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.
The elevation of tissues, elimination of excess, can in less advanced cases be performed directly on the neck. Excess fat is removed by liposuction, through a transverse incision in a fold, the skin of the front of the neck is undermined to expose the Platysma muscles; these are dissected free from surrounding tissues and then firmly sutured together, tightening up the anterior aspect of the neck, a platysmoplasty.
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.
Not infrequently, a combination of all procedures is called for: liposuction, platysmoplasty and face lift or rhytidectomy.