Deep neck lift in Thessaloniki and Athens, Greece

A deep neck lift reshapes the neck by treating the structures that lie beneath the platysma muscle: the submandibular salivary gland, the digastric muscles and the deep fat. The platysma is then tightened and the skin lifted, so that a clean angle forms again between the neck and the jawline.

The deeper the work, the more stable the tissues and the longer the result lasts. That is why a deep neck lift is usually done together with a deep plane facelift, so that face and neck are lifted as one unit. I perform it on its own only when a previous facelift did not correct the neck, and as part of facial feminisation surgery.

A deep neck lift suits men and women with a full or obtuse neck, a double chin that does not go with diet, visible neck bands, a large submandibular gland or loose skin. There is no strict age limit; which deep steps you need is decided at your examination.

At the consultation I examine your neck at rest and while you speak, and we decide together whether you need the neck alone or a combination with a deep plane facelift or another procedure. You receive a written plan and cost after the examination. The date of surgery is set once your pre-operative tests are complete.

What happens at the consultation?

I examine your neck at rest and while you speak, the platysma, the salivary gland and the fat under the jaw. I check whether the fullness lies above or below the muscle, how much the skin has loosened, the position of your chin and how the neck relates to the rest of your face. Every face is different, so the approach has to be holistic: together we decide whether you need the neck alone or a combination with a deep plane facelift or another procedure. You receive a written plan and cost after the examination.

The deep structures of the neck lie close to nerves and blood vessels. At any consultation, including mine, it is worth asking:

• Which deep structures do you treat: the glands, the digastric muscles, the deep fat?
• How do you decide whether the salivary gland needs reducing?
• How do you treat platysmal bands?
• Can I see neck cases with results at least one year after surgery?

What tests and instructions apply before surgery?

You will need pre-operative blood tests, and a cardiac check where appropriate for your age and medical history. Your blood pressure must be well controlled, because high blood pressure increases the risk of a haematoma. Smoking increases healing complications: stop 4 weeks before and 4 weeks after surgery. If you take anticoagulants or antiplatelet medicines, tell me; they are stopped only in agreement with the doctor who prescribes them. The date of surgery is set once your tests are complete.

A deep neck lift is performed under general anaesthesia. When added to a deep plane facelift, it adds 30 to 40 minutes to the operation; as a standalone procedure it takes about one hour. I always work in the same order, from deep to superficial, and carry out only the steps your neck needs.

The centre of the neck is reached through a small incision in the crease under the chin. Through it I reshape the fat, the platysma and, where needed, the deeper structures. When the neck is done together with a deep plane facelift, it is also lifted backwards through the incisions around the ear, so that the centre and the sides of the neck are corrected together. Every neck is assessed individually: the order is always the same; which steps are needed is not.

The submandibular salivary gland

A prominent gland shows as a bulge under the jaw, which often becomes more visible after liposuction or a facelift has removed the fat around it. I do not remove the whole gland: I reduce only the part that protrudes below the jaw, in the subcapsular plane, that is, from within its capsule. I use a vessel-sealing device (LigaSure), which cuts and seals at the same time, so bleeding is minimal.

Digastric muscles and deep fat

The front bellies of the digastric muscles sit under the chin. When they are bulky, they fill the angle under the jaw and stop the neck from gaining a clean contour; I then reduce or tighten them. The fat beneath the platysma cannot be removed with liposuction. I reduce it carefully, because removing too much leaves a hollow.

Platysma and neck bands

After the deep steps, the platysma is joined in the midline by plication, so that the neck angle forms again, like a “hammock” under the jaw. This hammock-type fixation deals better with problems under the jaw, in the double chin area. When there are visible bands, I also perform a horizontal myotomy, so that the cords do not form again.

The neck within a deep plane facelift

In a deep plane facelift the dissection starts at about the corner of the eye and continues in one piece down to the neck, beneath the mobile part of the SMAS, the superficial muscle layer of the face. The lift is almost vertical, at 60 to 70 degrees, directly against gravity, and the tissues are fixed to strong structures such as the mastoid process. A deep neck lift adds the correction of the centre of the neck. The deep plane facelift page explains this in detail.

