Face & Neck Lift

Face & Neck Lift — Surgical Case Study

Overview

This case describes the surgical management of age-related change in the lower face and neck in a woman in her early 70s, who presented with lower facial descent, midface volume loss, and an undefined neck contour, together with anterior cervical scarring from a neck lift performed more than two decades earlier. Her prior surgery, combined with the degree of anatomical change, called for a carefully considered operative plan.

The patient had been dissatisfied with the outcome of her original neck lift, and was particularly concerned about the residual anterior neck scarring, ongoing skin laxity, and the absence of a defined cervicomental angle. The areas she wished to address were the contour of the jawline, the platysmal banding through the neck, and the residual skin excess.

Preoperative assessment & clinical findings

Detailed clinical evaluation identified the following features:

Lower face & jawline

• Jowling bilaterally with reduced jawline definition, reflecting descent of the lower facial SMAS and overlying soft tissues
• Loss of the mandibular border contour with blending of the jowl into the upper neck
• Generalised lower facial skin laxity with reduced skin elasticity consistent with the patient’s age

Midface

• Midface volume deficiency with flattening of the malar eminences
• Reduced anterior projection of the cheek
• Midface volume loss, with relative fullness lower in the face by contrast

Neck & cervical region

• Platysma dehiscence — separation of the paired platysma muscle bands in the midline — producing visible anterior neck banding at rest
• Anterior neck skin excess with surface redundancy and sagging below the mandible
• Obtuse cervicomental angle with loss of the submental definition
• Anterior cervical scarring from prior neck lift surgery performed more than 20 years previously; the patient was specifically dissatisfied with the appearance of these scars
• No clinically significant deep neck fat excess requiring reduction

Operative plan & surgical decision-making

The surgical plan was designed to address each component of facial and cervical ageing in a layered, anatomically precise fashion. Given the patient’s prior neck surgery, particular care was taken in planning the cervical dissection to account for potential anatomical distortion from previous scarring.

The absence of significant deep cervical fat accumulation meant that deep neck fat reduction was not indicated; the operative focus was directed instead toward muscular recontouring, skin re-draping, and vector optimisation.

Procedure performed

Face lift — SMAS plication

A SMAS plication facelift technique was performed bilaterally. The superficial muscular aponeurotic system was plicated to reposition descended facial soft tissues, support the line of the jawline, and address jowling, with an appropriate vector of lift.

In patients over 70, particularly those with facial soft tissue atrophy, the SMAS becomes progressively thinner and less robust with age. Flap elevation in this setting carries a meaningful risk of inadvertent buttonholing or tearing of the SMAS, which compromises the structural integrity of the layer and the hold of suspension sutures placed into attenuated tissue. SMAS plication — imbrication of the SMAS in situ without flap elevation — avoids this risk. By suturing the SMAS upon itself, the technique recruits the full thickness of available tissue at the suture points and avoids the dissection plane where injury is most likely in thin or atrophic patients. The modest reduction in tissue mobilisation compared with a high-SMAS or composite flap approach is offset by the reduced risk profile in this demographic. In this patient — a woman in her early 70s with facial soft tissue atrophy consistent with her age — SMAS plication was the deliberate operative choice.

Neck lift — deep plane technique

A deep plane neck lift was performed, allowing release and repositioning of the deeper cervical soft tissue structures. This technique, combined with careful management of the previously scarred anterior neck, enabled comprehensive recontouring of the cervical region without relying solely on skin tension for the result.

Platysma plication — central

The dehisced platysma bands were identified and re-approximated in the midline using central platysma plication. This step directly addressed the visible anterior neck banding and restored muscular continuity, creating a defined midline neck contour.

Hyoid fixation

Hyoid fixation was performed to anchor the cervicomental soft tissues in their corrected position, supporting the definition of the cervicomental angle and reducing the risk of inferior descent of the corrected tissues over time. This technical step was central to achieving and maintaining the 90-degree cervicomental contour.

Mastoid crevasse fixation — lateral

Lateral suspension was achieved through mastoid crevasse fixation, providing durable anchoring of the repositioned lateral neck and lower facial tissues to the mastoid periosteum. This contributed to the maintained definition of the jawline and the overall vector of the neck result.

Fat grafting — malar regions

Structural fat grafting was performed to both malar regions to address midface volume deficiency. Fat was harvested, processed by micronisation to 1,200 rpm, and 4 cc was grafted to each side. Micronised grafting technique facilitates more homogeneous distribution and optimises graft take, contributing to volume restoration in the cheek.

Brow lift

A brow lift was not performed, as the patient’s brow position and upper facial aesthetics did not indicate intervention at this stage.

Results — 6 weeks postoperative

At six weeks postoperatively, change was visible across the targeted areas. It is important to note that facial surgical results continue to settle beyond this early timepoint as swelling resolves and tissues mature.

• Repositioning of the lower facial soft tissues, with the swelling of the early postoperative period still present
• Increased midface fullness from the malar fat grafting, with restored cheek projection
• A more continuous jawline, with resolution of jowling and a defined mandibular border contour
• Anterior neck without the previously visible platysmal banding
• The cervical skin has re-draped without residual excess, bunching or fold formation
• A defined cervicomental angle between the submentum and anterior neck

No deep neck fat reduction was required and none was performed; the neck contour result was achieved through muscular recontouring, suspension, and skin re-draping alone. The anterior cervical scarring from the prior neck lift has been incorporated into the revised surgical approach and is continuing to mature.

Recovery

Recovery from combined face and neck lift surgery follows a general pattern, though it varies between individuals:

• Swelling and bruising are expected through the first one to two weeks and settle gradually over the weeks that follow. At six weeks — the timepoint shown below — some swelling is still present and the contour continues to settle.
• Most people take around two to three weeks away from work and social commitments.
• Strenuous activity and exercise are avoided for at least six weeks.
• Sutures are removed in stages across the early follow-up appointments.
• The final result continues to mature over several months.

A GP referral is recommended before a surgical consultation, and a cooling-off period applies before proceeding with cosmetic surgery. All surgery carries risk; full information on the risks of surgery and recovery is available here, and a second opinion from an appropriately qualified health practitioner is encouraged.

Photographic comparison

Standardised clinical photography: preoperative and 6 weeks postoperative.

Pre-operative & 6-weeks post-operative. Additional views (oblique, lateral, submental) available on request.

Surgical technique summary

AHPRA Compliance Notice: This case study is intended for general information purposes only. Individual outcomes vary, as the result experienced by one person does not necessarily reflect the result another person may experience. All surgical procedures carry risks and require a recovery period. Results shown are specific to this patient and cannot be guaranteed for others. Surgery should only be considered after thorough consultation with an appropriately qualified Specialist Plastic Surgeon, and a second opinion is encouraged. Full information on the risks of surgery and recovery is available on our risks of surgery page. This content does not constitute medical advice.

Dr David Sparks — Specialist Plastic Surgeon | FRACS (Plast.) | MED0001863770 | The Coastal Clinic, Southport QLD | Fraser-Kirk Plastic Surgery, Sunshine Coast QLD