image-150x150 Neck Lift: Fit for a QueenFit for a Queen

A slender neck is the ultimate beauty ideal. Here’s how to revive an older neck.

BeautyHQ, March 2011.

By Tamsin Marshall.

I was once told, by an appearance medicine insider, that no one ever gets a facelift because of their forehead. We remedy that area constantly, but what isn’t so easy to fix is the lower half of the face. We neglect our necks, or perhaps what’s fairer to say is that suddenly time catches up with us, and we notice mini-chins and loose skin. It’s that sagging under the chin that drives our desire to hitch it back skyward.

The problem with age is that everything travels south. We lose collagen and elastin: skin renewal turns over more slowly. This loss of volume and the subsequent hollowing out under the eyes and around the mouth makes the face look less youthful.

Technically speaking, it’s the downward pull of the platysma muscle and the ptosis (drooping) of the facial portion of the muscle that creates jowls, with a resulting loss of definition of the chin and jaw line.

There are two ways to create a more youthful neckline – as a first step you might consider using Botox to soften the platysmal bands (the Nefertiti Neck Lift), or you might have surgery or liposuction.

Clearly the first is the most temporary option, one that creates a more subtle result. The second requires more downtime – it’s at least 10 days before you’d want to be seen in public and even then the true results aren’t fully visible until a few months have passed.

Ultimately surgery has the best outcome, especially for older patients or those who have undergone significant weight loss, but many professionals suggest Botox to help reduce both wrinkles and prominent band-like lines, because it helps clients look better quickly and with very little downtime.

The Nefertiti Neck Lift

This procedure is named after the Egyptian Queen Nefertiti, who three thousand years ago was considered the most beautiful woman in the world. Plastic surgeon Dr Stephen Gilbert FRCS FRACS says those same features are still the hallmarks of female beauty today, because Nefertiti’s long neck is perfectly balanced by her high widening crown.

“There’s a beautiful contemporary limestone bust in the Egyptian section of the Berlin museum which shows why,” says Dr Gilbert. “She was famous for a long, elegant, slender neck with a small chin, a straight well proportioned slightly upturned nose, high cheek bones and wide, mascara-edged eyes, framed by arching brows.”

Non-surgical treatment of the neck and bands with Botox can re-contour the jaw line and soften the physical bands. It’s not a widely known treatment due to restrictions around the prescribed use of Botox. Botox is approved for use in temporary improvement in the appearance of upper facial rhytides (glabellar lines, crow’s feet and forehead lines) in adults. It is not indicated for use in the lower face, but under section 29 of the Act it is allowed to be used at the discretion of the prescribing doctor, such as a plastic surgeon or very well qualified medical professional who has been approved for applying advanced Botox techniques.

Using someone trustworthy, trained and skilled is a must. Nurse Angela Frazer at Prescription Skincare has been administering Botox for the past 13 years. She is recognised internationally for her services to skin care and injecting technique, and is the only international board member on the American Society of Plastic Surgical Skin Care Specialists. She describes this non surgical treatment as minimally invasive, safe and effective.

“It’s very good for those wanting to treat just this area, or who consider themselves too young for surgery,” she advises. Patients are seated upright. The skin is cleansed and once the platysmal bands are identified Botox is injected deep into the dermis along the band. Similarly, the jaw line is injected at specific sites along the jaw.

The result is improved definition, a lift and elevation to the corners of the mouth, creating a ‘mini’ lift.

The ‘Smas’ Lift

Dr Gilbert highly recommends a neck and face-lift operation he performed recently on a 50 year-old patient, known as a High Extended Bi-Planar ‘smas’ lift.

“The ‘smas’ stands for superfacial musculoaponeurotic system, which is the strong fibrous layer lying in the face between the skin and the muscles of facial expression and extending into the neck as the platysma bands – looseness giving the ‘turkey gobbler’ look in older age,” he explains. The skin is opened up behind the front part of the ear (tragus) and in the crease behind the ear so the scar should not show, even with hair tied back, if done correctly.

But there are limits to what a surgeon can achieve, he says. “Of course you cannot expect a long elegant neck after a face and neck lift if your anatomy is short and stumpy. To get the best out of a neck lift and, if you have the right anatomy, possibly something like Nefertiti’s, you must have the deep facial tissues (smas) lifted surgically, near-vertically, in front of your ears to make the area under your chin snug. The long vertical muscle bands (platysma) in the front of your neck need to be sewn together and loose skin and platysma smoothed out and removed behind your ears.”

The skin is separated off the smas to about mid-cheek and then the smas is dissected and pulled upwards and backwards to be anchored securely to deeper tissue in the front of the top of the ear. Working from behind the ear, the skin is dissected off the platysma bands in the neck to the mid-line where, through a separate short transverse incision under the point of the chin, the platysma muscle bands are brought together to give a snug fit, just like Nefertiti and the real patients shown in this article.

Tightening the platysma backwards behind the ear and removing excess skin will further enhance a smooth result, says Dr Gilbert. The deep layer is in this way moved upwards in the face and the skin is moved backwards in the face and neck without tension. This results in the two planes and two directions of the ‘biplanar’ lift, which is the key to creating a natural, non-stretched look.

“Simple ‘weekend’ skin lifts and ‘S’ lifts cannot possibly give this result,” says Dr Gilbert. “In those, tension in the skin gives a tight look, the scars migrate forwards and the skin stretches again, the result lasting little more than the week after the weekend.”

Instead, Dr Gilbert recommends the High Extended Biplanar smas lift, usually augmented by fat injections to restore lost youthful volume, because it gives a longer lasting and more natural result.

“In the longer-necked patient, this will give a stunning result – like Nefertiti, or the more contemporary example, Audrey Hepburn.”

Let’s be clear, this is not a lunchtime procedure. It takes around five hours and is done as a day case under a general anaesthetic. You’ll need looking after that night by a responsible adult. If you are in skilled hands, complications are minimal.

Dr Gilbert says the operation improves both patients’ physical appearance and their confidence. His patients find it often works in their favour in business: “Younger people who took you for granted before now want to be your friend – and employ you.”