An internationally-known double-board certified facial plastic surgeon, Dr. P. Daniel Ward has addressed the aesthetic concerns of thousands of patients helping them restore and improve their self-confidence and self-esteem. Distinguished by attention to detail, a down-to-Earth approach, and a passion for his work, Dr. Ward is recognized as a top facial plastic surgeon around the world. Dr. Ward’s extensive educational credentials include a five-year residency in Otolaryngology-Head & Neck Surgery followed by completion of a Facial Plastic Surgery Fellowship. Haute Beauty chats with Dr. Ward to discuss the combo procedure, face and neck lifts, to create a more rejuvenated appearance.

Photo Credit: ShutterstockHaute Beauty: What is the primary difference between a face and neck lift? What does a facelift accomplish that a neck lift does not, and vice versa?

There is an old saying in facial plastic surgery that the best neck lift is a facelift. These two procedures have quite a bit of overlap. This overlap arises from the fact that, anatomically, they are related and there are some similar anatomic structures that are part of each.

As we age and as gravity exerts its downward pull on the face, the facial tissues descend downward and they meet in the area just under the face— the neck. The accumulation of tissue in this area is one of the most common complaints that patients have about aging.

In addition, the major structure related to aging in the neck, the platysma muscle, is anatomically analogous to the major structure related to aging in the face, the SMAS (Superficial Muscular Aponeurotic System). These two structures are the key to contemporary solutions to addressing both the neck and the face. Simply lifting the skin without addressing these two areas leads to inadequate results.

We can certainly lift the neck, but often lifting the neck without lifting the face leads to an odd appearance where the neck is lifted and refined, but the face does not match the neck.

HB: Do you have patients whose goals meet the criteria for one procedure versus the other, or do you recommend that the two be done in tandem? If not, which would you recommend over the other?

I almost always recommend that they be performed together. Doing one without the other almost always leads to an odd appearance. There are exceptions, of course. One example would be the patient who simply needs the neck addressed due to an underlying anatomic issue, such as fullness in this area from adipose tissue or muscle structure issues. This patient may benefit from a deep neck lift by itself. The other exception would be a patient who is concerned about jowl formation, but who does not have any sagging into the neck yet. This patient would benefit from a lift that addresses just the face.

Photo Credit: ShutterstockHB: Do either face or neck lifts change features on the face or surrounding area, in other words, how can patients expect their appearance to change with either procedure?

If done properly, in my opinion, other structures of the face should not be affected. In cases where other anatomic structures are affected, this could be due to an attempt to overtighten the face. I tell all of my patients that I want to get their faces just right. However, if I am going to, I’m going to go on less tightening. I can always tighten more, but releasing some of the signs of over-tightening can be impossible.

HB: Are both the facelift and the neck lift procedures to combat aging? Who is the primary demographic for both procedures?

Historically, both of these procedures have been thought of as anti-aging treatments. However, there is an increasing recognition that these procedures actually change the underlying structure of the face. For example, someone who has always had fullness in the area under the chin, especially if this is not due to the simple fluctuation of weight, can have this area reconstructed to a more pleasing appearance with a facelift and neck lift. Likewise, a patient with a full, round face, may benefit from a facelift as a way to in a more pleasing way and to deemphasize the full, round face.

HB: Do you perform one surgical procedure much more frequently than the other?

I almost always perform them in conjunction with each other with about equal frequency. However, patients come in for consultations more frequently with concerns about their necks. As we discuss their concerns with them, they are also typically frequently bothered by the jawline and the lack of definition of the jawline. By performing the facelift and the neck lift, we are able to rejuvenate both the face and the neck to create a more rejuvenated appearance.

HB: Have you seen an increased demand for one versus the other in the past several years? If so, why do you think that is? Is one technology and/or technique more advantageous and advanced than the other?

There has been increased demand for both procedures over the past several years. There are more patients who are seeking to undergo rejuvenation at a younger age. Many of these patients have tried fillers in the past and want more improvement than what can be achieved with filler injections. Many others have looked into the procedure due to a desire for a less dramatic change after the surgery. They would rather do a facelift at 45 and have a subtle improvement in appearance rather than wait until they are 55 or 60 and have a dramatic change in appearance.

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