Facelift Review: Why the Neck Lift Technique Matters

Hello.

A doctor who teaches doctors

I am Yu Young-gi, a board-certified plastic surgeon.

This is what I looked like a year ago when I was giving a live surgery lecture

showing doctors a facelift procedure in real time.

When I perform a facelift,

I use the deep plane of the SMAS layer

that is, an advanced technique that approaches through the deeper layer.

Building on that, I also use what is called an "extended deep plane,"

literally an "expanded deep plane" technique.

It is a highly difficult technique, but the results are on another level.

In addition, when making an incision to enter the deeper layer of the SMAS,

rather than deciding the incision line based on the protruding bony landmarks, which is the common method,

I use each patient's unique anatomical features as they are,

so that when lifting the SMAS layer,

it fits the skin incision like puzzle pieces,

naturally

and automatically fills in the 부족한 volume as well.

That was the lecture in which I showed and taught part of that technique.

For many reasons,

such as

too severe neck wrinkles,

too much sagging under the chin,

sagging submental fat,

loose neck skin,

very severe vertical wrinkles,

and so on,

many people have probably tried submental liposuction.

Many have also had thread lifting in the double-chin area.

Even if you have tried various other procedures or surgeries,

if you still cannot really tell that there was much difference before and after,

this article may be relevant to your situation.

I hope it helps.

Today's facelift review case is someone with overall very severe sagging.

Not only was the face sagging,

but the neck sagging was especially severe.

The eyebrows were also drooping badly..

Let's look at the preoperative appearance.

First, the front view.

The under-eye fat, a symbol of aging, is bulging outward.

Directly below that protruding fat is a deep groove that has sunken in.

This is called the tear trough.

The nasolabial folds and the marionette lines below them are both quite pronounced.

Both cheeks are significantly sagging.

Several layers of vertical wrinkles have formed on the neck.

Let's look at the 45-degree view.

The jowl area is sagging a lot,

so the marionette line wrinkles appear even deeper.

Also, the boundary between the face and the neck is not clear.

When I asked what the bump on the outer side of the forehead was,

she said it seemed to have appeared after hitting something a long time ago,

and since it had been there for a long time and was not bothering her much,

we decided to leave it as is.

Next is the 90-degree side view.

From the side, the boundary between the face and the neck is even less distinct.

In particular, the sagging in the middle of the neck is severe.

In fact, it is at an extremely difficult level that is rarely seen.

To address this kind of neck sagging, many patients ask the first question:

Can this improve with liposuction?

A hospital I consulted said liposuction would solve it.

My answer is always the same...

Liposuction alone will not make much of a difference before and after.

After hearing my answer, the next question is always similar.

Then what about double-chin muscle plication? I heard that would fix it.

And then they show me a screenshot of an ad they saw somewhere.

They recently visited this clinic for a consultation...

Most of the before-and-after ad photos they show are very dramatic changes.

At that point, I ask a question.

Where did they say the incision would be made, and how large would it be?

Most of the answers I heard at that point were that it would be about 0.5 cm or less,

with the incision made in the middle of the double chin.

But with an incision that small,

it is impossible to secure a field of view and perform platysma plication.

I can say this with certainty.

It is impossible.

When I harvest autologous rib cartilage for nasal surgery, I make a minimal incision of 1.1 cm.

(General incision length is 2.5 cm to 5 cm.)

For men who weigh a lot or have a large rib cage,

it may extend to about 1.5 cm at most in exceptional cases.

When performing a minimally invasive mini facelift, I make an incision of about 2.0 cm.

If the sagging is severe and the incision line needs to be longer,

it may extend to 2.5 to 3.0 cm,

but the standard is 2.0 cm.

Even though I usually aim to keep incision lines short,

when doing double-chin contouring,

I make an incision of at least 2.5 cm.

Only with that much incision can I secure a proper view.

(For reference, the incision is placed along the crease line that appears exactly when you lower your head, so it is not very noticeable.)

Of course, if the sagging is not severe,

there are cases where I do not do double-chin contouring but only double-chin muscle plication.

In such cases, the incision is about 1.5 cm.

For reference, what I am calling

double-chin contouring vs. double-chin muscle plication

are surgeries on completely different levels.

Anyway, if you only do simple double-chin muscle plication,

it will be hard to see the dramatic change shown in ads.

In the early stage after surgery, it may be possible temporarily,

but that can also be achieved by inserting mint threads alone.

However, with muscle plication alone, it will not last long,

and the effect will greatly diminish.

The platysma muscle, which is the target of simple muscle plication,

is a very, very fragile structure.

No matter how tightly you try to tie it,

if it is too tight, it can easily tear.

To transform the double chin into an ideal shape,

several combined methods must be used appropriately.

Fat that lies deeper than the platysma muscle

should be removed if needed.

The important point is that, as shown in the illustration below,

the usual liposuction method can only remove fat in the outer layer,

not fat deeper than the platysma.

The only way to safely remove fat from the deep layer

is to make an incision of at least about 2.5 cm,

secure a view, and carefully dissect it.

The usual liposuction method of scraping out fat with a cannula,

or the method of melting it with ultrasound and removing it,

cannot safely pass through that layer without an incision in the platysma,

so access itself is impossible.

And securing a clear view is important because

there are many blood vessels in that space.

