Dr. Nayak’s Deep Necklift is ideal for those candidates who have looseness and fullness in the neck area alone, with an overall good cheek and jawline contour. Patients who have very good skin elasticity are better candidates than those with significant crepey or loose skin. We used to call this procedure “incisionless” because the main incisions of a traditional necklift – around each ear – are eliminated. There is just one incision hidden in the crease behind the chin. Through this incision, Dr. Nayak reworks the deep muscle layers and fibrous tissue of the neck, which restores the neckline contour. Dr. Nayak also addresses the glands of the neck during a Deep Necklift. The reshaping of the deep foundation of the neck is the hallmark of this procedure. Because this procedure does not include the incisions around the ears that are performed during a mini lift, it does not address sagging of the lower portion of the face, such as looseness in the jawline or jowling.
It is a misconception that advanced age is the sole cause of an undefined neckline. Many patients have never had a defined neckline, even from an early age. In turn, patients in their 20s and 30s may be seeing the effects of aging of the neck sooner than their counterparts, yet their jawline contour is still defined. In general, patients ranging in age from 20-50, with little to no skin looseness and no jowling, who are non-smokers, in good health, and with a BMI of 33 or under, tend to be the best candidates.
The Deep Necklift is often performed in conjunction with buccal fat pad reduction for optimal rejuvenation. Some patients have a more full or round face, or what are referred to as “chipmunk cheeks”, in part from large buccal fat pads. This procedure is performed to help slim the cheeks and face. The buccal fat pads are walnut sized fat deposits deep in the cheeks, located just benind the corner of the mouth. The fat pad is accessed from inside the mouth through a small incision on each side. The pad is excised, and the incision is closed using dissolvable sutures.
Dr. Nayak performs the Deep Necklift procedures in his in-office, AAAHC-accredited operating suite, under fully monitored deep intravenous sedation. You will not be intubated with a breathing tube as with general anesthesia. A brain monitor is utilized to ensure your are sleepy enough to be comfortable and unaware of the procedure, but still breathe on your own. For patients who are not in optimal health and may require more observation or an overnight stay, surgery may need to be performed in a hospital or off-site surgical center, under general anesthesia.
THE CONSULTATIONLearn more about the consultation process
During your consultation for a Deep Necklift, Dr. Nayak will ask you to describe what bothers you about your neck, and may also ask you to talk about other related areas of your face, such as your skin tone, facial hollowing or cheek position. Dr. Nayak will likely ask you to point out, very specifically, what you’d like to see changed. Identifying exactly what needs to be addressed is the cornerstone of superior results.
Dr. Nayak will then review your medical history form, and may ask for some additional information from you. Current and past smoking habits, or the use of any nicotine products such as e-cigs, gum or patches are especially important to mention to Dr. Nayak during this part of the consultation as nicotine dramatically reduces the chances of proper healing. He will also pay special attention to parts of your medical history that need to be considered carefully when undertaking necklifting surgery, such as uncontrolled high blood pressure, bleeding disorders, or any medications or supplements you may take that thin the blood. Please be thorough in discussing these issues with him.
All over-the-counter pain/fever reducers (except Tylenol) are strictly off-limits for 2 weeks before and after surgery, including aspirin, ibuprofen, Aleve, and arthritis/pain medications. Additionally, supplements of any kind, including fish oil, flaxseed oil, vitamin E, ginkgo biloba, and St. John’s Wort are to be avoided. A complete list of medications and supplements to be avoided will be provided to you at your consultation, and also at your preoperative visit (see below).
THE PHYSICAL EXAMINATIONWhy is it important to see Dr. Nayak in person?
Dr. Nayak will then examine your neck to determine if you are a suitable candidate for this option, and to determine exactly what must be addressed to achieve optimum results. Some patients have more extensive aging changes or a tendency toward unpleasant skin wrinkling; these patients may require a laser procedure to address the texture of the skin. In addition, some may desire improvements of the eyelids, brows, chin, or earlobe areas to achieve balanced results. Dr. Nayak will take a few moments to discuss these options with you to make sure they meet your personal esthetic goals.
THE PREOPERATIVE VISITWhat to expect at your Pre-Op visit
Once you have decided to undergo a Deep Necklift, Dr. Nayak’s coordinators will help you schedule your surgical date, and give you the forms necessary to undergo any testing required to be completed before your preoperative visit. The preoperative visit will be scheduled 2 weeks preceding the surgical date. Expect to spend about an hour in the office on the day of your preoperative visit with our medical assistant. You will need to have an adult stay with you the night you return home after surgery; consider bringing this person with you to the preoperative visit. During this visit, you (and your helper, if present) will be educated on before and after instructions and copies will be sent home with you. You will also be given all of the prescriptions so that you may fill them well ahead of time. You will also be reminded to avoid any medications and supplements that thin the blood for 2 weeks before and after surgery.
Also at the preoperative visit, your preoperative photographs will be taken, the surgical consent form will be read to you, and you will have an opportunity to discuss any remaining questions. Finally, at the conclusion of this visit, the balance of your surgical fees will be due. Please come prepared to make your final payment.
