Plastic Surgery
Facelift With Neck Lift: When Do You Need Both?
Published · Haute MD Editorial Team
You are most likely to be advised to have a facelift and a neck lift together when aging shows in both zones at once: sagging cheeks, deeper folds, and jowls along the jawline, plus loose neck skin, fullness under the chin, or visible neck bands. The American Society of Plastic Surgeons (ASPS) describes a facelift (rhytidectomy) as improving visible signs of aging "in the face and neck," and a neck lift (lower rhytidectomy) as improving the "jawline and neck." The two overlap at the jawline, which is why surgeons often treat the lower face and neck in one operation. If your midface and jawline still look the way you want but your neck does not, ASPS notes that a neck lift alone "may be a good solution." Neither surgery changes your fundamental appearance or stops aging. Only an in-person exam by a qualified surgeon can tell you which you need. This is general information, not medical advice.
At a glance
Jowls, cheek sagging, and deeper nose-to-mouth folds together with loose neck skin, under-chin fullness, or neck bands: a facelift with neck lift is often discussed, usually as one combined operation, because both the lower face and neck show laxity. Neck skin laxity, under-chin fat, or muscle banding with an upper and midface you are still happy with: a neck lift alone may be enough, per ASPS. Midface and jowl sagging with a neck you are happy with: a facelift — ask how much neck work the planned technique includes. Mild under-chin fat, early laxity, or neck bands only: ASPS describes non-surgical options such as Kybella, Botox for bands, and laser for texture, which cannot match surgery but may delay or complement it. Fine lines, texture, pigmentation, brows, or eyelids: other procedures (skin treatments, brow lift, eyelid surgery) that ASPS lists as done in conjunction with — not replaced by — a facelift or neck lift.
What each procedure targets (ASPS)
Facelift (rhytidectomy): ASPS lists relaxation of facial skin causing sagging; deepening of the fold lines between the nose and corner of the mouth; facial fat that has fallen or disappeared; jowls in the cheeks and jaw; and loose skin and excess fat of the neck that can appear as a double chin or "turkey neck." Neck lift (lower rhytidectomy): ASPS lists excess fat and skin relaxation in the lower face that creates jowls; excess fatty deposits under the chin; loose neck skin; and muscle banding in the neck that creates abnormal contours. The lists overlap on purpose. Jowls and neck laxity sit on either side of the jawline, so a surgeon planning one area usually evaluates the other.
Signs you may need both
Ask a surgeon about a combined plan if several of these apply at the same time: jowls that break the line of the jaw; cheek descent and deeper nasolabial folds; laxity or crepey, excess neck skin rather than fat alone; a fuller area under the chin or loss of a defined chin-neck angle; and visible vertical neck bands (platysmal banding). Treating only one zone when both have aged may leave a mismatch — a lifted jawline above a loose neck, or a tightened neck below heavy jowls — which is why surgeons evaluate the face and neck together.
When one procedure may be enough
Neck lift alone: ASPS says some people "feel they are not ready for a full facelift because the upper face is still pleasing," yet notice neck wrinkling, a double chin or "turkey wattle," and jowl lines; in that case a neck lift may be a good solution. Facelift alone: if the jawline and cheeks are the issue and your neck looks right to you, a facelift may be enough — ask how much neck work the planned technique already includes, since that varies by surgeon and method. Neither, for now: for mild concerns, ASPS describes non-surgical options for the neck — Botox for vertical bands, fractionated laser for skin texture, dermal fillers for volume, and Kybella for fat under the chin. ASPS says these "cannot achieve the same results" as surgery but may delay when surgery becomes appropriate and can complement it later.
Combining them in one operation: what to ask
Facelift and neck-lift work can be performed in the same operation. Whether that suits you depends on your health, the extent of work planned, and your surgeon's approach. Ask: What exactly will be done to the face, the jawline, and the neck (skin, fat, muscle)? Is this one combined procedure or two? Does the facelift technique you recommend already include neck work? How does adding neck work change the length of surgery, the anesthesia plan, and where it is performed? Where will the incisions be? What recovery should I plan for with the neck component, and what follow-up visits are needed? Which risks change when the procedures are combined? Am I a good candidate today? (ASPS lists healthy individuals without conditions that impair healing, nonsmokers, and people with realistic expectations.) May I see before-and-after photos of your patients who had both?
Risks to discuss
ASPS lists these risks for facelift and neck lift: anesthesia risks, bleeding, fluid accumulation (hematoma), infection, numbness or skin-sensation changes, persistent pain, poor wound healing or skin loss, prolonged swelling, skin irregularities and discoloration, sutures surfacing, hair loss at incisions, unfavorable scarring, asymmetry or unsatisfactory results that may need revision, nerve injury (facial-nerve weakness for facelift; rare lower-lip weakness for neck lift), and rare deep vein thrombosis with cardiac or pulmonary complications. Discuss each with a board-certified surgeon.
Find a facial plastic surgeon
Start with Find a Doctor and the plastic surgery listings. Dr. Gene K. Lee is a board-certified plastic and reconstructive surgeon and founder of LA MÔEM Plastic Surgery in Beverly Hills; his profile lists facelift among the practice's facial procedures. Dr. Sam Rizk is a double board-certified facial plastic surgeon and director of Manhattan Facial Plastic Surgery on Park Avenue, New York; his profile lists facelift (including deep plane facelift) and neck lift procedures. Ask any surgeon how they decide between a facelift, a neck lift, or both for your anatomy.
Sources
American Society of Plastic Surgeons — "Facelift Surgery" (https://www.plasticsurgery.org/cosmetic-procedures/facelift). ASPS — "Neck Lift" (https://www.plasticsurgery.org/cosmetic-procedures/neck-lift). ASPS — facelift and neck lift candidates (https://www.plasticsurgery.org/cosmetic-procedures/facelift/candidates; https://www.plasticsurgery.org/cosmetic-procedures/neck-lift/candidates). ASPS — facelift and neck lift risks and safety (https://www.plasticsurgery.org/cosmetic-procedures/facelift/safety; https://www.plasticsurgery.org/cosmetic-procedures/neck-lift/safety). This information is general education, not medical advice, and does not create a doctor–patient relationship.
Frequently Asked Questions
Do I need a facelift and a neck lift, or just one?
It depends on where aging shows. Jowls and midface sagging plus loose neck skin, under-chin fullness, or bands usually point to a combined procedure. A neck-only concern with a face you are happy with may need only a neck lift (ASPS).
Does a facelift include the neck?
Often partly. ASPS lists loose neck skin and neck fat among the things a facelift improves. How much neck work is included depends on the technique, so ask whether a separate neck component is planned.
What is the difference between a neck lift and a lower facelift?
ASPS calls a neck lift a "lower rhytidectomy" focused on the jawline and neck. A facelift addresses the lower and midface as well. The terms overlap at the jawline, which is why the two are often performed together.
Can a neck lift be done without a facelift?
Yes. ASPS describes a neck lift as a possible solution when the neck doesn't match an upper face the patient is still happy with.
Are there non-surgical alternatives?
For mild concerns, ASPS lists Botox for neck bands, fractionated laser for texture, fillers for volume, and Kybella for under-chin fat. These can't match surgical results but may delay surgery or complement it.
Is it safer to do both at once or separately?
There is no single answer. Combining means one operation and one recovery period, but more surgical work in a single sitting. Discuss anesthesia, operating time, your health history, and the risk list with a board-certified surgeon.
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