You need to carefully avoid them and remove the sticky clumps of fat,

which are attached like a bunch of grapes,

while looking directly at them.

Another very important point in double-chin contouring is this:

If the submandibular gland has descended to a position lower than the hyoid bone,

it also needs partial resection.

This partial resection of the gland actually takes some time during surgery,

and people often say the learning curve is long even for those who are learning it. It is truly a part that requires highly advanced technique.

If this gland is not removed,

there can be a side effect where the sides of the neck bulge outward, making it look like a cobra neck.

In such cases, it should of course be removed.

Since the gland removed in this process is, in a sense, minor in size,

there has never been a case so far where removing a little caused a side effect.

The most important and largest salivary gland is located in front of the ear.

Even so, if a small amount is removed, saliva could theoretically dry up a little,

but no one has ever complained of such symptoms.

And the role of the digastric muscle is not that important,

but if the double chin bulges because of hypertrophy of this muscle,

I also smooth it down a bit.

And to share one tip that goes against many people's common sense:

I said earlier that the outer-side fat of the platysma, shown in the illustration, can be removed with liposuction.

Unless the patient is severely obese,

I almost never remove the outer-layer fat.

Usually, the reason for removing that fat is to more easily create the desired shape

(the only advantage is that the procedure is easier)

but surprisingly, or perhaps not surprisingly,

it is possible to get better results without removing that fat at all.

A dramatic change in the jawline does not mainly come from removing the outer-side fat of the platysma.

In fact, removal causes too many side effects.

Among them, the side effect of lumpiness is almost impossible to reconstruct later.

Returning to the main point,

I explained the realistic goals several times during the consultation with this patient.

For example:

The nasolabial folds will not disappear.

They will become lighter.

The established Indian lines will not disappear either.

They will become a little lighter.

The marionette lines will also not disappear.

However, as the deep grooves become shallower,

the shadows will be reduced.

The under-eye fat will become flatter.

However, the deep tear trough just below the protruding fat

will not disappear completely.

It is a lie to promise that it can be made completely flat.

Still, once the deep groove becomes a shallow groove

and becomes somewhat flatter,

the dark shadow will no longer form,

so it will look much brighter.

The jawline will likely improve a lot.

But among neck wrinkles, horizontal wrinkles are very difficult to remove.

Vertical wrinkles, however, will improve a lot.

and so on.

I kept checking whether she understood the realistic options for improvement

and explained them repeatedly.

I told her that if she thought the level of improvement I explained would be enough to satisfy her,

I would recommend surgery,

but if she thought her satisfaction would fall short based on the honest limitations I mentioned,

then she should not decide on surgery right away,

but take time to think carefully

and visit several other hospitals for consultations as well.

The patient definitely wanted the surgery,

but her business was so busy that it was hard to schedule.

Then we finally scheduled the day she was available and proceeded with surgery.

The following surgeries were all performed at once.

• Facelift (full face)

• Neck lift

• Double-chin contouring

• Lower blepharoplasty

• Endoscopic forehead lift

After the necessary immediate postoperative care was completed,

she returned to Thailand right away because of her business,

but when I visited Thailand for a lecture,

the timing worked out and I was able to check her progress. :)

Around the third week, she contacted the clinic worried that something hard could be felt in the neck,

so I intentionally scheduled a follow-up in the middle of my Thailand trip,

and fortunately, by the time I examined her,

the discomfort had already disappeared.^^

I was grateful that she kindly allowed me to post all of her before-and-after photos online freely,

and after we laughed and had a brief, friendly conversation, I came back. :)

Facelift review, 5 weeks after surgery.

Comparison photos before and after facelift, neck lift, and forehead lift.

With full-face facelift surgery, the midface, lower face, and jawline are lifted.

A neck lift improves vertical wrinkles and removes loose neck skin.

I explained double-chin contouring earlier in the article.

Lower blepharoplasty repositioned the fat under the eyes and partially removed loose skin.

The endoscopic forehead lift returned the drooping eyebrows to their original position from 30 years ago,

increasing the distance between the eyes and eyebrows, which had been narrow.

Usually, because of residual swelling, the effects are still somewhat limited at 5 weeks,

but by around 3 months the appearance is different,

and by 6 months it becomes even more natural,

often leading to an even better-looking change. haha

Next, I plan to cover a few facelift reviews of patients who had facelifts at another hospital

but were dissatisfied with the results and underwent revision surgery at our clinic.

Finally, one thing I want to ask you to keep in mind:

when you consult for plastic surgery,

if someone guarantees that just by having surgery,

it will "definitely work well" for the look the patient wants,

that "everything will definitely work out,"

that "all wrinkles will be completely smoothed out,"

and that "the tear trough will be completely smoothed out,"

please think more carefully and decide with caution.

There is no perfect result in the world.

Click the image below for Plus Friend chat inquiries

Roy Plastic Surgery Clinic (Line 3, Sinsa Station)

Main phone: 02-516-5525

Weekdays 10:00 ~ 19:00

Saturday 10:00 ~ 16:00

Roy Plastic Surgery complies with medical law.

The photos in this post were taken under the same conditions,

and are images captured with the patient's prior consent.

In addition, after plastic surgery or procedures, side effects such as bleeding, infection, and inflammation may occur depending on the individual, so caution is required.

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