“I don’t want a facelift. I only want a neck lift,” is a desire expressed by an increasing number of patients. According to the American Society of Plastic Surgery, neck lifts increased 6% last year alone.

What most patients are complaining about, if they just want a “neck lift,” is the “turkey wattle” sag of skin in the midline of the neck. What is important to recognize is that there are usually other factors also causing this unattractive, aging problem. Firstly, yes, the skin is sagging to the midline because it is losing its elasticity and stretching. Because of gravity, it falls towards the ground – it always looks better when you are lying down on your back! In addition, there is usually some excess fat above the underlying muscle which also sags, giving even more fullness to the area. Finally, the long, flat muscles of the neck, called the platysma, often become lax, droopy and separated in the midline. Sometimes this is associated with fat deep to the muscle also coming to protrude in the midline.

In most cases, all of these aging neck features are addressed at the same time as the jowls and mid face are lifted and re-draped in a “face and neck lift.” This is for the simple reason that the face and neck often age more or less together, and the best aesthetic result is achieved by correcting both the face and neck together.

But, if your neck has aged relatively more and you are happy with your face, there are ways to operate on your neck alone. In the younger patient, sometimes up to the early 50s, liposuction alone may give a reasonable improvement. This is if, and only if, excess fat is the major cause of the fullness or wattle and, in addition, your skin has enough elasticity to contract properly afterwards. If this procedure is selected, you must be moderate in your expectations.

An effective way to totally remove the excess fat and skin, and tighten the neck muscles, is through a direct excision of the skin, combined with liposuction and platysmaplasty. There are a variety of incisions that can be made to do this – you can discuss these options with your surgeon. But at the end of the day they all have one thing in common – there will be a midline incisional scar (usually irregular so as to camouflage it better) and often a short horizontal incisional scar at the area just under the chin and in the lower neck. These usually heal very well, and certainly the wattle contour deformity can be effectively removed or improved substantially. The result is real and very long-lasting.

You can see why it is so important to describe explicitly what you would like improved, and what you can live with, so your surgeon can focus on the options that will work best for you.