The patient is a 67 year old woman who didn’t like the fullness of her neck and felt that her face and neck had no separation. On examination the patient had a neck that was prominent and her chin did not have good projection. At her procedure which was performed safely and comfortably under general anesthesia, she had a face lift with a neck lift and a brow lift to restore the natural proportions to her face and to create a separation between face and neck. A chin implant was performed to further separate the face from the neck. She was back to walking outside the next morning and most of her swelling was resolved by the fifth day when she was back to her usual daily activities.
A neck lift can be performed either by itself when there is no jowling or, as it is more often done, combined with the facelift to both define both the face and neck and to provide a separation between these two areas. In this patient, the face seemed to flow into the neck without separation of these two areas and lack of definition of the jaw line. During this patient’s neck lift, fat was removed from above and beneath the neck muscles and the neck muscles themselves were tightened to push the neck backwards. The skin of the neck was then able to be lifted to create a smooth neck contour and separate the neck from the face.
The skin and fat of the cheek and jowl was likewise elevated but also pushed back and this also serves to define the face and create a separation between the face and neck by helping to make the chin appear to be more projecting and creating a stronger jaw line. Lastly, to better create a stronger and longer jaw line and separate the face from the neck, a moderate chin implant was placed. This not only brought the chin forward to create facial harmony but also made the jaw line appear longer, thus separating the face from the neck. Chin implants are not commonly performed when face lifts are done because the simple lifting of the jowl along with moving the soft tissue of the neck backwards makes the chin appear to have more projection (stick out more) and so chin implants are not needed to make the chin look better.
But in this patient one can see that when an imaginary line is dropped from the front edge of the brow region straight down, the chin is clearly behind the line and so a chin implant was required. The chin implant subtly creates a longer but not larger chin and so doesn’t call attention to itself but rather just helps define the jaw line and therefore separate the face from the neck. The increased projection of the chin also helps to diminish the marionette line and highlight the lips, making them appear more contoured and better defined.
The patient also had eyelid surgery where fat was relocated and the skin was smoothed out. This improves on facial harmony because the lid moves into the cheek with evenness and no indentation between the two areas.
