Neck Lift in Londrina, Brazil: deep rejuvenation of the neck
The neck is one of the first areas of the body to show signs of aging. While many people invest in skincare for the face, the neck is often neglected, and when the signs appear — double chin, vertical bands, sagging skin, loss of the cervical angle — the frustration is immense. No cream, laser, or non-surgical treatment can significantly reverse these changes. As a neck lift specialist in Brazil, I offer advanced neck rejuvenation techniques that deliver lasting, natural results.
The neck lift, also known as cervicoplasty, is the surgery that specifically addresses the aging of the neck. And when I talk about deep neck lift, I am referring to an even more comprehensive procedure that goes beyond the skin and the platysma muscle to treat deep structures such as subplatysmal fat, digastric muscles, and even submandibular glands when necessary.
In my practice as a plastic surgeon in Londrina, Brazil, neck treatment is an integral part of almost every deep plane facial lift I perform. For international patients considering cosmetic surgery in Brazil, I also combine the neck lift with procedures such as brow lift for comprehensive facial rejuvenation. However, there are patients who benefit from an isolated neck lift or a more aggressive cervical treatment as the main procedure. On this page, I will explain in detail everything about the neck lift and the deep neck lift: when each is recommended, how I perform these surgeries, and what you can expect in terms of results.
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Subscribe on YouTubeWhy the neck ages so much
To understand the neck lift, it is necessary to understand why the neck ages so visibly. The skin of the neck is thinner than that of the face, has fewer sebaceous glands, and receives less attention in daily care. Additionally, the neck is constantly in motion — flexion, extension, rotation — which accelerates the loss of elasticity.
As the years go by, several changes happen simultaneously:
- Loss of skin elasticity: the production of collagen and elastin decreases, and the skin of the neck begins to sag, forming folds and horizontal wrinkles.
- Loosening of the platysma muscle: this thin muscle that extends from the chest to the jaw loses tone. Its medial edges separate, creating the famous platysmal bands — those two vertical cords that appear on the neck.
- Fat accumulation: both above and below the platysma, fat deposits can accumulate, forming a double chin and obscuring the angle between the chin and the neck.
- Ptosis of the submandibular glands: with the loss of support, these salivary glands can become prominent, creating lateral bulges on the neck.
- Hypertrophy of the digastric muscles: the anterior belly of the digastric can contribute to a bulky appearance under the chin.
- Bone resorption: the jaw loses projection with age, contributing to the loss of definition of the cervico-mandibular contour.
Each of these factors requires a specific approach. That is why a well-executed neck lift is not simply "pulling the skin" — it is a detailed job on multiple anatomical layers.
Isolated neck lift versus neck lift as part of a facelift
A question I frequently receive is: "Can I just do the neck, without touching the face?" The answer is: it depends. And this assessment is crucial for the final result.
When an isolated neck lift is recommended
There are patients, usually younger (between thirty-five and fifty years old), who show predominant aging in the neck with the middle third of the face still well preserved. These patients may have:
- Genetic double chin, present since youth
- Early platysmal bands
- Excess submental fat that has not responded to diet or exercise
- Naturally short neck or with little definition of the cervical angle
For these patients, an isolated neck lift can deliver excellent results without the need for a complete facelift. The surgery is shorter, the recovery is faster, and the result is focused exactly where the problem is.
When the neck needs to be treated along with the face
In most patients over fifty years old, aging affects both the face and the neck. Treating only the neck in these cases would create a visible imbalance — a rejuvenated neck with an aged face. It's like painting half of a wall.
In my deep plane facelift, neck treatment is already included. The dissection in the deep plane naturally extends to the cervical region, allowing me to treat the platysmal bands, remove subplatysmal fat, work on the digastric, and reposition the entire structure in a unified procedure. The result is a natural, balanced rejuvenation of the face and neck as a unit.
The concept of deep neck lift
The term deep neck lift specifically refers to the treatment of structures that lie below the platysma muscle. While a conventional neck lift may be limited to the skin and the platysma, the deep neck lift goes further to treat:
- Subplatysmal fat
- Digastric muscles
- Submandibular glands
- Prevertebral fat
This deeper approach is what differentiates a good result from an exceptional one, especially in patients with more challenging necks.
