving an ageing mid-face untreated can look unbalanced, which is why a neck lift is frequently combined with a facelift.

Who it may suit

• People with loose or sagging neck skin
• People with visible platysmal banding
• People with a jawline blurred by skin laxity
• People bothered by excess fat under the chin
• People in good general health with realistic expectations
• Non-smokers, or those willing to stop before surgery - smoking significantly raises the risk of skin necrosis in neck and face surgery

Most people cannot tell which procedure suits them, and that is expected. It is a surgical judgement made at consultation after examination.

Surgical techniques

• Traditional neck lift - incisions behind the ears and under the chin, removing excess skin and tightening the platysma.
• Neck liposuction - removes fat under the chin and along the jawline. Suited to younger patients with good skin elasticity who do not need muscle tightening. On its own it does nothing for loose skin or bands.
• Platysmaplasty - tightening the platysma muscle to correct vertical bands.
• Deep plane facelift - repositions skin and underlying muscle with less tension and allows recontouring of the neck as well as the face, where both are being addressed.

A combination is often used. Which combination depends on whether your concern is skin, fat, muscle, or all three.

The procedure step by step

1. Anaesthesia - general anaesthesia, or local anaesthesia with sedation.
2. Incisions - behind the ears and, where needed, under the chin, following natural creases.
3. Fat removal and muscle tightening - excess fat removed by liposuction if required, and the platysma tightened.
4. Skin removal - the skin is redraped and excess trimmed.
5. Closure - with sutures.

Surgery typically takes two to three hours. Most patients go home the same day with post-operative instructions.

Recovery

• Week 1 - swelling and bruising peak. Discomfort is managed with prescribed pain relief. A compression garment is worn to reduce swelling.
• Weeks 2 to 3 - swelling subsides. Most patients return to light activities, including desk work and social outings.
• Weeks 4 to 6 - swelling continues to improve and the neck contour becomes clearer.
• 3 to 6 months - the result settles and scars fade.

Numbness of the neck and around the ears is common early on and can take months to resolve; occasionally it is permanent. Recovery is longer where a neck lift is combined with a facelift.

Results and how long they last

Noticeable improvement is usually visible within four to six weeks, with the final result apparent at three to six months as swelling resolves and tissues settle.

Results commonly last around 10 to 15 years, though this varies with genetics, skin quality, weight fluctuation and lifestyle. Ageing continues from the new starting point. Maintaining a stable weight and using sun protection preserve the result more than anything else.

Scarring

A neck lift involves incisions and therefore permanent scars. They are placed behind the ears and in the natural crease under the chin, where they are generally well concealed, and they fade over months - but they do not disappear. Scars in the neck can sometimes thicken or widen, and some people are prone to keloid scarring.

Risks and complications

A neck lift is major surgery. Risks and potential complications include:

• Haematoma - a collection of blood under the skin, which may require a return to theatre
• Nerve injury - injury to the marginal mandibular nerve can cause an uneven smile or lower lip weakness; injury to the great auricular nerve can cause permanent numbness of part of the ear
• Numbness or altered sensation of the neck and ears, which may be permanent
• Skin necrosis - death of skin at the edges of the flap, substantially more likely in smokers
• Infection
• Permanent scarring, including thickened or keloid scars
• Contour irregularity, visible ridging, or a residual or recurrent band
• Asymmetry
• Delayed wound healing and wound separation
• Salivary gland injury or a visible submandibular gland
• Anaesthesia complications
• Deep vein thrombosis and pulmonary embolism
• An unsatisfactory result and the possible need for revision surgery

Seek urgent attention for rapidly increasing swelling on one side of the neck, severe pain, or difficulty breathing after surgery.

Please read our information on the risks and complications of cosmetic surgery before proceeding.

Non-surgical alternatives

Non-surgical options - including fat-dissolving injections for submental fat, neck thread lifts, and skin resurfacing or chemical peels for texture - produce temporary and generally modest changes. They do not remove excess skin and do not tighten the platysma.

For younger patients with mild changes and good skin elasticity, they are a reasonable option. Where there is significant loose skin or established banding, they will not achieve what surgery achieves, and it is better to know that before starting a course of maintenance treatments.

Cost and booking

Neck lift cost depends on the technique, complexity, whether it is combined with a facelift or other procedures, the anaesthetic and the facility. A personalised quote is provided at consultation, and includes fees for the surgeon, assistant if required, hospital, anaesthesia, recovery care and follow-up.

A neck lift performed for cosmetic reasons is not covered by Medicare. As at September 2024 and including GST, a consultation with a Specialist Plastic Surgeon is $350.

Since 1 July 2023, a GP referral is required before seeing a plastic surgeon about cosmetic surgery, and a cooling-off period applies after your second consultation before surgery can be booked. Payment for major surgery is due four weeks before the procedure.

Phone Me Clinic on 1300 852 050 or use the contact form. Me Clinic is at 4 Burke Road, Malvern East VIC 3145.

Related pages

See facelift, facial surgery before and after, chin and neck liposuction, neck thread lift, recovery after surgery, or all face procedures.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.