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This article has been meticulously reviewed for medical accuracy by New York board-certified facial plastic surgeon, Dr. Dilip Madnani on September 28, 2024.
It often happens unexpectedly: for years, your neck remains firm, with a clear jawline defining your face—until one day, you observe that the skin from your chin to your chest appears loose. What triggers this? It could be aging, genetic factors, gravity…the reasons are numerous. However, no quantity of expensive creams, facial exercises, or home-use jawline sculpting tools will significantly tighten sagging jowls.
Fortunately, there are two prominent in-office treatments that can deliver noticeable neck-enhancing results: a lower facelift and a neck lift. While both can enhance the definition along the jawline, there are notable differences between the two. Here, we break down each procedure and its potential risks to help you decide which one is right for you.
First, what is a lower facelift?
“A lower facelift addresses the jowls and the neck [by repositioning the skin and muscle],” explains New York City facial plastic surgeon Dr. Jennifer Levine. During the procedure, the upper portion of the platysma muscle—which spans from the upper chest, across the collarbone, and along the sides of the neck—is commonly adjusted. The platysma muscle is attached to a layer of firm tissue, or fascia, known as the superficial musculoaponeurotic system (SMAS). “By repositioning this layer, tissues and fat pads that have descended are returned to their original positions,” elaborates Southlake, Texas, facial plastic surgeon Dr. Jordan Rihani. “This also facilitates improvement in the appearance of the nasolabial folds and marionette lines.”
While a full facelift can tackle sagging across the upper face, midface, and lower face, a lower facelift specifically focuses on loose jowls, laugh lines, and drooping cheeks. The incision for a lower facelift usually starts near the front of the ears and extends to the hairline. Skin, fat tissue, and the platysma muscle are then pulled into a raised position to give the jawline a more robust appearance.
What is a neck lift?
A neck lift is akin to a lower facelift in concept, but its primary goal is to improve the appearance of the neck—not laugh lines or sagging cheeks. “The incisions are made further behind the ear and into the hairline, to remove excess neck skin,” notes Dr. Rihani. “The SMAS layer is repositioned in a similar manner [as a lower facelift] but extends further down [the neck].”
Additionally, if a patient has prominent bands in the front of the neck, these are managed through a small incision under the chin during a neck lift. As we age, the platysma muscles often separate and form two distinct vertical bands running from the chin to the chest. Consequently, doctors frequently opt for a platysmaplasty—also known as a neck lift—to stitch these two band-like muscles together and smooth the area.
For those dealing with a double chin, liposuction is often combined with a neck lift to remove excess fat from the area and enhance the jaw angles. Finally, patients struggling with skin looseness—a primary cause of the so-called turkey neck—will undergo skin trimming during a neck lift to sharpen the jawline.
“Patients with significant skin laxity in the neck and wide separation of the platysmal bands in the midline will likely need a lower facelift simultaneously,” advises New York board-certified facial plastic surgeon, Dr. Dilip Madnani. “It’s quite challenging to address just the neck banding without considering the jowling, as the face and neck skin and muscle layers are interconnected.”
What are the main differences between a lower facelift and a neck lift?
Although some people use these terms interchangeably, there are distinct differences between the two procedures. According to Dr. Levine, a traditional neck lift does not address the jawline and jowls—it only affects the neck. “The difference also lies in the incision,” she adds. “To reposition the lower face, there needs to be an anterior incision, meaning an incision in the front of the ear, as well as behind the ear.” This incision can be extended higher to also lift the cheek area. Conversely, a neck lift involves incisions generally around the ears and below the chin. According to Dr. Madnani, for patients with minimal skin looseness, a neck lift can sometimes be performed solely via an anterior approach—under the chin—and can yield excellent results, especially when combined with liposuction. “A lower facelift cannot be addressed via this approach,” he adds.
Related: 5 Signs You’re a Good Candidate for a Facelift—and 4 Signs You’re Not
Who is a good candidate for a lower facelift, and who would be a better candidate for a neck lift?
“Most [good candidates for these procedures] need both a lower facelift and a neck lift,” stresses Dr. Levine. Many patients require some correction to both the neck and the lower face since, anatomically, the muscle extends from the lower face to the neck—it’s all interconnected. “To achieve harmonious results and avoid discrepancies between the face and neck, both should be performed,” adds Dr. Levine.
Dr. Rihani agrees: “When patients develop sufficient skin laxity to warrant a neck lift, many of them also have enough skin that will likely need a lower facelift as well,” he says. However, for patients concerned about the location of the incisions or for those with only mild jowling, a neck lift may be performed alone. If the patient has significant visible platysmal banding, a neck lift done under the chin, to bring the muscle bands together, is necessary—not a lower facelift.
On the other hand, the ideal candidate for a lower facelift is a patient with some jowling but minimal sagging or extra skin along their neck. Patients who need a lift along their mouth to correct laugh lines, in addition to lifting the skin around the jawline, are more suitable for a lower facelift. Ultimately, the unique anatomy of the patient guides the doctor’s treatment plan.
Related: Sharon Osbourne Opened Up About Her Facelift Complication. Plastic Surgeons Explain Why It Can Happen.
Do the risks differ between the two procedures?
As with any surgical operation, there are risks associated with getting a lower facelift or a neck lift. Between them, the risks are very similar. “The main risk is a hematoma, which is a collection of blood under the skin,” explains Dr. Levine. “Patients should avoid aspirin, Advil, Motrin, and all medications and supplements that cause increased bleeding [before surgery].” Dr. Madnani advises his patients to refrain from exercising, heavy lifting (more than 10 lbs), bending over, or walking up many flights of stairs for two weeks after surgery to further reduce the risk of hematoma.
Patients should also stop smoking several weeks before the surgery. “This is crucial to prevent wound healing complications and necrosis, or death of the skin flaps,” explains Dr. Levine. The risk of injury to the facial nerve is uncommon but possible, and Dr. Rihani warns that sensation in the skin may be temporarily altered post-surgery. To ensure a favorable outcome, these procedures should always be performed by an experienced plastic surgeon who is well-versed in facial anatomy.