The structures I treat in a deep neck lift
Let me detail each anatomical structure I address during a deep neck lift. This level of detail is what allows for truly transformative results.
Supraplatysmal fat: the superficial layer
Above the platysma muscle is a layer of fat that contributes to the double chin. This fat can be removed by liposuction or direct excision. It is the most accessible layer and the one most surgeons treat. But treating only this layer is insufficient in many cases.
Platysma muscle: the cervical bands
The platysma is a thin, broad muscle that extends from the upper chest to the jaw. With aging, its medial edges separate, forming the platysmal bands — those two vertical cords that become especially visible when you contract your neck or speak emphatically.
In the neck lift, I perform platysmaplasty: through an incision under the chin of three to four centimeters, I bring the medial edges of the platysma closer together at the midline with sutures in multiple layers. In some cases, I also remove a strip of muscle to reduce its volume. The result is a smooth neck, free of cords, with a defined contour.
Subplatysmal fat: the deep double chin
Below the platysma is another layer of fat that conventional liposuction simply cannot reach. This deep fat is one of the main contributors to the lack of definition of the cervico-mental angle. In the deep neck lift, I have direct access to this fat and can remove it under direct vision, with millimeter precision.
Digastric muscles: volume under the chin
The digastric muscles have an anterior belly located just below the chin. In some patients, these bellies are naturally bulky and significantly contribute to a full appearance in this region. When I identify this condition, I perform a partial and controlled reduction of the anterior belly of the digastric, preserving its function while eliminating excess volume.
Submandibular glands: the lateral bulge
The submandibular glands are salivary glands located in the lateral region of the neck, just below the jaw. With aging and the loss of tissue support, these glands can become prominent and visible, creating bulges that impair the cervical contour.
In cases where the glands are significantly ptotic or enlarged, I can perform a partial reduction or repositioning, always preserving salivary function. This is one of the most delicate steps of the deep neck lift and requires deep anatomical knowledge to avoid injury to critical structures such as the marginal mandibular nerve.
How I perform the neck lift: the surgery step by step
The neck lift surgery can be performed in isolation or as part of a deep plane facelift. I will describe the complete procedure here, from preparation to closure.
Anesthesia and positioning
The neck lift is performed under general anesthesia in a fully equipped operating room. I work with experienced anesthesiologists who monitor all vital parameters during the surgery. The patient is positioned with the head slightly elevated to optimize the visualization of the cervical structures.
Submental incision
The main incision is made under the chin, in a natural fold of the skin, approximately three to four centimeters long. This incision is practically invisible after healing. Through it, I have access to all the deep structures of the neck.
Superficial liposuction
I start with careful liposuction of the supraplatysmal fat, both in the submental region and on the sides of the neck. I use thin cannulas to preserve the skin's vascularization and avoid irregularities.
Access to the deep plane
I open the platysma at the midline to access the deep structures. It is at this moment that the deep neck lift differentiates itself from the conventional neck lift. Under direct vision, I can identify and treat each structure with precision.
Removal of subplatysmal fat
With the platysma opened, I carefully remove the deep fat that contributes to the double chin. This removal is done under direct vision, allowing for precise sculpting of the cervico-mental angle without the risk of irregularities.
Treatment of the digastrics
When the anterior bellies of the digastric muscles are hypertrophied, I perform a controlled partial reduction. I use bipolar cautery for precise hemostasis and preserve the central tendinous insertion to maintain muscle function.
Treatment of the submandibular glands
In recommended cases, I perform partial reduction or repositioning of the submandibular glands. This step requires maximum care with the marginal mandibular nerve and the Wharton duct.
Platysmaplasty
I bring the medial edges of the platysma closer together at the midline with sutures in multiple layers. This suture creates a continuous muscle band that supports the entire cervical contour. In some patients, I also perform lateral plication of the platysma to further define the cervical angle.
Periauricular incisions (when necessary)
If there is significant excess skin on the neck, incisions around the ear are necessary — in the preauricular fold, around the lobe, and continuing behind the ear to the scalp. These incisions allow me to redrape the excess skin and remove it, creating a clean and defined contour.
