The neckline is one of the most defining characteristics of a youthful appearance. When patients come to see Dr. Lopez seeking facial plastic surgery, it's not uncommon for them to focus on a single aspect of their appearance rather than the overall picture. One of the most common concerns he hears from patients seeking facelifts is the "turkey wattle," the loose skin dangling under the chin. Many times patients will request just a "neck lift." In male patients, a direct excision of the loose skin and fat under the chin can produce a very nice result.  A necklift will address the “turkey wattle”, but it will not address the jowling very well.  Dr. Lopez will advise you as to whether a necklift alone will treat your area of concern.

Dr. Lopez is a board certified facial plastic surgeon, trained to perform plastic surgery exclusively on faces and necks.  Some patients not ready for cosmetic surgery are better served with conservative measures, such as Botox for fine lines and wrinkles or fillers for deeper wrinkles. Patients who educate themselves about facial rejuvenation know when and if the time is right to proceed.

When discussing rejuvenation procedures the best place to start is by looking at before and after photos to see just what can be accomplished. As you will see in the photos, patients often ask to combine a necklift with other cosmetic surgery. Eyelid lift, chin implants, facelift, rhinoplasty (nasal surgery), otoplasty (ear surgery) and lip surgery can also be performed in conjunction with a necklift.

At your initial consultation, Dr. Lopez evaluates your bony and soft tissue architecture of your face and neck. Assessment of the face and neck provides the basis for what one may expect from a necklift. Skin type, ethnic background and age, along with the degree of deformity and function are important factors influencing the outcome of surgery.

As with all facial plastic surgery, a thorough health assessment and realistic expectations are prerequisites. Your understanding of procedures and routines is essential to a successful final result. Following your consultation, we continue our discussion at the preoperative appointment.

BEFORE NECKLIFT SURGERY

At your preoperative appointment Dr. Lopez will provide all the instructions for you to follow before and after surgery. A necklift takes about one hour depending on the facial structure and amount of excess tissue prior to surgery. If you are having a combination of procedures your surgery will take longer. Recovery time from the anesthetic takes about an hour and you will be discharged about three to four hours from the time of admission.

PREOPERATIVE NECKLIFT INSTRUCTIONS

AFTER NECKLIFT SURGERY

When you wake up from surgery you will notice a soft, bulky head wrap dressing.  Following your necklift, the nurses will ask assist you to meet the discharge criteria: to drink liquids, walk with a steady gait, void, and manage your discomfort. For patients who have a combination of procedures such as an eye lift, your vision may be cloudy from the ointment we place in your eyes at the time of surgery. The nurses will review all instructions you will need for care following your necklift.

You will be asked to come to see Dr. Lopez the following day after surgery for a dressing change.  You will be asked to return in six to eight days for suture removal.

POSTOPERATIVE NECKLIFT INSTRUCTIONS

Wound care

Keep dressing dry and intact the evening after surgery. Notify Dr. Lopez if the dressings become loose or fall off.  Following dressing removal the day after surgery, you will be given an elastic wrap to wear for 1 week that can be taken off to shower.  You can shower 48 hours after the surgery. Cleaning the suture with a Q-tip dipped in hydrogen peroxide once a day and then applying the antibiotic ointment three times a day is an essential part of the healing process. Sutures that have been kept lubricated with ointment are less painful to remove. Keep elastic wrap in place at all times other than suture care and showers.

Medications

Most patients complain of discomfort more than pain. Use pain medication as directed/as needed. Vicodin and Percocet contain Tylenol. Do not take additional Tylenol or acetaminophen while taking Vicodin or Percocet. Do not drive or drink alcohol while taking pain medication. Taking pain medication with food helps minimize nausea sometimes associated with pain medications.

Diet

Advance diet from liquids to soft food (oatmeal, French toast, yogurt, soup, pasta) to your regular diet as tolerated. You have no diet restrictions.  Often the anesthesia you received can make your stomach feel uneasy for the first 24 hours so avoid large meals.

Activity

Rest for entire day after surgery. Sleep with head of the bed elevated or use two to three pillows for one week after surgery. Absolutely no bending, lifting or straining. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap. No driving for one week following surgery. 7-10 days off work is recommended.

Bruising can be camouflaged at one week postoperatively with make-up. Always protect your face from the sun. At this point, a hat and sunglasses are a good idea. It is ok to apply sunscreen, cosmetics or facial creams two weeks after surgery. Avoid unprotected prolonged sun exposure for three months following a necklift to prevent pigmentation of incision lines.

Final Result

Following a necklift, it takes time for the swelling to subside and for the skin to heal. Most patients return to work one to two weeks following surgery, depending on the degree of privacy one is trying to maintain. At two weeks postoperatively, swelling and bruising may be apparent to you but not to many of your coworkers and closest friends.

