Roslyn Heights, New York

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The Giveaway to aging and the failed face lift

The neck with its overhanging jowl, transverse liner, “turkey gobble”, deep folds and deep central hollow is characteristic of age. Concurrently there is the heavy obtuse, neck meets face iguana like look, implying to the observer over indulgence, decadence or simply exhaustion. Surgically both types of neckline can be hereditary and both can be radically transformed by surgery.

To truly repair a neckline is generally not simple or easy. It requires a detailed knowledge of the deeper anatomy and its corresponding problems. Tightening the skin will not work. Pulling the cords apart will not work and certainly sticking a liposucker in will not work. I can say this because I have tried all of the above. If you look at actresses in their 30’s and 40’s and study their necklines, you will see their neck cords dancing and tightening no matter how beautiful they look.

Necklines consist of thin skin with a variable layer of fat that may, if necessary be removed. The real defect represents a muscle hammock, which is normally supportive, but tears centrally. The central edges of the hammock fall forward leaving a central depression. The edges of the center than contract like a bow-string. When this happens, the central neck IS TOO SHORT of skin, looking from the side. The neck has become the hypotenuse of a triangle that is the shortest distance between the collar bone and chin, instead of a right angle. As the skin shortens it produces the transverse folds that define the collapsed neck. Repairing the muscle anatomy (not skin) automatically produces a lateral skin redundancy as if you were shortening a jump rope.

There are many other niceties of neckline repair. Often times (particularly men) there is bulky fat deep to muscle acting to break open or keep open the central defect. Glands below the jaw (salivary) can collapse if unsupported. Moreover, there are a host of deeper issues that can and should be addressed by someone with advanced training in head & neck anatomy.

By and large, the neckline has been resistant to advances in fillers and Botox. Fat dissolving agents which are true bile acid derivatives, are costly, require multiple treatments and do nothing to the overlying skin, muscle, and sub muscle defects. Repairing male necklines is particularly cogent in decreasing sleep apnea when the neck is bulky and heavy. Reducing neckline bulk, by itself, creates the impression of massive weight loss.

A strong natural neckline and jaw line, which is both predictable and supportive, can only be gained by expanding the parameters of Plastic surgery.


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