Can a Facelift and Neck Lift Be Done Together? Platysmal Bands, the Jawline and the Process
Yes, in most patients a facelift and neck lift are done together, because the SMAS layer in the cheek continues into the neck as the platysma muscle, and sagging along the jawline and looseness in the neck usually come from the same process. If the laxity is only in the neck and under the chin, a neck lift on its own or double chin liposuction may be enough. After the combined operation, most patients return to social life within 2–3 weeks; which option suits you is decided at consultation.
For many people considering a facelift, the main concern is not just the cheeks but a less defined jawline and a loose neck. That is why the question “Should the face and neck be lifted together, or is a neck lift alone enough?” is one of the topics discussed most often at consultation. In this guide we look at why the lower face and neck are usually assessed together, platysmal bands, the jawline, when a neck lift on its own may be enough, and how the process unfolds when both are done in one operation.
Why are the lower face and neck assessed together?
The lower face and neck are assessed together in most patients because, anatomically, they form one continuous structure. The SMAS layer in the cheek and along the jawline (the layer of muscle and connective tissue beneath the facial skin) continues in the neck as a thin, broad muscle called the platysma.
As this layer loosens with age, the cheek tissue descends, sagging forms along the jawline (jowls), and looseness and bands in the neck become more visible. If only a facelift is done, the neck may continue to look older; if only a neck lift is done, there may be a mismatch between the cheeks and jawline and the neck. This is why most facelift operations are planned to address the lower face and neck together. For an overview of the facelift process, see our facelift page.
What are platysmal bands and how are they corrected?
Platysmal bands are vertical cords running down from under the chin, formed when the front edges of the platysma muscle in the neck separate and loosen with age; they become especially noticeable when you talk or clench your teeth.
In surgery, these bands can be addressed in two ways:
- Support from the side (lateral): During a facelift, the platysma is repositioned towards the area behind the ear and gains tension from the sides of the neck.
- Repair at the midline (platysmaplasty): Through an incision a few centimetres long under the chin, the separated front edges of the muscle are stitched together. This approach is often added when the bands are prominent.
For mild bands, Botox can also be used as a temporary solution; however, if there is loose skin and muscle sagging, its effect is limited. Midline platysmaplasty is usually added when the bands are prominent and visible even at rest, when the muscle edges have separated markedly at the midline, or when additional fat contouring is needed under the chin. The under-chin (submental) incision is made when a platysmaplasty is needed or to give the jawline sharper definition, and it is made in most patients. In mild laxity, especially in young patients with little excess skin, tightening from the sides alone, without a platysmaplasty, may be enough; this is decided at consultation.
Why does the jawline lose definition?
A loss of definition along the jawline does not have a single cause; loosening of the SMAS and platysma, fat build-up under the chin, descent of the salivary gland (the submandibular gland) and the bone structure all play a part together.
- Tissue sagging: As the cheek tissue descends, jowls form along the edge of the jaw and the jawline looks uneven.
- Fat distribution: Fat can build up under the chin (a double chin), either under the skin or as deep fat beneath the muscle.
- Bone structure: A receding chin can lead to a poorly defined chin–neck angle, even at a young age. In this case, options such as a face implant may also be considered.
- Submandibular gland ptosis: The salivary gland under the jaw (the submandibular gland) dropping lower with age also blurs the jawline.
Good planning depends on telling which cause is dominant; for this reason, at consultation the face and neck are examined together, standing, and with the head in different positions.
When can a neck lift on its own be enough?
A neck lift on its own may be enough for people whose laxity is mainly in the neck and under the chin, with no marked sagging in the cheeks or along the jawline. If there is only excess fat under the chin and skin elasticity is good, double chin liposuction may be considered on its own.
| Option | Who may it suit better? | Incision | Limitations |
|---|---|---|---|
| Double chin liposuction | People with excess fat under the chin and good skin elasticity, usually younger | Openings a few millimetres in size under the chin and/or behind the ear | Does not correct loose skin or platysmal bands |
| Neck lift on its own | People with loose skin and bands on the neck, whose cheeks and jawline are relatively well preserved | An under-chin incision and, if needed, incisions behind the ear | Does not correct jowls or midface sagging; a mismatch between the face and neck may result |
| Lower face and neck lift together | People with both sagging along the jawline and looseness in the neck | An incision running in front of and behind the ear into the hair-bearing scalp, plus an under-chin incision in most patients | Longer operation and recovery; scars and risks need a more thorough assessment |
Which option suits you is determined at consultation according to skin quality, age, fat distribution and expectations. For a detailed comparison, see our articles “Neck lift vs neck liposuction” and “Who is a neck lift suitable for?”. In general, double chin liposuction alone may be enough for people with good skin elasticity whose fullness comes mainly from fat under the chin. If the cheeks and jawline are relatively well preserved and the problem is concentrated in loose skin and muscle in the neck, a neck lift on its own may be considered. If there is also sagging in the cheeks and along the jawline, treating the face and neck together gives a more balanced result in most patients.
What is the process when a facelift and neck lift are done together?
With a combined lower face and neck lift, the process moves through consultation and planning, the day of surgery, the first week, and a recovery period spread over a few months; most patients can return to social life within 2–3 weeks.
- Consultation and preparation: Your general health, the medicines you take (particularly blood thinners) and smoking are assessed. Because smoking has a negative effect on healing, stopping in the period leading up to surgery and afterwards is recommended.