Auersvald hemostatic mesh
I apply the hemostatic mesh developed by Drs. André and Luiz Auersvald to eliminate dead space, drastically reduce the risk of hematoma, and eliminate the need for drains. The mesh is removed in forty-eight hours in the office, simply and painlessly.
Indications and ideal candidates for the neck lift
Not every aging neck requires surgery, and not every patient is an ideal candidate for the neck lift. During the consultation, I carefully evaluate each case to recommend the best treatment.
You may be a candidate for the neck lift if you have
- Visible platysmal bands: those vertical cords that appear on the neck, especially when speaking or contracting the muscles.
- Persistent double chin: accumulation of fat under the chin that does not respond to diet or exercise.
- Loss of the cervico-mental angle: the angle between the chin and the neck should be approximately 105 to 120 degrees, but with aging or unfavorable genetics, this angle opens up, creating a "turkey neck" appearance.
- Excess skin on the neck: skin laxity that creates folds and horizontal wrinkles.
- Undefined jawline: when the transition between the jaw and the neck becomes unclear, with accumulation of fat and skin along the jawline.
- Dissatisfaction with a genetically full neck: some young patients already have a bulky neck due to genetic inheritance, without any aging involved.
Anatomical factors that influence the result
During the consultation, I carefully evaluate some factors that directly impact the result of the neck lift:
- Position of the hyoid bone: patients with a low hyoid bone position will have a naturally more obtuse cervical angle, and it is important for them to know that the surgery significantly improves this, but does not create a 90-degree angle in these cases.
- Retrognathia: a retruded chin worsens the appearance of the neck. In these cases, I combine the neck lift with mentoplasty or genioplasty to project the chin and improve the overall profile.
- Skin quality: thin and sun-damaged skin requires special care to avoid irregularities.
- Body weight: overweight patients may benefit from weight loss before surgery to optimize the result.
Procedures I combine with the neck lift
The neck lift is rarely performed in complete isolation. In the vast majority of cases, I combine it with other procedures for a natural, balanced, and complete result.
Deep plane facelift
The most frequent and powerful combination. The deep plane facelift addresses the middle and lower third of the face, while the neck lift completes the rejuvenation of the cervical region. Together, they offer the most complete and natural result possible. In my technique, the dissection is continuous from the face to the neck, allowing for uniform repositioning of the entire structure.
Mentoplasty or genioplasty
Patients with a retruded chin benefit greatly from the combination of neck lift with mentoplasty. The projection of the chin dramatically improves the profile and redefines the cervico-mental angle. In many cases, mentoplasty enhances the result of the neck lift to the point of being almost indispensable.
Submental liposuction
In younger patients with good skin elasticity and predominantly fatty double chins, liposuction can be performed as a complement. But it is important to understand that liposuction alone does not address platysmal bands, deep fat, or excess skin.
Blepharoplasty
The blepharoplasty addresses the eyelids and complements overall rejuvenation. When performed together with the neck lift and facelift, the result is a complete transformation of the appearance.
Facial fat grafting
The fat grafting restores lost volume in the face and brings stem cells that regenerate the skin. It is the ideal complement for any facial and cervical rejuvenation surgery.
Preparation for surgery
Proper preparation is essential for a safe surgery and an excellent result. I follow a strict protocol that I share with each patient during the consultation.
Pre-operative exams
I request the following exams before surgery:
- Complete blood count
- PT with INR + aPTT
- Creatinine and BUN
- Fasting blood glucose
- Total proteins and fractions
- Urinalysis
- EKG
- Pre-operative cardiac clearance
Medications to be discontinued
Two weeks before and two weeks after surgery, you should discontinue:
- Aspirin (acetylsalicylic acid, ASA, Bufferin)
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- High doses of Vitamin E
- Ginkgo biloba and other herbal remedies
- High doses of Omega 3
- Arnica
Smoking
Cigarette smoking must be stopped at least two weeks before and two weeks after surgery. Nicotine severely compromises blood circulation in the skin, significantly increasing the risk of skin necrosis and healing complications. In the neck, where the skin is thinner and the vascularization is more delicate, this risk is even greater.
