Expert Doctor

Neck Contouring

Pablo Prichard, MD

Scottsdale, AZ

Neck Contouring

Neck contouring is a procedure that gives a smoother and firmer appearance to the patient’s neck and chin as well as a younger look by eliminating loose skin and fat. It can also provide a more defined jawline to help restore balance to the face.

There are many different types of neck contouring procedures. In general, the surgeon is looking for problem areas such as loose skin, excess fat, and sagging muscles. When patients think of their neck, they picture the neck and jawline together. Patients like to see a smooth jawline without any kind of jowling or break. With a stronger and more defined jawline, the facial features that frame the face look more youthful.  Anyone that has loose skin or a turkey wobble can have these problems addressed by neck contouring.



There are a variety of methods used to remove fat. If there is tight skin in the area but too much fat like a double chin, liposuction, Kybella, CoolSculpting, or UltraShape are great options to get rid of the fat. As long as there is no loose skin or muscle, everything will contour nicely.



If there is loose skin in the area and the doctor does liposuction or a fat loss procedure, it will actually worsen the contour because the loose skin is now deflated and even looser. At that point, the patient needs some kind of tightening procedure. A neck lift is the gold standard but it is also a surgically invasive choice. It tightens the muscles of the neck and can also tighten the salivary glands if need be. Sometimes the glands will be taken out if they are really loose. The doctor will tighten the skin at the same time and all those things can be done surgically.



If a patient does not need much tightness, nonsurgical approaches like Ulthera can tighten the skin and the muscle of the neck area. The results will not be as impressive as surgical results, but if less lift is needed, then it is a viable option. An alternative approach depends on the degree to which  muscle and skin are sagging or the shape of the neck.

The decision to use a surgical or non-surgical approach depends on the looseness of skin as well as the muscle. Options like Ulthera actually tighten the muscle. The best procedures tend to tighten the deep structures. Someone who has experienced a large weight gain or weight loss usually has skin falling because they have stretched the skin out and it fell as they lost the weight. In that case, to fix the skin only, a facelift that is a skin only facelift as opposed to a full facelift would be able to fix the problem. If, however, the facial and neck muscles are stretched, a full facelift elevates the muscle that was  pulled down from weight gain. Doing a skin only procedure on a patient who also has a muscle issue is not going to make a big difference because the skin is very flexible. Pulling the skin up without correcting the underlying muscle problem is a waste of time; the muscle is going to pull the skin back down in a very short period of time.



A platysmaplasty is when the platysma muscle that is located in the neck is lifted. The platysma is the broad band of muscle that goes from the chin to the clavicle area. Straining the neck accentuates that muscle in the neck and it sags over time by gravity and weakness in the muscle. By lifting the platysma, the skin will contour to the lifted muscle.



Some patients can have strong tissue that has simply fallen.  A surgeon can fix this with tightening. This tissue will withstand the tightening more than weak and fragile tissue. Some limitations come from the experience of the surgeon doing the procedure while other limitations come from the tissue that the surgeon is working with.



The strength of the neck tissue is related to the health of the patient. Someone who has had diabetes or has smoked for many years tends to not have strong tissue. There are also certain genetic problems where the tissue is too stretchy and may affect the outcome of neck contouring. There are patient-specific issues that need to be addressed in a consultation to identify how good a candidate the patient is for this procedure. Also, age and lack of hormones such as growth hormone and testosterone have negative effects on the tissue strength.



Being a smoker or having diabetes is a big risk for any type of neck lift or facelift procedure. When the surgeon is elevating and dissecting the different tissue planes, all of the tissue planes are separated so they can be tightened individually in an actual neck lift or facelift. Patients who have diabetes or are long term smokers have a reduced blood flow to the tissue. That makes the tissues weaker and more likely for that tissue to die after it has been elevated and separated from these components.

Doing a surgical neck lift causes an immediate loss of sensation in the neck but the sensation loss is temporary. Within six months to a year, the patient has almost normal sensation again.

The more dangerous nerve damage is related to muscle function. If there is a nerve cut or damage during the procedure, other things can be affected like the smile. One side of the smile can move more than the other and that will be a noticeable change. The facial nerve goes from behind the ear and around the earlobe and then stretches into five branches. If any branch is damaged, it affects the muscle that goes to that branch. Affecting the nerve close to the main trunk before it branches can paralyze an entire side of the face. The damage to the nerves can be permanent. If the nerve was simply stretched out, it usually returns to normal but a nerve cut during the procedure is a permanent issue.



Nonsurgical procedures like Ulthera, CoolSculpting and UltraShape really have no downtime. There might be some swelling for a week.

Recovery from a neck lift is more extensive because a neck lift separates the layers from each other. The patient will need to wear a facial compression garment that goes from underneath the chin and neck area to above the head in order to compress the swelling so it does not stretch those tissues. The patient has to wear it for about two weeks to keep the swelling to a minimum. The patient also has to keep the head elevated because the less blood pressure to the head, the less swelling there will be. The patient also cannot do any heavy lifting. Less pressure and less swelling means better results in the end. A typical full recovery takes about a month.



The results depend on what the surgeon does because a true facelift with muscle tightening shows immediate results. After about a month, most of the swelling goes away and the results tend to last for about 10 years in a muscle tightening facelift. This facelift involves neck contouring because facelifts are often combined with neck lifts.

Skin only facelift results tend to be short-lived unless it was a patient who lost weight because their muscles may not have loosened. It might just be the skin that is the problem. If the muscles are not loose, a skin only facelift can be appropriate for the patient.

Nonsurgical results for fat loss procedures are permanent unless the patient gains more weight. If the patient goes on to gain another 20 pounds, they are going to gain weight in the neck as well



While neck contouring can give a smoother and firmer appearance to the neck of a patient, the type of technique used for neck contouring depends on the surgical approach of the doctor. Patients should consult with an experienced doctor to determine exactly how the neck contouring needs to be performed to achieve the goals of the patient.


Written by Cosmetic Town Editorial Team- MA

Based on an exclusive interview with Pablo Prichard, MD in Phoenix, AZ