THE SURGICAL VISITWhat happens on the day of surgery?
You will be asked to arrive at 7:00 AM on the morning of your planned surgery. If you are having your surgery at an outside facility, you may be asked to arrive earlier. The night before your procedure, you should have nothing to eat after 10pm, or drink (not even water, candy, coffee or gum) after midnight. If Dr. Nayak prescribed antibiotics, oral sedatives, or if you take blood pressure medication in the mornings, you should take these with a small sip of clear water. Do not take any diabetes or blood sugar lowering medications that morning.
You will need an able-bodied, capable, adult companion to take you home after surgery and stay with you overnight. Your companion may wait in our comfortable waiting area, watching TV, reading, and enjoying coffee, soda, and snacks. Alternatively, if your companion wishes to leave a mobile telephone number, we can call him or her at the conclusion of the procedure.
Upon your arrival, Dr. Nayak’s staff will greet you and review your medical history, looking for any new changes since your initial consultation. Dr. Nayak and his staff will also confirm that they and you are in agreement about which procedures are to be performed, and those areas will be marked with you sitting upright in a chair. If you are a woman under 50 and have not been surgically sterilized, a urine pregnancy test will be performed. In any case, you will have one last opportunity to have last-minute questions answered and use the restroom, and will be escorted to our AAAHC-accredited surgical suite.
Once there, you will be positioned comfortably on your back, with pillows behind your knees and under your neck. You will be covered with warm blankets for optimal comfort.
Painless blood pressure, and oxygen monitors will be placed on your arm, and finger, and massaging air-filled stockings will be placed on your legs and thighs to encourage excellent circulation while you are lying down. Most patients truly enjoy these stockings and find them very soothing. A brainwave monitor will also be applied, allowing Dr. Nayak to monitor your sedative state.
Dr. Nayak and his staff will then perform one final time-out aloud to ensure all details of surgery are correct and agreed upon among the providers. As the sedation takes effect, you will drift off to sleep and your neck will then be slowly, gently numbed with local anesthesia, and sterile towels will be placed around your face and neck.
Through the hidden incision under your chin, Dr. Nayak will resculpt the fat, muscle, and gland layers deep to the platysma to reveal your neck’s full potential. He will then tighten looseness of the platysma muscle. Once the deep reshaping has been accomplished, the incision skin is redraped, and the chin incision is meticulously closed. If appropriate, the “chipmunk cheek” buccal fullness will be removed from inside the mouth.
YOUR RECOVERYLearn more about the recovery process
At the conclusion of your procedure, Dr. Nayak will tell your companion how everything went, and he or she will have the opportunity to see you. You will be mildly bruised and swollen at this point. You will have two drains in place, one on either side of your neck. The drains help to greatly reduce the amount of bruising, although you will still have bruising as a result of the procedure. There will be no other dressings, wraps, or straps.
You will be asked to spend about one hour with us in recovery, prior to being discharged. Dr. Nayak will call you the evening of the procedure to check on your progress, and you will also be given Dr. Nayak’s personal cellular phone number in case questions should arise after hours or on the weekends.
YOUR RECOVERY – WEEK 1
Due to the use of long lasting injectable numbing medication, most patients feel tightness, and some feel slight discomfort after surgery. This medication can keep tissues numb for up to 24 hours. Many patients find they nap intermittently the first afternoon. Nausea is rare, as several measures are taken before, during, and after the surgery to prevent it. Patients typically need only Tylenol alone right from the start, although prescription pain pills are used by some for 2-4 days after the procedure, and then switch to Tylenol – all other over-the-counter pain preparations are off-limits.
On the day after surgery, we will see you for your first follow-up visit at Dr. Nayak’s office – you will need a driver for this appointment. You will enter via a private entrance, bypassing the reception area. Dr. Nayak will perform an exam to make sure you are healing properly. You should bring a scarf with you that day to wear home.
After 24 hours, you will be able to shower and get all sutures wet. You should refrain from exercise, heavy lifting, and prolonged periods of looking down for two weeks.
Your next checkups will be as follows: Day 5 (both drains are removed), day 7, and day 10. Dissolvable sutures will be removed on days 7 and 10.
Swelling typically peaks between days 3-5. By day 7, it is likely that you can wear makeup, if you wish, to cover any residual bruising. By 1 week, the majority of patients who do not bruise easily are back to their normal routines and are feeling like themselves. Patients who bruise easily may require another week for some of the bruising to lessen, those patients should plan closer to 2 weeks before returning to normal social activity.
YOUR RECOVERY – LONG TERM
Over the ensuing weeks and months, you will find that your incision line, hidden behind your chin, will become less and less noticeable. Generally, it is pink in the beginning stages of healing, but is easily covered with regular makeup. By 3-4 months, the pinkness is mostly gone, and the incision is fading out.
While the longevity of results depends on lifestyle, genetics, and ongoing skin care and sun protection, Deep Necklifts are quite durable. As the aging process continues, patients may desire treatment in other areas of the face, such as the cheeks, eyes, or jowls. These areas are best address through other types of procedures. The area under the chin, however, is unlikely to need deep reshaping ever again.