Incisions and stitches

The incision under the chin is small and hidden in its shadow. When the neck is done together with a facelift, the incisions run around the ear: depending on how much excess skin there is, they start in front of the sideburn, continue behind the tragus in women and in front of it in men (so the beard line does not shift), pass under the earlobe, go up behind the ear and down towards the hairline. The skin is closed without tension, which helps the scar heal fine, and the hairline does not change. The stitches are internal and absorbable, so none need removing.

The combination of newer medicines and a special haemostatic net usually makes drains unnecessary and markedly reduces bruising and swelling.

Combined procedures

Most often the deep neck lift is done together with a deep plane facelift. Neck liposuction, where needed, enhances the result further. In the same operation I can perform eyelid surgery (blepharoplasty), a brow and forehead lift, a lip lift, facial fat transfer or a chin implant, so that the upper and lower face stay in proportion. Skin treatments such as laser and peels bring out the result further.

Hospital stay

You stay in hospital from a few hours to one day, depending on whether the deep neck lift is done on its own or with a facelift. You need someone to accompany you home, and you must not drive after a general anaesthetic.

There is usually no pain, but a feeling of pressure in the neck can last 2 to 3 weeks. Most people return to work and social life in 10 to 15 days. A firmer swelling under the jaw softens within 6 to 8 weeks, and the final result settles at 6 to 12 months.

Recovery and the appearance of scars vary from person to person and are not always predictable. Numbness in the skin of the neck and face fades gradually over 3 to 6 months, and muscle movement may be affected for a while, without lasting effect. In my experience, recovery after a deep plane facelift with a deep neck lift is generally easier than after other facelift techniques, probably because the main lift is done in the deep layer and skin undermining is limited.

Plan to stay in Greece for 5 to 10 days after a deep neck lift. You spend from a few hours to one day in hospital, and the stitches are internal and absorbable, so none need removing.

• Hospital: from a few hours to one day, depending on whether the deep neck lift is done on its own or together with a facelift.
• Before flying: from day 5, alone or with a deep plane facelift, after your final check the day before the flight.
• Stitches: internal and absorbable, so none need removing.
• Follow-up: by video call at 10 days, 1 month, 6 months and 1 year.
• At home: you need someone to accompany you when you leave the hospital, and you must not drive after a general anaesthetic. For the first week, rest with your head raised. Most people are back at work in 10 to 15 days, light exercise resumes after 3 weeks and strenuous exercise after 6 weeks.

A deep neck lift gives a clean neck angle and a defined jawline, with a natural result that does not change your features or expression. The improvement is visible from the first weeks, but the final result matures after the sixth month and can take up to 12 months. How long it lasts depends mainly on keeping your weight stable.

A deep neck lift is performed close to nerves, blood vessels and the salivary gland, so it calls for specialist experience. Serious complications are rare and most can be treated. Swelling, firm swelling under the jaw and numbness are common but temporary. I explain the risks for your own case at the consultation.

Reducing the submandibular salivary gland is the step patients ask about most. In more than 80 of my own reductions with a vessel-sealing device I have had no sialocele, haematoma or nerve injury, in line with the published literature [1, 2].

Smoking. Stop 4 weeks before and 4 weeks after surgery; smoking reduces the blood supply to the skin and increases healing complications.

Anticoagulants. Tell me if you take anticoagulants or antiplatelet medicines. They are always stopped in agreement with the doctor who prescribes them.

I do not publish prices. The cost depends on whether the deep neck lift is done on its own or with a deep plane facelift, which deep steps your neck needs, and any combined procedures. You receive a written quote after your examination at the consultation.

• Whether the deep neck lift is done on its own or as part of a deep plane facelift.
• Which deep steps are needed: glands, digastric muscles, deep fat, bands.
• Combination with neck liposuction, a chin implant or other facial procedures.
• The length of the operation and of the hospital stay.
• Whether it is a first operation or a correction after a previous facelift.