Because the neck tends to reveal your age more clearly—and age faster—than your face, it is a key area to address when talking about facial aging.
Some people catch the early signs, like skin texture changes, and horizontal lines across the neck. For these concerns, skin treatments, like chemical peels, energy treatments for skin and dermal stimulating filler treatments can help. For minimal sagging or excess fat is approached with liposuction, or muscle tightening through small incisions. As skin laxity worsens, energy-based lifting treatments come into play.
But once you reach the point where there's noticeable sagging or that "turkey neck" look, surgery is needed for real improvement.
The neck is just as visible as the face, so it's crucial to include it in any rejuvenation plan. Don't focus only on the face and neglect the neck—it's on display every day, too.
Find out why the neck is so tricky to treat, how to pick the right surgeon for a neck lift, and why it's often paired with a face lift. Learn what causes neck aging and how to prevent it and treat it.
Links
Learn more about neck lift and skin quality treatments
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
Transcript
Summer Hardy (00:01):
Welcome to Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host, Summer Hardy, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator, and technology innovator. The title of today's episode is No More Turkey Gobbler: All Things Neck. I get the idea here from the title Dr. Bass, but what is the scope of the topic and why is the neck so important?
Dr. Lawrence Bass (00:32):
Well, the neck tends to show your decade of age even more clearly than your face and age a little more quickly than the face. So it's a very important area when we talk about facial aging. And if you have that hanging wattle of skin under the chin, that definitively pegs you in a certain decade of life. So typically in your sixties, maybe in your fifties, but everyone's going to know for sure you're not in forties or thirties. And the neck is a zone under the jawline, including that area under the chin that's horizontal, but also the area from the Adam's apple down, that includes the Adam's apple and the neck skin going down to the collarbone or clavicles and the top of the chest. And it generally includes the area where the sternocleidomastoid muscle is, the strong muscle on either side of the neck that creates a V or demarcation line for the front of the neck in the back of the neck. It's behind that, but most people don't see the back parts of your neck when you're talking to them or when you're walking around.
Summer Hardy (02:00):
Okay, that makes sense. And then given the title of this episode, can you tell me what is a turkey gobbler Dr. Bass?
Dr. Lawrence Bass (02:08):
So as I mentioned, it's that hanging wattle of skin that hangs down from underneath the chin to just above the Adam's apple. Some people have vertical banding even when they're very young. That's not a turkey gobbler, but when you really start to have that hanging band of skin and fat, that's not muscle tenting up and that represents substantial excess of skin. That's a turkey gobbler that puts you in your sixties, maybe in your later fifties, except for folks who have lost massive amounts of weight that defines your decade. And most people really hate it and feel it makes them look considerably less attractive. It's typically associated with a bunch of other aging changes, and so it's something people really want to chase and get rid of.
Summer Hardy (03:12):
Got it. What is the treatment for a turkey gobbler? Are there nonsurgical options?
Dr. Lawrence Bass (03:17):
So by the time you reach the stage where you have that actual hanging band of skin and fat, you are past the stage where there's any meaningful treatment using nonsurgical methods. And I do a lot of research and I'm very interested in new technologies and I've tried all kinds of technologies on these things and I've succeeded in taking a component, a percentage if you will, of the turkey wattle out. But if you have that hanging turkey gobbler and I take 20% of it away, which would be a really good result and I've succeeded in doing that in some folks, you still have 80% of it present. You still have an obvious visible turkey gobbler. You're still obviously in your sixties, you're not in that adult indeterminate stage that we're trying to create with facial rejuvenation. So in my view, that's a failure. And my experience with patients has been that they're still unhappy with their appearance because they were really looking to minimize that. We never get rid of a hundred percent, but if we got rid of 80 or 90% of what's there or 95% if we were really lucky, you look definitively better and the future is mild rather than being obvious.
(04:49):
But if you only take 10, 20, 30% away, the future is still obviously there and you're still obviously in that later stage of life.
Summer Hardy (05:01):
I didn't realize that once you can really see it, surgery is one of the main options then. So what kinds of aging changes are typical in the neck?
Dr. Lawrence Bass (05:11):
So even though we titled the episode about the turkey gobbler, we're really, as we said in the subtitle, talking about all things neck. So just like the face, the neck is an area anatomically that that has a lot of complexity. There are a lot of different structures under there in a very small amount of space. A lot of those structures are really important things for your life and well being. So someone who works in the neck needs to be intimately familiar with all of that anatomy and like the face, unfortunately, there's not a single thing that ages in the neck, a single anatomic structure that needs to be addressed. But there are multiple components and those components include skin quality things. So skin quality talks about redness and vascular changes, pigmentary changes like age spots and sort of bronzing of the skin, the turgor of the skin.
