The jawline marks a border between two surgical territories. Above it sits the domain of the facelift; below it, the neck lift. Aging ignores that border, and a plan that stops at it can leave a smooth lower face sitting above a loose neck.
The practice of Leo Lapuerta, MD, FACS, addresses this in both its facelift and neck lift guidance. On the facelift side, the practice states that patients with neck laxity often need a neck lift at the same time for a cleaner result, and that when facial aging extends into the neck, a neck lift may be recommended with the facelift for more balanced correction. Dr. Lapuerta is a triple board-certified plastic surgeon with more than 30 years of experience and more than 30,000 surgical and non-surgical procedures.
The boundary between operations
A facelift, or rhytidectomy, lifts deeper tissues, tightens the support layer beneath the skin and removes excess skin. The practice describes its aim as restoring youthful contours in the lower face and neck. Its list of treatable concerns includes sagging skin along the jawline, jowls, deep nasolabial folds and excess skin beneath the chin.
A neck lift works on the structures below. Dr. Lapuerta divides it into two procedures: platysmaplasty, which alters the neck muscles, and cervicoplasty, which removes excess skin. Liposuction comes first when fat pockets need removal. The incision sits under the chin and, in some cases, behind or in front of the ears.
The two operations overlap at the jaw and under the chin. The practice lists a smoother transition from face to neck among a facelift’s benefits, and that transition is the zone where a single procedure can fall short when both regions have aged.
The case for one plan
The practice frames the best facelift results as coherent ones. By its description, the face and neck match, the jawline looks cleaner, and the skin sits with a better fit over the underlying support. A lifted cheek above a neck with loose skin, slack muscle or fat beneath the chin breaks that coherence.
Dr. Lapuerta described his approach to anatomy in his own words: “It allows me to work with what I have in a given patient presentation and utilize all aspects of that patient’s anatomy, with its benefits and limitations, along with my skills to create both the desired aesthetic and a functionally beneficial outcome for my patients.”
That view shapes the consultation. The practice says facelift planning starts with the full picture, including facial structure, skin elasticity, skin quality, degree of loose skin, and the pattern of aging across the cheeks, jawline and neck.
Cases for a neck lift alone
The reverse also happens. The practice describes neck lift patients who are happy with the youthful appearance of their face but troubled by a neck that shows age earlier. For them, a full facelift is not yet necessary, and a neck lift alone can bring the neck in line with the face.
The practice also flags a different culprit. Some neck problems trace back to a weak chin, since the neck cannot hold a defined contour without support from the chin bone. A chin implant may be recommended, and a neck lift may still be needed afterward.
Its facelift guidance offers a caution that applies here: combination plans work best when each element is selected for a reason and not added by default. Some patients need both operations. Others need one.
The trade in downtime
Combining procedures changes the recovery picture. The practice notes that facelift social downtime depends on the extent of surgery, the presence of a neck lift and the patient’s own healing pattern, and that treatment length varies when a neck lift or other procedures are added.
The two operations share some features. Each can involve incisions near the ears, placed to limit visible scarring, and each calls for keeping the head elevated in the first days of recovery. Each carries surgical risks that a consultation should cover.
Dr. Lapuerta serves as Chairman of Plastic Surgery at St. Joseph Hospital and is teaching faculty for plastic and reconstructive surgery programs at UT-Houston, the University of Texas Medical Branch in Galveston and Houston Methodist Hospital. For a patient who sees jowls in the mirror and loose skin in a side profile, the deciding question for the exam room is narrow: whether the neck has aged along with the face, or on its own schedule.
This article is for general information only and is not medical advice. Results vary from patient to patient. Consult a board-certified plastic surgeon or your physician about your own situation. Written in partnership with Joseph Lambert, a publicist working with Leo Lapuerta, MD Plastic Surgery.