- Surgery: The incisions are placed in the natural creases in front of and behind the ear and, in most patients, under the chin. The deep tissues are repositioned and excess skin is removed. The under-chin incision allows removal of the fat beneath the platysma muscle (subplatysmal fat), reduction of the digastric muscle (a small muscle under the chin) if needed, and reduction of the submandibular gland where necessary. These three steps are important surgical manoeuvres in giving the neck the desired shape. The technique used (such as SMAS or deep plane) is chosen for each person; for the differences, see our deep plane vs SMAS comparison. General anaesthesia is usually preferred for a lower face and neck lift, although local anaesthesia can be used in suitable patients; the length of the operation varies with the extent of the procedures but is mostly a few hours. In most cases two nights of observation in hospital are planned; the anaesthesia method and hospital stay are decided at consultation and at the anaesthetic assessment.
- The first few days: Swelling, tightness and bruising of the face and neck are expected; pain is usually controlled with medication. Keeping your head raised and not bending your neck excessively are recommended. In some patients a thin drain may be placed to prevent fluid build-up, and a supportive dressing may be applied to the face and neck; when a drain is used, it is usually removed within the first 1–2 days. After that, wearing a supportive face and neck band for a period may be recommended.
- Weeks 1–2: Dissolvable stitches are mostly used; if there are stitches that need removing, they are usually taken out on day 10. Swelling and bruising reduce noticeably.
- Weeks 2–3 and beyond: Most patients return to social life and desk-based work. Firmness or reduced sensation in the neck can last a few months; the final result usually settles within 3–6 months.
If you are travelling to Istanbul, plan your stay around the hospital nights and the early check-ups, including stitch removal if it is needed, rather than around the operation date alone.
What are the risks?
A facelift and neck lift is a commonly performed operation; even so, like all surgery it carries risks, and these should be discussed in advance.
- Haematoma (a collection of blood under the skin): This is the most common early complication after a facelift; high blood pressure increases the risk. It usually appears within the first 24 hours and may need treatment.
- Nerve effects: Temporary weakness can occur, particularly in the nerve branch that moves the lower lip; permanent damage is rare.
- Reduced sensation: Temporary numbness around the ears and in the neck is common.
- Wound healing problems and scarring: Blood supply to the skin can be affected, particularly in smokers; scar quality varies from person to person.
- Contour irregularity: Removing too much fat from under the chin can cause a hollowed appearance in the neck; for this reason, fat removal is planned in a balanced way.
Results vary from person to person, and the decision is made at consultation.
What should you look for when choosing a surgeon for a facelift and neck lift?
When choosing a surgeon for a facelift and neck lift, the key criteria are that the surgeon is a specialist in plastic, reconstructive and aesthetic surgery, their experience in face and neck surgery, that the operation is performed in a hospital setting, and that the options are explained clearly along with their risks. There are many specialists working in this field in Türkiye and in Istanbul; when comparing, it is helpful to check whether the recommended approach is explained with reference to your own face. For Assoc. Prof. Dr. Yalçın Bayram’s professional background, see the about us page, and for details of the procedure, see our facelift page.
What is assessed at consultation when the face and neck are planned together?
At consultation, sagging in the cheeks and along the jawline, the elasticity of the neck skin, platysmal bands, whether the fat under the chin lies under the skin or beneath the muscle, the position of the salivary glands and the structure of the jawbone are all assessed together. For a natural look, it is important that the face and neck are treated in harmony with each other, that the deep tissues are repositioned without putting excessive tension on the skin, and that the incisions are placed in natural creases. Because removing too much fat from the neck can lead to a hollowed or uneven appearance, fat contouring is planned in moderation.
For a personal assessment, you can book a consultation through the contact page.
For the stages of the operation and recovery, see how a facelift is performed; for incision sites and scar care, see will a facelift leave a scar?; and for objective criteria when choosing a surgeon, see how to choose a facelift surgeon.
Frequently Asked Questions
Is the neck automatically lifted during a facelift?
Partly. Because the platysma muscle is also tightened from the sides during a facelift, the upper part of the neck improves to some extent. However, to shape the neck fully, an additional incision is made under the chin in most patients, and the platysmal bands and the fat beneath the muscle are corrected through it. In some young patients with little excess skin, tightening from the sides alone may be enough; this is decided at consultation.
Can I have just a neck lift?
If the laxity is mainly in the neck and under the chin, and the cheeks and jawline are relatively well preserved, a neck lift on its own may be enough. If there is marked sagging along the jawline, a neck lift alone may lead to a mismatch between the face and neck.
Can platysmal bands be corrected with Botox?
For mild bands, Botox can relax the muscle and soften the bands temporarily; the effect usually lasts a few months. If loose skin and muscle sagging are marked, its effect is limited and surgical options are considered.
When can I go back to work after a combined facelift and neck lift?
Most patients can return to social life and desk-based work within 2–3 weeks. Heavy physical exertion and sport usually require a longer wait. The timing varies from person to person and is decided according to your check-ups.
Does a neck lift leave scars?
Every surgical incision leaves a scar. In a neck lift and facelift, the incisions are placed in the natural creases in front of and behind the ear and, in most patients, under the chin; in most patients they become less noticeable over time. Scar quality varies with skin type and healing.
Medical review: This article has been medically reviewed by Assoc. Prof. Dr. Yalçın Bayram, specialist in plastic, reconstructive and aesthetic surgery (Şişli, Istanbul). For his background and academic publications, see about us. This article is for general information; the right approach for you is decided at consultation.