(06:20):
Does it look floppy and parchment like or is it firm and springy like youthful skin? And texture, wrinkles and crepiness has that skin texture declines. You show more and more aligns wrinkles and irregularity. So those are skin quality issues. Then there's skin laxity, which starts out as a little bit of hanginess and progresses to the point where you really have the turkey gobbler. There are muscle changes like separation of some of the platysma muscle, which is really a paired muscle and that can show some vertical banding and other kinds of lines and also contribute to dissent and blunting of the cervicomental angle. The angle between the horizontal and the vertical glands in the neck can also show, so glands like the submandibular gland that sit under the jaw, tucked up behind the jaw when we're young, start to sag and droop down and they can show on the side of the neck just under the jawline. And finally fat, which can be excessive in the neck, building up, contributing to fullness, contributing to blunting of the demarcation between the jawline and the neck and fullness of the area under the jawline and under the chin.
(07:53):
So those are a long laundry list of all of the small things that can go together to create an aging appearance in the neck.
Summer Hardy (08:05):
Wow, there are a lot of small details that's really interesting. When do they show and what are the big factors in this area?
Dr. Lawrence Bass (08:12):
So of course aging is variable, so there's no single age where a given feature is going to show, but we do age based on some controllable factors and some that are not currently controllable. So sun exposure is a big factor in skin aging and neck skin is really affected by that as well as smoking. Those are our two big controllable factors. And then there's also timing of skin aging based on your skin type fair thin skin tends stage more quickly than thicker, darker skin. So those are some of the factors. But most people by the time they're in their forties, will start to have some texture changes in the skin of their neck, often even in the thirties and some fair skin, people who get a lot of sun can start to see these changes in their late twenties. There we're mostly talking about skin laxity changes and laxity starts to creep in and most patients in their fifties accelerate in the sixties. And for women menopause is a watershed where again, skin laxity and other skin aging changes can speed up.
Summer Hardy (09:37):
Okay. So we've heard about a few of the problems. What is the approach to treatment?
Dr. Lawrence Bass (09:42):
Well, this depends on what is really showing and predominates in the appearance of the neck and on when the patient shows up asking for help. So some people come very early, they're starting to see some skin quality changes, some lines going side to side across the bottom of the neck, a little bit of sagging of skin or a little bit of fullness or banding of skin. So at that point, skin quality treatments are going to be the focus and sometimes liposuction or a little muscle tightening just done through small incisions under the chin. As skin laxity progresses, we can come in with energy based treatments for the skin, and these are ideally for people in their forties and some people in their fifties who don't yet need a surgical neck lift or a surgical facelift, if they just have a little laxity, those energy-based treatments can give them what they need, which is just a little bit of tighten up. But if there's significant laxity or the obvious turkey gobbler, those technologies are not going to be able to contribute enough change to make a meaningful difference.
Summer Hardy (11:05):
I've heard that the neck is harder to treat. Is this true? And if so, why?
Dr. Lawrence Bass (11:11):
The neck skin is significantly different from our face skin, even though the neck skin is only a few inches away from the face, blood supply is different, the thickness of the skin is different. And most importantly, there are things called adnexal structures in the skin. So these are sweat glands, oil glands, hair follicles, things that are in the skin that are not skin material, skin fabric themselves. And that's a source of healing and regeneration in part for skin when it's wounded. And just in terms of its regeneration and turnover, skin turnover declines as we age and our neck skin has a thousand fold fewer adnexal structures than our face skin. So that skin is going to show aging changes first. And it also tells us why it's going to be harder to treat because its ability to heal and regenerate is significantly less than that of face skin.
Summer Hardy (12:26):
That's really interesting. Here's something I've always wondered about, what is the difference between a facelift and a neck lift?
Dr. Lawrence Bass (12:35):
So that difference means a lot more to patients semantically than it does to plastic surgeons. There are some procedures that focus on addressing lax skin in the neck or addressing deeper structures in the neck. And these are sometimes done in early stage of aging where we make an incision just in front of the ear or just behind the ear to lift the skin just in the neck in a more focused fashion. But most of the time we're making a more extensive incision that's both in front of and behind the ear and back into the posterior hairline. And we're generally resetting in harmony, a lot of the tissues in the face and neck because a key element of what both a facelift or a neck lift are aiming to correct is hanging skin in the neck and a sharpening of the jawline. And the jawline is that demarcation between the face and the neck.
(13:50):
So in either a facelift or a neck lift, that has to be made as sharp, defined and youthful as it possibly can be. And that means that all the adjacent structures both above and below are going to require a little bit of tinkering so that everything remains in harmony. So there are just facelifts and just neck lifts, but most techniques are going to involve at least some work in all or both of those areas. And that doesn't really modulate the recovery, which is part of the reason why some people are focused on getting just a neck lift or just a facelift because they don't want to mess with more than they have to. And you get more or less the same recovery if you have a proper neck lift or facelift. Just the area where that bruising or swelling may occur is slightly larger, but it doesn't necessarily last any longer. If you're adding a bunch of other procedures, it may last a little longer, but not between the facelift and the neck lift.
Summer Hardy (15:07):
Okay, that makes a lot of sense. Thanks for explaining. So then more recently, I've heard the term deep plane neck lift mentioned. What does this mean and how is it different from traditional neck lifts?