General guidelines
The day before surgery, I recommend a light meal. Nothing by mouth (NPO) for eight hours before the scheduled time. Come to the hospital wearing comfortable clothing, preferably with a front opening (button-up shirt), so you do not have to pull anything over your head post-operatively. Do not wear jewelry, makeup, or nail polish.
Post-operative care for the neck lift: what to expect
The recovery from the neck lift is generally more comfortable than patients imagine. The Auersvald hemostatic mesh greatly contributes to a smoother recovery.
First 48 hours
You will leave surgery with a compressive dressing on your neck and the hemostatic mesh in place. There will be swelling and some discomfort, controlled with medication. Keep your head elevated — sleep with two or three pillows — and apply cold compresses as directed. Avoid sudden neck movements.
Removal of the hemostatic mesh
In forty-eight hours, you will return to the office for the removal of the hemostatic mesh and dressing change. This procedure is simple and painless. At this point, many patients are surprised by the difference in the contour of their neck.
First week
Swelling peaks between the second and third day, gradually decreasing. Bruising is common and may track down to the chest due to gravity. This is absolutely normal and resolves spontaneously in ten to fourteen days. Stitches from the submental incision are removed between the seventh and tenth day.
Second to fourth week
The majority of patients are presentable for social activities in two weeks, although still with some residual swelling. Makeup can be used carefully to camouflage any remaining bruises. Avoid intense exercise, direct sun exposure, and any trauma to the area.
One to six months
The result progressively refines. Residual swelling continues to subside, tissues settle, and scars mature. The area under the chin may present a temporary sensation of hardness, which is normal and resolves over time. The definitive result emerges between six months and one year.
Important care during recovery
- Sleep on your back, with your head elevated
- Avoid lowering your head in the first two weeks
- Do not engage in physical exertion for thirty days
- Use sunscreen on your neck daily after healing
- Strictly follow the prescribed medication
- Attend all follow-up appointments
Risks and complications of the neck lift
Like any surgery, the neck lift involves risks. My philosophy is to be absolutely transparent about them, so you can make an informed decision.
Hematoma
The most common complication of any lift procedure. The Auersvald hemostatic mesh that I use drastically reduces this risk, eliminating the dead space where blood could accumulate. When it occurs, it is usually small and can be drained in the office.
Nerve injury
The most vulnerable nerve during the neck lift is the marginal mandibular nerve, responsible for the movement of the lower lip. Permanent injuries are extremely rare with proper technique. Temporary paresthesias (sensitivity changes) in the skin of the neck are common and resolve in weeks to months.
Contour irregularities
Asymmetries or contour irregularities may occur, especially if fat is removed unevenly. My meticulous approach under direct vision significantly minimizes this risk.
Scars
The submental incision heals very well in most patients, becoming practically invisible in a natural fold. Periauricular incisions, when necessary, are also positioned in natural folds and creases.
Infection
Rare with adequate antibiotic prophylaxis. When it occurs, it usually responds well to antibiotic treatment.
Unsatisfactory results
Factors such as low hyoid bone position, uncorrected retrognathia, or unrealistic expectations can lead to dissatisfaction. That is why the pre-operative consultation is so important: it is where I set expectations and honestly explain what I can and cannot achieve.
Neck lift versus non-surgical treatments
I need to be honest about a topic that many professionals avoid: the limits of non-surgical treatments for the neck.
Microfocused ultrasound (Ultraformer, Ultherapy)
Promises "surgery-free lifting" through ultrasound waves that heat the SMAS. In practice, the result is subtle and temporary. It does not treat platysmal bands, does not remove deep fat, does not reposition structures. It can be useful for maintenance after a lift, but does not replace surgery when there is real sagging.
Radiofrequency (Morpheus8, FLX)
Stimulates collagen through heat. Offers modest improvement in skin quality, but does not treat any of the deep structures we discussed. For platysmal bands and real double chin, radiofrequency is insufficient.
PDO lifting threads
Create temporary mechanical support with absorbable threads. The result lasts months, not years. They do not treat fat, do not treat muscle, do not remove excess skin. And when the threads are absorbed, everything returns to how it was — or worse, with irregular fibrosis.
