What’s actually bugging you about your neck? For most of us it’s fat, loose skin or the cords running down the front, and each one has its own fix. Neck liposuction takes out fat under the chin, as long as your skin is firm enough to shrink back afterward. A platysmaplasty tightens the thin neck muscle whose edges show up as those cords. A neck lift can do all of it, and it’s the only one of the three that actually removes loose skin. Botox, Kybella and devices help with smaller concerns, though none of them takes away sagging.
Fat, loose skin or bands?
“My neck” can mean three different things, and mixing them up is where most of the confusion about neck treatments starts.
Fat. This is a soft fullness under the chin that you can pinch, sometimes called a double chin, and it can show up at any age and any weight.
Loose skin. This is skin that hangs or folds, especially when you look down, plus jowls where the jaw meets the neck. Neck skin has less of the stuff that keeps skin springy than most places, which is why crepey texture is so hard to change without surgery.
Muscle bands. These are vertical cords running from under the chin down the neck, and they show more when you clench your jaw or grimace. They’re the edges of the platysma muscle, and they tend to stand out more as we get older.
Plenty of necks have two or three of these at once. A board-certified surgeon will look at your neck both relaxed and tensed and check where the fat sits, and that exam decides the treatment far more than the procedure name you walk in with.
What each procedure fixes
The three surgeries overlap more than their names suggest, and surgeons often combine them in one visit. This is how they line up once you know which of the three concerns is yours.
Neck liposuction removes fat through a thin tube slipped in through tiny cuts, and plastic surgeons count the chin and neck among the areas it treats well. It’s made for fullness under the chin. It doesn’t touch the bands, and it can’t reach fat that sits under the muscle instead of on top of it, which surgeons handle during a neck lift.
A platysmaplasty tightens the neck muscle, which softens the bands and sharpens the angle under your jaw. It’s often paired with liposuction and is a common part of a neck lift, but on its own it does little for loose skin.
A neck lift handles jowls, fat under the chin, loose skin and bands all together. The surgeon sculpts the fat, usually tightens the muscle, smooths the skin back into place and trims away the extra. It’s the one to look at when skin is the main concern, though it won’t change crepey surface texture.
Where the cuts and scars go
Neck liposuction works through a few tiny cuts, so it leaves the smallest marks of the three. One plastic surgeon describes it as a ladder with three steps: standard liposuction, a version that adds heat under the skin for a little tightening, and then a neck lift with smaller cuts. Ask your surgeon where on that ladder your own neck falls, since the answer shapes the size of the scars as well as the result.
A platysmaplasty usually needs just one small cut under the chin, tucked where it’s hard to spot.
A neck lift traditionally starts in the hairline at the sideburn, curves around the ear and ends in the hair behind it, often with a second small cut under the chin for liposuction and the muscle repair. A limited-incision lift keeps the cuts around the ears, so the scars are shorter, but the results may be smaller too.
Whose neck each one suits
Neck liposuction comes down to your skin. The American Society of Plastic Surgeons (ASPS) says it does best with firm, stretchy skin, and skin that’s been thinned by weight loss or age won’t reshape as well. It suits someone with a full chin and a crisp jawline hiding underneath.
A platysmaplasty suits bands with good skin. If that’s you, ask whether it would be enough on its own, because bands plus hanging skin usually point to a full neck lift.
A neck lift is a great fit for someone whose neck has aged faster than their face, and the classic case is a midface you’re happy with paired with a jaw and neck you’re not. Good candidates are healthy, don’t smoke and have realistic hopes. If your jowls and lower face have dropped a lot, a facelift and neck lift together often does more, because the jawline is where the two meet.
Nonsurgical help and where it stops
ASPS notes that nonsurgical neck treatments come with quicker recovery and fewer risks, though none of them does what surgery does. What they can do is put surgery off or add to its results.
Botox for bands. Botox Cosmetic is FDA-approved to soften moderate to severe neck bands for a while by relaxing the muscle. Other brands, and the jawline “Nefertiti lift,” are off-label. It lasts a few months and doesn’t change fat or loose skin.