Dr. Lawrence Bass (15:20):
So deep plane techniques, which is really a better way of putting it than neck lift, is sort of a marketing term that a lot of people who are promoting deep plane facelift are using, but it does have some significant medical meaning to most of us in plastic surgery. And the important thing here is that there are a bunch of structures in the neck that need to be addressed in a patient who has a significant amount of aging besides just the skin. And so deep techniques, deep plane techniques in the neck mean addressing things that are under the skin and under the platysma muscle. So in addition to taking out subcutaneous fat, often there is fat under the platysma and that fat needs to be reduced to create the shape in the submental area or the area under the chin that we want. Some patients, if you just take the subcutaneous fat, they'll still have some bulging under the chin that has to be done in proper measure because if that's over aggressively done, you can get concavity and hollowness under there what's called the cobrah neck deformity, which is undesirable. There are also muscles there, the anterior gastric muscles that sometimes contribute to fullness, and sometimes these are at least the anterior leg of that muscle is debulked. The submandibular gland, which we talked about previously, which can start to sag down, can either be tugged up in some techniques or more commonly debulked.
(17:14):
And there's a lot of different kind of effort, more extensive effort being expended on how the platysma muscle itself is handled separate from the skin draping that takes place in the neck to tailor out the laxity. So controversial which techniques work best for the platysma and It's probably different in different patients depending on what their neck shape is like. And so examination and customization of the for any patient is important when you're chasing more advanced techniques as part of an neck lift.
Summer Hardy (17:58):
Can you tell me a bit more about the approach to procedure selection? What is the best option and how should I choose?
Dr. Lawrence Bass (18:05):
So in terms of which procedure for skin lifting, as I was just explaining, we need to customize based on the shape of the neck, the shape of the jawline. Some people have a very long jaw, a very projecting jaw, other people do not. Some people have a jaw that's angulated very much up and other people have a much more horizontal jaw. That's all going to affect how things drape with the skin, the fat, the other structures in the neck, people have different positioning to the hyoid bone. It's a little bone that sits again at the cervical mental angle. The intersection between the horizontal and the vertical above the Adam's apple and how low or high that bone sits is going to affect the shape of the neck, how much fat is there, how much skin laxity. So what all of that means as a bottom line is there's no one procedure that's the right procedure.
(19:13):
And also different surgeons have different approaches using the same basic techniques. So what's most useful is to work with someone who's an experienced plastic surgeon, knows what works well in their hands, looks closely at which features and what layout is present in your neck, listens carefully to which features bother you the most and make sure that they work that into the plan. So that's in terms of skin laxity and surgery. In terms of skin quality treatments, there's really a big range of treatments and there are a lot of different ways to push the skin quality and get it to improve. These treatments are going to vary depending on how extensive the finding is, how severe it is. So even if you pick the exact same laser or the exact same PRP treatment, you're going to do it differently based on what the stage of aging is, what the skin type is, how severe the finding is, what other associated findings are there, and how many treatments you're willing to have, and how much recovery time you're willing to have. So you pick something that's a good intersection of all of those factors and it should be pretty clear from that discussion. Again, there's no one right answer or one best technique, but it depends bothering you and how much effort you're planning to expend to chase that feature and get it corrected.
Summer Hardy (20:55):
Got it. And what are your takeaways, Dr. Bass?
Dr. Lawrence Bass (20:59):
So the neck is a really important area to include in any rejuvenation plan. It's just as important as the face because people see it all day every day. It's not an area of the body that's hidden. So don't chase away aging changes on the face and forget to treat the neck. That's really important as a first step. Recognize that it's going to take more treatments to get a given amount of correction on the neck than on the face, so it's more treatments. It's a slower and more limited response when you treat the neck. because of that difference in the skin biology, that means you really ought to plan early and get a jumpstart on things before they're really set in cement and difficult to undo. So working on skin quality early, certainly with sunscreen in your twenties and starting to look at skin products and protection and moisturizing in your thirties and maybe even some in-office treatments is really important, especially skin quality things. The laxity comes later, typically late forties, the second half of forties, fifties, and sixties. But skin quality is going to start to show problems earlier in most folks. Finally, probably the best results are obtained with a multimodality approach that addresses all of the little aging changes in at least some measure, and that also allows you to use things for what they're good for, use things in a moderate amount rather than trying to take one modality and pushing it too hard, which gives you diminishing returns and potentially more risk of complications.
Summer Hardy (23:05):
Thank you Dr. Bass for getting me up to speed on all things neck with this fascinating look at a critical area. Thank you for listening to the Park Avenue Plastic Surgery Class Podcast. Follow us on Apple Podcasts, write a review, and share the show with your friends. Be sure to join us next time to avoid missing all the great content that is coming your way. If you want to contact us with comments or questions, we'd love to hear from you, send us an email at [email protected] or DM us on Instagram at @drbassnyc.
