The direct neck lift scar
A drooping or drooping neck is often the most annoying facial change for men as they age. Known as neck stubble, this loose skin and fat causes a loss of the once sharp neck angle. This new roll of displaced neck skin can interfere with shirt collars and is annoying as it tends to shift when you move. Such beards on the neck are usually not present before the age of 55 or older, unless one has lost a lot of weight at a younger age.
While a conventional facelift is the ideal method for an aging neck, men are much more sensitive to this procedure. Concerns about their recovery, visible scars around their ears, lack of good hairline and density, where the scars would be, and fear of being recognized as having had a facelift make many men shy away from serious consideration.
An alternative to the facelift in older men is the direct neck lift. Instead of working the extra neck skin up and toward the ears (and subsequent scarring), the direct neck lift removes the skin in the midline of the neck where it meets. This is a much simpler operation, with very little recovery, no more pain than a little tightness in the neck, and no hairline changes or scarring around the ears.
The obvious disadvantage of a direct neck lift is the scar. Instead of being around the ears as in a typical facelift, a midline scar is created that runs down the middle of the neck. While the direct neck lift is much simpler and even more effective in creating a steep neck angle, the relevant question is what the scar looks like and how noticeable it is.
The best answer to that question is to look at the actual neck scars from the procedure. In my plastic surgery practice in Indianapolis, my experience shows that the scars are quite acceptable. I have yet to have a male patient tell me he regrets having the procedure done and finds the scar on his neck worse than the original stubble on his neck.
Why do neck scars usually turn out quite well? Besides good surgical technique, the main reason is the unique healing quality of bearded skin. Men’s skin is thicker, has more blood vessels, and heals better due to cellular contributions from hair follicles. Also, most men do daily scar treatment after surgery, they shave. This is the equivalent of doing daily microdermabrasion scar treatments for years.
Not all neck scars will be perfect. Some will develop a thickening of the neck scar just above the Adam’s apple (thyroid cartilage) where the tension of the skin closure was greatest due to excision. Many men do not feel that this is a problem. For others, I treat it with some steroid injections or do a small in-office Z-plasty for relief for the first year after surgery.