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BitarNeck Lift (Lower Rhytidectomy)

INTRODUCTION

“I want to look better, but I don’t want a face-lift.” We hear this in our office all the time. We offer a neck lift procedure to our patients who are unhappy with their necks and do not want -or do not need- a facelift. When the neck area begins to sag, it can make you look older. The reasons why men and women choose to have neck lifts in their thirties, forties, and up to their seventies vary from wanting to look good to being able to shave better.

When someone looks in the mirror and is unhappy with their face, it can sometimes be difficult to verbalize why they are unhappy. Assuming that genetics and the aging process play a role in a person’s unhappiness with their appearance, it is important to identify the problem and offer a surgical solution:

• If a patient is unhappy with excess fat in their neck but has good skin tone and good muscle tone of their neck, then he/she is a good candidate for neck liposuction.
• If a patient is unhappy with excess fat in their neck and has loose skin and/or muscle in their neck, then he/she is a good candidate for a neck lift.
• If a patient is unhappy with laxity in their neck as well as their jowls and jaw line then he/she is a good candidate for a mini facelift.
• If a patient is unhappy with their neck, jowls, and cheeks then he/she is a good candidate for a face-lift.
• If a patient is unhappy with droopy eyebrows and wrinkles in the forehead then he/she is a good candidate for a forehead lift.

BENEFITS OF SURGERY

• The scars are practically hidden behind the ears and under the chin. No scars appear in front of the ears.
• This neck lift technique enables a patient who is only bothered by their neck to have an excellent long-term alternative to a facelift.
• This technique is flexible and can be adjusted to different shapes of necks with varying amounts of fat, laxity of skin, and laxity of muscle, with excellent long-term results.

PREPARING FOR SURGERY

An initial consultation is set-up where we discuss the neck lift procedure and whether you are a good candidate for the surgery. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are asked to stop medications that cause bleeding, such as aspirin, or aspirin-like products (Motrin or Ibuprofen), a week before this procedure. You are asked to stop smoking two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery that you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.

HOW WE MINIMIZE COMPLICATIONS OF NECK LIFTS

At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible, anticipating problems or set-backs, and addressing them before they happen. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.

General Complications
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class surgery center with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.

Bleeding
Bleeding after a neck lift is rare. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. The use of tumescent solution before liposuction of the neck is performed during a neck lift minimizes bleeding. In my practice the rate of significant bleeding is less than 1%. The treatment of a hematoma or a blood clot under the neck skin is to open the incision and remove the blood clot. Typically, this is a straightforward procedure.

Infection
The most important step in avoiding infections, in my opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, my patients are prescribed antibiotics to minimize infection. As a result of these extra precautions, my rate of infection after a neck lift is extremely rare.

Open Wounds
In a neck lift, there is manipulation of a relatively large amount of skin and the closure of skin under some mild tension. Because the incisions are under tension, there can be either loss of some skin or a small opening of the wound behind the ears. This is treated with dressing changes and cleaning of the wound in the office as needed. This can occur in about 1% of patients. Usually, the wounds heal very well, and nothing further needs to be done with nicely hidden scars. Very rarely, we may need to do a scar revision to improve the appearance of that scar.

Nerve Injury
One advantage of a neck lift over a face lift is that there are fewer nerves in the neck that may be affected by surgery. The result is a minimal rate of nerve injury. In rare instances, temporary loss of sensation from a “stunned” nerve or a bruised nerve may occur in the time period after surgery. This may result temporarily in an uneven smile, but full nerve function usually returns within days to weeks.

Smoking
Smoking is an absolute contraindication in neck lift. The carbon monoxide and nicotine in cigarette smoke causes severe reduction in blood supply to the skin and breast tissue during healing. This results in delayed wound healing, wound separation, death of the skin, and a higher risk of infection. Cotinine testing is performed in patients with a smoking history to ensure that they are safe when having this procedure.

