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Aging and the effects of gravity cause the facial skin to loosen...
Parts that make up the lower face and neck area are the lower cheeks, the jawline and neck. Aging and the effects of gravity cause the facial skin to loosen and sag down the jawline (jowls), resulting in loss of definition to the facial oval and the face gaining a rather rectangular shape. Deep lines developing at the corners of the mouth and running in a downward direction as far as the outer corners of the chin or the jawline start to take shape (marionette lines), neck skin loosens and sags, flaccid muscles under neck skin give rise to vertical bands (turkey neck), fat accumulates under the chin, and the neck angle loses definition. In some people, severe sagging of the neck may occur without any significant aging signs in other parts of the face.
The objective of lower face and neck lift surgery is to tighten and remove excess skin, apply sutures to tighten the muscles under the skin, remove excess neck fat, suture and tighten the neck muscles, and restore definition to the neck. Procedures applied to that end are face and neck lift surgeries, neck liposuction, thread lift, and in some cases placement of chin implants and fat injections.
Lower face and neck rejuvenation procedures are often performed as part of full-face rejuvenation. Yet, it can also be done alone in cases where there is no significant problem in a patient’s upper and mid face. Persons with jowls, neck fat, and sagging neck skin are suitable candidates for this type of surgery, which is usually done on patients over the age of 40.
Face and neck lift: The procedure involves an incision that starts in front of the earlobe and continues around the ear into the lower scalp to elevate the skin of the face and neck. If there is not much problem in the neck, the only scar that will be left is in front of the ear, which is referred to as limited incision facelift. The underlying muscles referred to as SMAS, including those responsible for facial mimic, are tightened and shaped with suitably placed sutures. If this is not done, the face will soon return to its old shape. Any fat deposits on the neck are removed by liposuction. To correct excessive vertical banding of the neck (turkey neck), a short incision under the chin is used to elevate neck skin and the muscles are stitched together. This will restore definition and contour to the neck. A receding chin can be improved with a chin implant or fat injection. Marionette lines extending downwards from the corners of the mouth are filled up with fat injection. Any unwanted fat deposits in the lower face can be corrected with liposuction. Excess skin on the face and neck is excised. The incisions are closed with sutures placed in front and behind the earlobe and hidden in the lower scalp.
Liposuction: For young patients with good skin elasticity, liposuction can be an effective tool to restore definition and contour to the neck without surgery. The fat obtained in this process can be used for chin contouring and marionette line improvement.
Thread lift: For patients with good skin elasticity who want to avoid scars to the furthest extent, thread lift can be an efficient option where subsequent to liposuction neck skin is simply suspended using special threads through short incisions beneath the earlobe. The lift can be complemented by fat injections and a chin implant.
Neck liposuction and thread lift can be performed under local anesthesia and sedation, whereas face and neck lift surgeries must be done in an operating room under general anesthesia or strong sedation.
Liposuction and thread lift are painless procedures. After face and neck lift, patients rather complain of tightness and pressure sensation than pain, which resolves quickly in a short few days. It would be right to say that these procedures are generally painless.
Healing after neck liposuction and thread lift is fast. A bandage is applied to the neck which must be worn for 3 days. Patients are discharged on the same day. Face and neck lifts are accompanied by swelling and bruising which dissolve within a week. To accelerate tightening of neck skin, patients are advised to do neck massage in the first 2 months after surgery.
After face and neck lift, patients have to stay in hospital overnight. Drains are withdrawn the next day and the patient is discharged. Swelling and bruising will regress within a week to a large extent. Sutures are removed after 6 days. Patients can have their first shower 48 hours after surgery. It may take as long as 20 days until swelling and bruising dissolve completely. However, depending on skin thickness and the procedures done, it may take up to 3 months until the face acquires its final shape. Like with all other face surgeries, patients are strongly advised to avoid direct exposure to sunlight for 3 months after lower face rejuvenation.
Swelling and bruising are normal side effects of surgery and they are transient. Bleeding shortly after surgery is a serious complication. To avoid that, patients must discontinue intake of blood thinners before surgery. High blood pressure must be taken under control and kept low both during and after surgery. If bleeding occurs despite all, it must be stopped surgically. Persistent edema may occur on the neck, in which case it may take longer than expected before the neck is smooth and thin. The process can be supported with auxiliary treatment methods like lymph drainage massage, radiofrequency or deep ultrasound treatment. In rare instances, neck and face lift surgery can lead to lower lip paralysis and movement impairment. These complications are almost always temporary and resolve after a few days; sometimes, however, they continue for a couple of weeks.
The most feared complication is difficult scar healing, affecting mainly smokers, and excessive skin excision. The chances to face this problem are higher especially in cases of excessive lift, patients with post-operative bleeding and smokers. Smokers are strongly advised to stop smoking at least 3 weeks prior to surgery.
Surgery does not prevent aging, and there may be some loosening and sagging of the tightened skin after surgery. A return to the pre-operation state is, however, impossible. How long the effects will last surely depends on the surgical technique and the personal characteristics of the patient. Sagging will occur faster in patients with thick and fatty skin.
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