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I am 53 years old and although my neck is tight, it looks very gaunt. When I smile...

Q:

I am 53 years old and although my neck is tight, it looks very gaunt. When I smile it appears stringy vertically. My face is smooth and without sag, but I have very fine thin skin. For my age I have less than average wrinkles and no visable pores. I cannot see that a neck lift could help me as I feel if anything my skin looks TOO tight and I need more fat to hide the stringiness. What procedure do you suggest is needed to make improvement in my appearance?

A:

Schedule a consultation with a Board Certified Plastic Surgeon.

You may be a good candidate for fat transfer to the face.

A:

When we think of face and neck lifts, we normally think about reducing loose and redundant skin. A quality Facelift and Necklift, however, focuses on more than just the skin.

It sounds like you have visible bands on your neck, not from loose skin, but from the platysma muscle that is underneath the skin.  Smiling, and widely showing your teeth, will make the platysma muscle contract. If there is a separation of the muscle down the middle of the neck, this leads to exaggerated vertical bands running up and down the front of the neck.

A platysmaplasty may be just the thing to smooth out the appearance of your neck. Repairing the muscle is like applying a corset to support the tissues beneath the skin. It can reduce the exaggerated banding, while smoothing and supporting the necks normal contours.

I cannot tell you that this is the best procedure for your neck, but it is worth discussing it with a Board Certified Plastic Surgeon in your area.

More information on necklifts, facelifts and even mini-facelifts is available here, on the ASAPS web site, and on my personal websites DrMele.com and SanFranciscoPlasticSurgeryBlog.com. Click on the links below for more details:

Necklift, Facelift (Rhytidectomy) Information

Facelift (Rhytidectomy) compared to the mini-facelift (with before and after pictures).

Joseph A. Mele, III, MD, FACS Certified by the American Board of Plastic Surgery and the American Board of Surgery Walnut Creek, CA (925) 943-6353 www.DrMele.com www.SanFranciscoPlasticSurgeryBlog.com www.CirugiaPlasticaSanFrancisco.com www.SanFranciscoBreast.com

A:

In some cases the use of Dysport or other botulinum toxin preparations can be useful to relax the neck muscles and achieve a softened appearance to the neck without a facelift. This is especially true for vertical bands that appear with forced smiling.

A:

The stringiness you describe is most likely the platysma muscle which becomes visible through the skin when you animate.  Botox is a good solution for diminishing the bands which you describe.

Volume replacement in the neck is tricky as the skin is so thin, anything can be visible.  I have used Sculptra to increase volume in the neck with nice improvement.

I recommend meeting with one of our Board Certified Plastic Surgeons to discuss your options.

Good luck.

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