RECOVERY

Our office will provide a comprehensive post-operative plan to ensure the best possible outcome. The plan will include what to expect postoperatively, such as estimated recovery time, pain management, garments or dressings, and anticipated activity level. For your safety, we require that an adult stay with you at least the first 24 hours after surgery and drives you to your next day follow-up visit. With most facial procedures, you will be instructed to limit activity for the first week or two, which could include restrictions on driving, prolonged travel and flying. In addition, we ask you refrain from exercise until cleared by the physician, usually around four weeks post-op. You are asked to refrain from smoking for a minimum of two weeks. To optimize healing, we recommend that you eat a high protein diet. You should anticipate a variable degree of bruising and swelling, as with any surgical procedure; light make-up may be used to cover bruises starting a week after surgery. We also offer scar creams at an additional cost to optimize results.

To promote healing and minimize complications, you will be seen in a series of post-op appointments, including the day after surgery. These appointments will continue throughout the first year after the procedure to make sure you are healing as planned. For your added convenience, you also have direct access to Dr. Bitar’s cell phone number if you need to reach him after hours. The final post-op visit, one year after surgery, is one of our favorites since the results are fully apparent and we love seeing our patients happy. You are always welcome to come back and see us, even years after your surgery.

MAXIMIZING POSITIVE OUTCOMES

At the Bitar Cosmetic Surgery Institute, we take pride in providing our patients with the best surgical experience possible, emphasizing patient safety while trying to optimize surgical results. This is a process that includes comprehensive pre-operative preparation and patient education, the development of a personalized operative plan, and a thoughtful post operative care regimen emphasizing patient comfort and promoting recovery.

There are a number of strategies which the Institute has adapted to further ensure patient safety. We are selective and only offer surgery to patients whose general health and lifestyle choices permit healing and facilitate recovery. To minimize risk, we require a preoperative assessment that includes a thoughtful history and physical exam, as well as targeted laboratory tests.

We operate at accredited hospitals and surgicenters that have demonstrated a commitment to the highest standards of care, employing board certified anesthesiologists and nurses. We adhere to well established surgical principles designed to ensure patient safety and have developed policies and protocols to minimize the risk of infection. Dr. Bitar is committed to continuing education, honing his skills and introducing new techniques always with the aim of improving safety and surgical results.

We emphasize patient safety in our peri-operative care plan, advocating early mobilization, optimizing nutrition, and providing detailed care instructions. After surgery, patients are seen in our office frequently and early, starting the day after their procedure, and a staff member is available around the clock for any questions or concerns. Our entire team is committed to our patients’ well being and every measure is designed to minimize potential complications, promote comfortable and rapid recovery, and optimize surgical results.

WHY CHOOSE BITAR COSMETIC SURGERY INSTITUTE?

Our commitment to excellence and exceptional patient care is in every step of your doctor-patient experience. Dr. George Bitar is a distinguished board certified plastic surgeon who exclusively performs cosmetic surgery. The doctor stays on the cutting edge of advancements in cosmetic surgery and technology to offer the best possible results. With a blend of artistry and meticulous surgical technique, he is able to achieve beautiful and natural results for his patients. We provide a high level of patient safety and our experienced and caring staff will be with you every step of the way. Our institute offers a wide variety of surgical and non-surgical options, from skin care, injectables and lasers to in-office or hospital options, to provide a versatile approach to fit individual patient needs. Your aesthetic goals are our priority and each procedure is customized to ensure you receive the best possible outcome.

For more information, call our office at 703-206-0506.

Content on this website is for information only and should not be used to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.

RELATED ARTICLES

Algorithm for Simplified Neck Rejuvenation
A book chapter written by Dr. George Bitar and Dr. Vincent Giampapa in the book “Simplified Facial Rejuvenation” by Mel Schiffman et. al.

Before You Go to New York for Cosmetic Surgery…
“If you want the best bagel, you go to Zabar’s, the best show you go to Broadway, and the best neck lift, you go to New York. So, I did, and I learned how to perform the best neck lift there.”

A New Neck Lift Technique
“When the neck area begins to sag, it can make you look older than you are. With this in mind, both men and women in their thirties and forties are having neck lifts and not waiting for their faces to sag to get a facelift.”