Final results following a necklift are not apparent for one full year following surgery Dr. Lopez will want to see you 3, 6 and 12 months after the surgery to ensure that you are healing as anticipated.

FREQUENTLY ASKED QUESTIONS

1) Will I look like someone else after a necklift?
Many of Dr. Lopez’s patients report that when they return to their normal life, their friends comment, “You look great. Are you getting more sleep?”, “Did you change your hairstyle” or "You look less stressed and tired”.  Dr. Lopez will not change the way you look, just enhance it. A well done necklift will avoid an “operated” look, yet be able to restore the patient’s face and neck to a more youthful appearance.

2) Does Dr. Lopez tighten the neck muscles?
Yes, the relaxed muscles are "tightened" under the skin and the excess skin is removed. Tightening the muscles of the neck eliminates the saggy skin in the midline of the neck, often termed the “turkey wattle” which results in a more youthful appearance. Successful facial rejuvenation involves manipulating both muscles and skin.

3) How long does a necklift last?
You will continue to age after the surgery, but for patients who do not smoke, do not abuse the sun, are in good general health and have good genetics, a necklift can last upwards of 10 years. For patients who elect to abuse their skin and body, the improvement one see with a necklift will not last as long.

4) How can you tell if I need a chin implant?
For patients with weakly projecting chins, a chin implant can greatly improve their facial harmony and enhance the ultimate outcome after a facelift.  Dr. Lopez will assess your overall facial anatomy in order to determine if a chin implant is indicated.

5) I have a double chin and jowls.  Can Dr. Lopez fix them?
Each patient will have different anatomy which dictates the degree of improvement that is possible: however, the primary goal of a necklift is to improve the double chin. 

6) Does a facelift get rid of wrinkles?
A necklift is performed to remove sagging tissues in the midline of the neck.  There is usually some improvement in wrinkles around the neck; however, facial resurfacing, Botox, and dermabrasion are more appropriate procedures for elimination of wrinkles.

7) How much pain will I experience?
Fortunately, most procedures on the face cause mild discomfort.   However, Dr. Lopez does provide all patients with prescriptions for pain medication.  Most patients may use the prescription medication for one to two days after surgery and then switch to Extra Strength Tylenol.

8) Will I be awake during surgery?
You will have the choice to have local anesthesia, general anesthesia or IV sedation (medicine administered through an IV) and a local anesthetic (numbing medication administered in the operating room).  In the latter two situations, patients are asleep during surgery. Patients do not hear or feel anything and are comfortable during the operation. Patients wake up very soon after the surgery is completed.

9) Do I go home after the surgery?
Yes, most necklifts are done on an outpatient basis. Because you will go home after receiving sedation, you will need to make arrangements for a responsible adult to drive you home, to stay with you overnight and to drive you to our office for your first postoperative appointment. Your first appointment is usually the day after surgery. Patients having surgery must stay in the immediate San Antonio area overnight.

10) How long should I stay in San Antonio following surgery?
Most patients stay in San Antonio about seven to ten days following surgery. After that it's ok to fly or travel long distances.

11) When can I return to work?
Most of Dr. Lopez’s patients take about two weeks off of work. After two weeks, most of the residual bruising and swelling can easily be camouflaged with cover-up.

12) When can I exercise?
Dr. Lopez prefers that aerobic activities be avoided for two weeks after surgery.  In addition, heavy weightlifting or more strenuous workouts should be avoided for three weeks postoperatively. It' is extremely important to avoid bending, lifting or straining during the early postoperative period as these activities can increase swelling and delay healing.

13) Will I bruise and swell afterwards and how long will it last?
Unfortunately it is impossible to do surgery without causing swelling.  Dr. Lopez does everything possible to minimize the amount of swelling that occurs.  Generally, postoperative swelling begins to resolve at the end of the first week.  Bruising is extremely variable.  Patients that have a tendency to bruise will generally bruise for about 10 days.  Patients that don’t tend to bruise may have minimal if any bruising.  Complete resolution of bruising and swelling may take two to three weeks. However, bruises may be camouflaged fairly easily at seven to ten days with a concealer stick.

NECKLIFT PREOPERATIVE INSTRUCTIONS

14) Should I do anything before to prepare for surgery?
You will have a preoperative appointment with Dr. Lopez and his staff to go over the preoperative instructions.

15) Why do I need a preoperative appointment?
This is an essential appointment to prepare you for your upcoming surgery.  Dr. Lopez will take preoperative photographs at the visit as well as go over the procedure again to ensure that everyone is on the same page.  All questions that you have will be answered on that visit as well.  You will often times be given your prescriptions on the preoperative visit day.

