The neck can have a major influence on our aesthetic look. In fact, many believe that a well-contoured neck is the most important piece for a youthful appearance. An aging neck is characterized by skin laxity, submental fat excess, and skin band formation. Although aging is usually responsible for those changes occurring in the neck, there are other factors, such as weight changes, sun exposure, lifestyle qualities, and facial skeletal structures. For example, individuals can develop excess skin laxity following significant weight loss. Similarly, a patient can have a lack of definition of the neck angle because of lack of chin projection. Patients can develop or be born with stubborn fat in the submental region that is unresponsive to diet or exercise. Patients unhappy with the look and contour of their neck may be great candidates for a neck rejuvenation.
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors that are considered top leaders in the field of facial aesthetic surgery. These includes, Dr. James E. Zins, Michael E. Lee, and Hunt E. Neurohr, major contributors to the field of facelift and necklift. Because of his strong passion for facial rejuvenation, Dr. Couto has co-authored multiple scientific articles and book chapters about facelift and necklift. Furthermore, Dr. Couto has been a faculty member of the annual American Society Plastic Surgery (ASPS) face and neck rejuvenation course.
Neck rejuvenation involves a variety of procedures, which main objective is to optimize the contour and the definition of the neck. These procedures can include fat removal through liposuction to excision and tightening of loose skin with neck lift or skin tightening energy-based device.
An individual that is unhappy with the appearance of their neck either by loose skin, excess fat, or skin band formations. Patients also exhibiting aging changes of the lower face, such as saggy skin, jowling, and accentuated facial folds may be candidate for a concomitant face and neck rejuvenation.
The consultation is divided into five parts:
1) Health and Medical History Evaluation
A comprehensive evaluation of your medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. It is important to tell Dr. Couto if you utilize any nicotine products (eg cigarette, nicotine patch, vape, etc.), if you have uncontrolled high blood sugar levels (eg diabetes) or if you take any medications, supplements, or other drugs as these can have a big impact on your surgery. An example is aspirin or blood thinners, which can lead to the formation of a hematoma after your procedure. These are common risk factors that can be easily modified with lifestyle changes and can affect your surgical results. Although this procedure is low risk, your health and safety will always be our main priority. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential to obtain the best possible result.
2) Discuss with the Patient About Surgical Goals
Dr. Couto has a deep discussion with the patient to learn about their concerns and goals. Listening to their interest is crucial, since it is our priority to determine if we can meet their expectations. We focus on learning whether the patient is particularly interested in addressing an specific area of the face or if the patient is interested in a face and neck rejuvenation.
3) Physical Exam
Dr. Couto treats the face and neck as whole, not by areas. Therefore, a systematic analysis of the face and neck is performed. A youthful appearance is marked by smooth transitions between different areas of the face and neck. As a result, Dr. Couto not only examines the regions the patient is mainly concerned with, but also those surrounding areas and structures of the face and neck that could help achieve a balanced and refreshing look.
4) Recommendations & Surgical Plan
Following the physical exam, Dr. Couto develops a personalized surgical plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient the indicated surgical techniques and explains in detail everything pertaining to the procedure and its recovery.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized price quote that is tailored to the procedure(s) discussed during the consultation and review the steps involved in booking the procedure with us.
Neck rejuvenation can consist of elimination of stubborn fat with liposuction or excision and tightening of loose skin either through a neck lift approach or the use of skin tightening energy-based devices.
There are different techniques that Dr. Couto uses to perform neck rejuvenation:
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again, and clarify any questions involving the surgery. Furthermore, we will thoroughly review with the patient the preoperative/postoperative instructions and medication regimen, and schedule your future post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this increases the risk of bleeding. Furthermore, we remind them that smoking, vaping, or using any nicotine products will affect the results and recovery. There is significant scientific evidence that patient actively using of nicotine (eg. cigarettes, vaping, chewing, etc) have 12 times higher risk of complications following facelift/necklift surgery when compared to non-smoker patients (reference). Nicotine affects a person’s capacity for healing; thus, affecting your wounds and scars. During the initial consultation, Dr. Couto will ask the patient to stop smoking at least 8 weeks before the operation to reduce the risk of complications. Patients with a history of diabetes mellitus must have a glycosylated hemoglobin (HbA1c) of 7 or less to be able proceed with surgery. If the HbA1c is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize your medications or diet to help lower the HbA1c levels. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with supplements available in our practice.
We provide our patients with a detailed postoperative protocol to ensure that they have a comfortable and quick recovery. Surgical drains are only required for patients undergoing an extended necklift, for all other techniques, drains are not necessary. Surgical drains help prevent fluid collection in the neck and expedite the recovery. They are typically removed 48 hours after surgery. The patient will wear specialized face and neck compression garments that help minimize swelling and skin contour irregularities. Swelling and bruising are to be expected, and they can be noticeable for a week. Rarely, patients experience pain or discomfort following this surgery. It is very unusual for a necklift patient to require narcotic pain medications. We normally recommend our patients to take 7 days off from work (less if working from home). The same day after surgery, Dr. Couto always instructs the patient to have a couple of walking laps around the house or neighborhood. Patients can resume their aerobic exercises (eg. running, spinning, biking) 4 weeks after surgery and strengthening/abdominal exercises 6 weeks after surgery.
There isn’t! Every person ages in a different way and at a different rate; therefore, there isn’t a correct age to undergo a facial rejuvenation. The timing of a necklift is mainly determined by the skin quality and elasticity of an individual. These intrinsic skin characteristics are not only influenced by age, but also by genetics, weight changes, sun exposure, history of smoking and other lifestyle qualities. It is for that reason that during the consultation we perform a systematic analysis of the entire face and neck. This enables us to develop customized surgical plan that are based on your facial features, personal needs, and aesthetic desires.
The only technique that requires placement of surgical drains is the extended necklift. The drains prevent fluid from accumulating in the neck region and helps expedite the recovery. Furthermore, they are commonly removed 24-48 hours after surgery.
Uncontrolled diabetes can affect the ability of the body to heal wounds properly. Therefore, it is crucial for diabetic patients to have their blood sugar levels under control for this procedure. Patients with an HbA1c of 7 or less are candidates for this procedure.
Patients undergoing an extended necklift need to stop smoking or use nicotine products at least 6 weeks before surgery. There are numerous scientific studies showing that smoking cigarettes and/or using nicotine products increase your risk of postoperative complications. Nicotine affects the vascularity, and thus prevents the body from healing wounds properly following surgery.