Kybella for fat. Kybella is an injection approved for moderate to severe fat under the chin. It breaks down fat cells over a series of sessions spaced at least a month apart, and people in the trials had up to six. Swelling, bruising, pain and numbness where it’s injected are very common. Its label also warns about nerve injury that can make your smile uneven and about trouble swallowing, and it doesn’t tighten skin.
Devices and microneedling. Ultrasound, radiofrequency microneedling and lasers may smooth texture and tighten things a little, and one plastic surgeon sees ultrasound mainly as a tone-and-texture treatment. Our comparison of Ultherapy, Thermage and Sofwave goes deeper on what the tightening devices do best.
Filler. Hyaluronic acid filler is sometimes used for the horizontal “necklace” lines, but it wears off over time and won’t lift sagging.
Healing after a neck lift
You may go home with a bandage around your face and neck and a thin drain. Keep your head raised above your heart and straight, without much twisting or bending (a foam slope like the Ruqmuis 10-Inch Bed Wedge Pillow is much steadier for sleeping than a stack of pillows), and stick to clothes you don’t have to pull over your head while the cuts heal, like a button-front Ekouaer Women’s Button-Down Pajama Set. The ASPS patient page is very firm about one thing: don’t put ice on your neck, because it can cut off blood flow to the skin. Swelling takes several weeks to months to settle, and scars can take up to six months to fade and flatten, so give it that long before you judge the result.
Once your surgeon says the cuts have closed, scar care and sun protection take over. A silicone gel with sunscreen built in, like Biocorneum Silicone Scar Gel with SPF 30, goes on the healed incisions, and a zinc oxide stick like Blue Lizard Sensitive Mineral Sunscreen Stick SPF 50+ swipes easily along scars under the jaw and behind the ear.
Neck lift risks to know about
The listed risks of neck lift surgery include problems from anesthesia, bleeding and blood pooling under the skin, along with infection, a lopsided result, numbness, lasting pain, slow healing and swelling that hangs around. Rarer ones include blood clots and nerve injury that can weaken the lower lip. You can also get bumpy or discolored skin, skin loss, stitches poking through, hair loss along the scars, poor scarring, or a result that needs another surgery. Kybella has its own warnings too, including the nerve and swallowing risks above.
What a neck lift costs
The latest ASPS numbers put the average surgeon’s fee for a neck lift at about $7,885, and that covers the surgeon only. Anesthesia, the facility, tests, prescriptions and garments cost extra, prices vary by city and surgeon, and insurance usually doesn’t cover it. Nonsurgical treatments cost less per visit but need repeating, so add them up over the years before you compare.
Matching the fix to your neck
In your thirties with a full chin and a firm jawline under it? Ask about liposuction or Kybella, and be wary of anyone who leads with a neck lift.
Mostly vertical cords? Botox Cosmetic for bands is a sensible first step, since it’s approved for exactly that, and you’ll find out whether softer bands are all you really wanted. If you’d like something lasting, ask about a platysmaplasty.
Skin hangs or folds when you look down? Liposuction alone will probably leave you wanting more, so ask a surgeon about a neck lift and what a limited-incision version would and wouldn’t do for you.
Mostly texture and fine lines? Surgery isn’t the answer here. Daily sunscreen on your neck, and maybe microneedling or a laser, is the better route, and our skin tightening guide covers what’s worth it.
Jowls and lower face have dropped too? Ask whether a neck lift alone will match your face or whether doing both makes more sense. Our guide to alternatives to a facelift covers the in-between options.
Neck lift basics
How long does a neck lift last? Often 10 years or more. You keep aging, but your neck usually stays better than it would have without surgery.
Can liposuction tighten neck skin? A little, and only if the skin still has bounce. Skin that’s very loose has to be removed, and that takes a neck lift.
Who should do a neck lift? A board-certified plastic surgeon or facial plastic surgeon who does many necks, in an accredited facility. Keep sunscreen on your neck every day either way, and find more on procedures in our skin archive.
