Before and after photos of a patient who underwent direct excision with Z-plasty under local anesthesia. The “after” photo was taken 14 years post-op. COURTESY FINGER AND ASSOCIATES

With younger patients, a primary concern about the neck is fat deposits under the chin. This fat is often genetic or from excess weight gain.

Often, though, the patient is not overweight, yet there is still excess fat in the neck area.

If one is young, a simple, one-time liposuction can be performed under local anesthesia, which will permanently remove the fat. The procedure takes less than an hour and has no downtime, except for some minimal bruising and swelling.

As one gets older, however, the skin loses its elasticity, and there might be a need to remove or tighten the skin.

ThermiTight employs a probe that is inserted under the skin of the neck, and this will tighten the skin as well as help with loss of elasticity. Thermitight can be used just for loose skin and can be done simultaneously with liposuction if there is also fat involved – although the ThermiTight itself does melt fat.

Additionally, for sun-damaged loose neck skin, a Fraxel laser can tighten mild to moderate skin excess successfully. This is done under local anesthesia. There is some recovery time required because of swelling and redness that results from the treatment.

If one has too much saggy skin, direct excision of skin with a Z-plasty of the neck area is another option. Also done under local anesthesia, this involves removing a wedge of the skin and suturing the area in the form of a zig-zag.

Once the sutured area heals, the scar is usually barely perceptible. Many patients, especially men, like this procedure because it can reduce the look of a “turkey gobbler” neck without the need of a facelift.

However, if someone has loose skin, with or without excess fat in the jowl area, a facelift might be recommended.

A facelift is the gold standard when it comes to tightening up the lower face and jowls. However, it does require general anesthesia and a 10- to 14-day recovery period.

In the past, a facelift was about the only option available. With the advent of liposuction, ThermiTight, and direct excision of the sagging skin, there are now less-invasive procedures available that do not require general anesthesia and have less recovery time.

Some patients have the “bands” in their necks, but long-term elimination of these bands can be inconsistent. Tightening the neck and severing the bands during a facelift can be successful in many cases. In other cases, a Botox injection every four to five months seems to help as well.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton.