Understanding Deep Neck Lift Surgery: A Comprehensive Guide to Advanced Cervical Procedures

By Dr Scott J Turner, Specialist Plastic Surgeon (FRACS) | Sydney & Brisbane

The cervical region plays a fundamental role in establishing facial harmony, with the interface between the lower face and neck contributing substantially to overall proportions. Over time, genetic predisposition, environmental exposure, and the natural ageing process combine to produce changes including tissue laxity, visible platysmal banding, and submental fat accumulation. Whilst conventional neck lift techniques primarily address surface-level structures, contemporary understanding of cervical anatomy has enabled the development of more thorough surgical methods. This sophisticated approach, termed deep neck lift surgery, targets the foundational structures responsible for persistent cervical concerns, potentially delivering more enduring outcomes for carefully selected patients.

The Role of the Neck in Facial Balance

The cervical region contributes to harmonious facial proportions through several mechanisms. Certain anatomical characteristics are typically associated with a well-balanced neck profile, including clear demarcation between the face and neck along the mandibular border, a cervicomental angle (formed between the chin and anterior neck) generally measuring between 105 and 120 degrees, and discernible anatomical landmarks such as the subhyoid depression that establish a pleasing contour.

For women, these features are widely recognised as contributing to balanced facial aesthetics. For men, a more prominent jawline and angular facial architecture are frequently desired. Comprehending these anatomical parameters assists in guiding surgical planning and establishing appropriate patient expectations.

What Causes Changes to the Neck?

The cervical region undergoes alterations over time due to intrinsic factors (such as hereditary predisposition) and extrinsic influences (including ultraviolet exposure and tobacco use). These modifications may include:

Changes in skin quality: With advancing years, dermal collagen and elastin diminish, potentially resulting in thinning, fine lines, and tissue laxity. Environmental factors, particularly sun exposure, can hasten these changes.

Alterations in fat distribution: Fat accumulation in the submental region may produce the appearance commonly described as a double chin. This occurs independently of overall body composition and may be substantially influenced by genetic factors.

Muscular changes: The platysma, extending from the chest to the mandibular border, may lose tone and develop vertical bands termed platysmal bands. A platysmaplasty procedure can address these specific concerns.

Skeletal modifications: Bone remodelling in the jaw over time may result in less distinct mandibular definition, which can contribute to the appearance of soft tissue descent.

Cervical Anatomy: A Multi-Layered Structure

Understanding the anatomical architecture of the neck proves essential for appropriate surgical planning. The cervical region can be conceptualised as comprising three distinct layers:

The Superficial Layer

This comprises the skin (the outermost structure affected by environmental factors and intrinsic ageing) and the subcutaneous adipose tissue situated immediately beneath. These structures can contribute to fullness or laxity and represent the primary targets of conventional neck lift procedures.

The Intermediate Layer

The platysma muscle is a superficial muscle that may lose tone over time, resulting in visible banding. Intermuscular fat tissue located between the muscle layers can also contribute to cervical fullness. 

The Deep Layer

This layer encompasses subplatysmal structures, including deeper fatty deposits, the digastric muscles, and submandibular glands. These structures receive support from skeletal elements comprising the mandible, hyoid bone, and cervical vertebrae. Conventional neck lift techniques cannot access these deeper structures.

A Comprehensive, Layered Approach to Cervical Correction

Dr Scott J Turner’s practice focuses on a thorough, layered methodology for cervical correction. By addressing each anatomical layer where indicated, this approach aims to correct the underlying structural modifications contributing to cervical concerns. It may deliver more lasting and natural-appearing outcomes compared to superficial techniques alone.

Addressing the Superficial Layer

The cervical skin loses collagen and elastin over time, potentially resulting in laxity and wrinkling. Subcutaneous adipose tissue located between the skin and the platysma muscle can accumulate, particularly beneath the chin, contributing to submental fullness.

For patients presenting with isolated submental fullness but minimal skin laxity, non-surgical treatments may prove appropriate. However, neck liposuction remains the most effective procedure for precise fat removal, particularly when deeper structures are involved. Liposuction can be performed through small incisions and proves particularly effective when combined with a neck lift procedure.

Addressing the Intermediate Layer

The platysma muscle changes over time, potentially contributing to the appearance of vertical bands. These bands can be present at rest (static bands) or manifest with facial movement (dynamic bands).

To address platysmal banding, surgeons typically employ a technique known as anterior platysmaplasty, where the muscle edges are tightened. Dr Turner utilises an advanced 3D Z-platysmaplasty technique, which involves horizontal transection of the platysma muscle to separate it into upper and lower segments. This three-dimensional approach may reduce the likelihood of band recurrence compared to simple plication techniques.

Addressing the Deep Layer

The deep structures of the neck, including subplatysmal adipose tissue, digastric muscles, and submandibular glands, may become more prominent over time, contributing to a fuller cervical appearance. These structures cannot be adequately addressed through conventional superficial techniques.

Deep neck lift surgery employs a dual-plane approach that permits access to these deeper anatomical components. Subplatysmal fat can be directly excised rather than relying on liposuction alone. When digastric muscles contribute to central cervical fullness, careful contouring may be performed. In patients where submandibular glands have become prominent, partial gland reduction may be considered to achieve an appropriate contour.

Who May Be Suitable for Deep Neck Lift Surgery?

Deep neck lift surgery is typically indicated for patients presenting with specific anatomical characteristics that require intervention beyond superficial tissue modification.

Inherited anatomical characteristics: Some individuals are born with prominent submandibular glands, bulky digastric muscles, or excessive subplatysmal adipose deposits that create persistent cervical fullness regardless of weight or age. These inherited characteristics may require surgical intervention at the deeper anatomical level.

Suboptimal outcomes from previous surgery: Patients who have undergone conventional neck lift or neck liposuction with disappointing outcomes may have underlying deep structural concerns that were not addressed during the initial procedure.

Persistent central fullness despite weight loss: Ongoing fullness beneath the chin that does not respond to diet, exercise, or non-surgical treatments may indicate deeper structural concerns.

Disproportionate facial-cervical appearance: When facelift procedures produce good results but the neck appears disproportionately different, a deep neck lift may provide more comprehensive correction.

Appropriate candidates should be in excellent overall health, as a deep neck lift represents a more extensive procedure than conventional techniques. This surgery requires good cardiovascular health, normal coagulation function, and the ability to undergo longer anaesthesia.

The Deep Neck Lift Procedure: What to Expect

Deep neck lift surgery is performed under general anaesthesia in a fully accredited hospital with a qualified anaesthetist. The procedure typically requires approximately 3 hours, and Dr Turner recommends overnight hospital observation before discharge the following day.

Incision Placement

Incisions are strategically positioned to provide surgical access whilst minimising visible scarring. These include post-auricular incisions placed behind each ear and a submental incision in the natural crease beneath the chin.

Zone-Based Surgical Approach

The deep neck lift systematically addresses three distinct anatomical zones:

Zone I (Submental Region): The subplatysmal space is accessed to permit direct excision of deep adipose deposits. Digastric muscles are assessed and contoured if contributing to central bulging. A strategic patch of adipose tissue is preserved at the hyoid level to maintain natural contour.

Zone II (Body of Mandible): Submandibular glands undergo careful assessment. When enlarged or descended below the mandibular border, partial reduction may be performed. This zone frequently proves critical for achieving appropriate jawline definition.

Zone III (Angle of Mandible): When anatomical assessment reveals prominent parotid gland tails creating posterior jawline fullness, partial reduction may be performed to establish appropriate posterior jawline contour.

Recovery Following Deep Neck Lift Surgery

Recovery from deep neck lift surgery follows a predictable timeline. Initial swelling and bruising typically subside within two to three weeks. A haemostatic net applied during surgery remains in place for 48-72 hours, followed by a compression garment worn continuously for one week, then at night for an additional one to two weeks.

Most patients return to desk-based work within two to three weeks, with complete healing and final results emerging over three to six months. Strenuous activities, exercise, and heavy lifting should be avoided for four to six weeks, though light walking is encouraged from day one.

For patients who have undergone submandibular gland reduction, following a salivary-resting diet for two weeks proves essential, which involves avoiding salty, sour, spicy, and overly sweet foods, to help reduce the risk of fluid collection.

Risks and Complications

All surgical procedures carry inherent risks. Whilst deep neck lift surgery has an excellent safety profile when performed by an experienced Specialist Plastic Surgeon, it represents a more complex procedure than conventional neck lift and carries specific considerations.

Common temporary effects include swelling, bruising, temporary numbness, tightness, and mild asymmetry during healing. Complications specific to deep anatomical work may include sialocele (salivary fluid collection occurring in approximately 2% of patients), temporary lower lip weakness (occurring in up to 4% of patients, usually resolving within 6-12 weeks), and, rarely, Frey’s syndrome.

Other potential risks include haematoma formation, infection, unfavourable scarring, and nerve injury affecting facial movement or sensation. Through meticulous surgical technique and comprehensive pre-operative assessment, Dr Turner aims to minimise these risks whilst optimising patient safety.

Combined Procedures

Deep neck lift is frequently combined with facelift surgery to comprehensively address concerns across the lower face and cervical region. Dr Turner offers various facelift techniques, including deep plane facelift, vertical facelift, and mini facelift, depending on individual patient requirements.

Additional procedures that may be performed concurrently include blepharoplasty, brow lift, facial fat transfer, and chin implants. Combining procedures may prove efficient, potentially reducing overall recovery time compared to staging procedures separately.

Next Steps

If you are considering a neck lift or wish to explore your options for cervical surgery, Dr Scott J Turner, Specialist Plastic Surgeon (FRACS), is available to provide a comprehensive assessment and discuss appropriate surgical approaches based on your individual anatomy and concerns.

Dr Turner consults from clinics in Sydney and Brisbane. To schedule a consultation, please contact us.