16) What else can I do to do to prepare for surgery?
Dr. Lopez likes to have patients that have well controlled blood sugar to drink three eight ounce glasses of pineapple juice for at least one week before surgery.  Pineapple juice can help minimize the postoperative swelling. Patients that use tobacco will be asked to stop for six weeks before and six weeks following surgery. Tobacco has properties that impede wounds from healing.  Dr. Lopez will encourage tobacco users to not resume smoking at all after surgery; in fact many of his patients have used the surgery as their motivation to quit smoking.

17) What about my daily medications before surgery?
In general you will be allowed to take most of your daily medications.  Medications that thin the blood such as ibuprofen, vitamin E, and herbal supplements need to be stopped two weeks before surgery.   You can continue to take a multivitamin.  Aspirin needs to be stopped three weeks before surgery.  Dr. Lopez will provide a "Medication List" that reviews all medications and supplements to avoid prior to surgery.

18) Do I need any special prescriptions before surgery?
Dr. Lopez will generally give you a prescription for an antibiotic, a pain medicine, antibiotic ointment, as well as an anti-swelling medication. He also asks you to start taking Vitamin C 1 gram per day for 1 week before surgery to continue for 2 weeks after surgery.

NECKLIFT POSTOPERATIVE INSTRUCTIONS

19) What will I feel when I wake up from surgery?
Most patients report only mild to moderate discomfort associated with some tightness or pulling. This pulling sensation, most noticeable under the chin, subsides after about three weeks. Dr. Lopez will make sure you are not nauseated or queasy.

20) How will I look like when I wake up from surgery?
Following the procedure, you will have a soft head wrap around your head and under your chin. This helps minimize swelling. The head wrap will be removed in the office the following day. You may have some bruising, however, this typically is more pronounced 24-48 hours after the procedure.

21) How can I prevent bruising?
Most patents will have a little bruising. We can try to minimize bruising by using Arnica before and after the procedure. Arnica is a natural "herb" that helps prevent bruising.

22) How do I take care of the incisions?
The areas that are sutured will require some simple care.  Dr. Lopez asks that you use a Q-tip to cleanse the sutures with peroxide once a day and apply an antibiotic ointment three times a day to keep the sutures soft. In six to eight days, when the time arrives for suture removal, sutures that have been cared for will slide out easily.

23) When can I shower?
You can shower 48 hours after the surgery.  Make sure that you pat dry the incisions well after the shower and apply the antibiotic ointment.

24) What medications do I take following surgery?
Dr. Lopez will ask you to take the following medications starting the day of surgery:
  1- An antibiotic - generally Keflex for one week
  2- Pain medicine - Vicodin or Percocet to take as needed
  3- Antibiotic ointment- to place on the incision sites at least three times a day
  4- Antiswelling medication- for patients that are not diabetic a Medrol dosepak will be given
  5- Vitamin C 1 gram for 1 week before and two weeks following surgery to promote healing
  6- Arnica- place under the tongue three tabs three times a day before meals for two weeks.

25) When do I start taking these prescriptions?
Patients take their pain medication as needed. Begin taking vitamin C one week before surgery.  You can begin taking Arnica the day before surgery.  The antibiotic and swelling medications begin when you arrive home following surgery. Unless you are notified otherwise, resume all daily medications when you arrive home from surgery.

26) Are there any food to avoid following surgery?
No. Dr. Lopez encourages you to eat a well-balanced diet.  You may notice that saltier foods can cause you to swell for a longer period of time.

27) When is my first postoperative appointment?
You will be asked to see Dr. Lopez on the first day following necklift for removal of head wrap dressing. You will need someone to drive you to this appointment.

28) What about my regular daily activities?
Sleep with head of the bed elevated or use two to three pillows for one week.  Absolutely no bending, lifting or straining for two weeks. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap.

29) How can I minimize the swelling and bruising?
Most of Dr. Lopez’s patents will have a little bruising. He minimizes bruising by having patients stop all blood thinners well ahead of surgery as well as using Arnica before and after the procedure.  A good night’s sleep is vital to healthy healing.  Patients are also asked to sleep with their head at least at 45 degrees to minimize the swelling.

30) When will I look normal?
You will be presentable at two to three weeks. You will look great at six weeks and even better at six months as things settle and expressions become more natural. At three weeks you know you are well on the way to recovery and most patients resume routine activities around two to three weeks following surgery. Final results are evaluated at one year.

31) How often do I need to return for postoperative visits?
Dr. Lopez likes to see his patients 3, 6, and 12 months after the procedure to ensure that the healing is going as expected.