Muscle Descent

A Necklift addresses the jaw line

Although excess fat under the jaw line can be most easily removed by liposuction, when the skin is sagging in folds and a “turkey wattle” has formed, the surgical requirements are greater.

When there is a substantial degree of dependent and folded skin, this will involve not only the neck but also the face, and is most probably going to be treated by a full face lift, undermining the tissues of the face through an incision made around the ear, then drawing up and back the liberated skin to remove the wrinkles, excising the excess at the upper margin, and closing the wound at the ear.

Face lift is a unique procedure

There is no “one procedure fits all,” it’s not like an appendectomy where a set piece of the body is removed. Face lift, a rhytidectomy on a large scale, is a balance between minimising the surgical interference and maximising the alteration: a reconstruction of the facial skin. As such, it is on every occasion an agreement between what the patient would like to have changed and how the surgeon thinks it can best be carried out.

In principle, the incision is made far back in the face, anterior (sometimes only, or also posterior) to the ear, and the facial skin tissues are lifted from the deeper tissues by undermining them. When the skin and subcutaneous tissues have been lifted as a unit, necessary tightening up (plication) of the muscular aponeurosis is performed as the surgeon considers indicated. The freed skin of the face is then drawn back and up to the incision line, and the newly defined excess quantity is trimmed off.

Under the combined effects of weight gain and age, every component of our body seems to slide downwards, the forehead slides down, the cheeks fall, the breasts droop and the stomach hangs.

By no means alone in this problem are the muscles, in particular at the face, Occipito-frontalis at the forehead and Platysma at the mid and lower face. The former causes the upper eyelids to droop, the latter drags on the skin to which it is attached and is in part the cause of the falling and wrinkling of the skin of the face.

There are three changes in the aging face: facial descent, deflation, and radial expansion. Descent is the downward displacement of the facial soft tissues; deflation is the loss of facial fat; radial expansion is the loosening of some of the facial tissue.

The platysma muscle extends from the lower face down the entire neck. In the lower face, its descent creates the jowl. In the neck, the descent of platysma causes the bands that appear in the front of the neck, framing the trachea.

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