Botulinum toxin in the neck (Nefertiti lift)
The application of Botox on the platysmal bands can temporarily soften them, with results lasting three to four months. Useful for patients who are not ready for surgery or as postoperative maintenance, but does not solve the problem definitively.
Cryolipolysis (CoolSculpting) on the chin
Reduces localized fat through cooling. Can eliminate a modest percentage of superficial submental fat. Does not treat deep fat, bands, or sagging skin. Modest results for mild cases.
The reality is that when there is significant skin sagging, visible platysmal bands, or deep fat, surgery is the only way to achieve truly transformative results. Non-surgical treatments have their place — usually for maintenance or very early cases — but do not replace the scalpel when the indication is surgical.
Frequently asked questions about neck lift
What is the difference between a neck lift and a deep neck lift?
The conventional neck lift treats the skin and the platysma muscle. The deep neck lift goes further, accessing structures below the platysma: subplatysmal fat, digastric muscles, and submandibular glands. I perform the deep neck lift on all patients who present volume in these deep structures, ensuring a more complete and defined result.
Can I have a neck lift without having a facelift?
Yes, when aging is predominantly cervical and the middle third of the face is well preserved. This is more common in younger patients with genetic double chins or early platysmal bands. I evaluate each case individually during the consultation to recommend the best approach.
Does chin liposuction replace a neck lift?
Not in most cases. Liposuction only removes superficial fat and depends on the skin's ability to retract. It does not treat platysmal bands, deep fat, digastrics, or submandibular glands. For young patients with good skin and exclusively fatty double chins, liposuction may be sufficient. For others, the neck lift offers a far superior result.
How long does the result of a neck lift last?
The result of a neck lift is long-lasting. The fat removed does not return, the treated platysmal bands remain corrected, and the repositioning of deep structures is permanent. Naturally, aging continues, and after ten to fifteen years some patients opt for a revision. But you will always look better than if you had not had the surgery.
Does neck lift surgery hurt?
The postoperative discomfort of a neck lift is surprisingly mild. Most patients describe more of a feeling of tightness and pressure than actual pain. The prescribed pain medication controls discomfort very well. After two to three days, most patients only need OTC pain medication such as acetaminophen.
How long does neck lift surgery take?
The isolated neck lift lasts between two and three hours. When combined with deep plane facelift, fat grafting, and other procedures, the total surgery can take five to six hours. It is performed under general anesthesia in a fully equipped operating room.
Does a neck lift leave visible scars?
The main incision is made under the chin, in a natural fold, and is practically invisible after healing. When periauricular incisions are necessary for excess skin removal, they are hidden in the folds of the ear and behind it, following the same lines as the facelift.
What is the ideal age to have a neck lift?
There is no fixed ideal age. I have patients in their thirties to forties with genetic double chins who benefit from an isolated neck lift, and patients in their sixties to seventies who need a neck lift combined with facelift. What determines the indication is the anatomical condition, not chronological age.
Can I have a neck lift if I have already had chin liposuction before?
Yes. In fact, many of my neck lift patients have already tried liposuction and were dissatisfied because the problem went beyond superficial fat. The neck lift complements and deepens the treatment, addressing the structures that liposuction did not reach.
What is the hemostatic mesh that Dr. Zamarian uses?
It is a technique developed by plastic surgeons André and Luiz Auersvald, from Curitiba, which consists of transfixing stitches with nylon thread creating a mesh that eliminates dead space under the skin. The benefits are: elimination of the need for drains, drastic reduction of the risk of hematoma, and better neck contour. The mesh is removed in forty-eight hours in the office, simply and painlessly.
Can men have a neck lift?
Yes, and it is one of the most sought-after facial surgeries by the male audience. The neck lift in men follows the same principles, with special attention to the positioning of the incisions due to facial hair. The male facelift with complete cervical treatment is one of the procedures I perform most on male patients.
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Dr. Walter Zamarian Jr.
Plastic Surgeon in Londrina - Brazil
Rua Engenheiro Omar Rupp, 186
Londrina - Brazil
ZIP 86015-360
Brazil
YouTube Channel: Dr. Walter Zamarian Jr.
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