Video calls did something mirrors never did. They showed people their own faces from below, for hours a day, and many did not like the view of their necks and jawlines. The American Society of Plastic Surgeons recorded a 2 percent rise in neck lifts in 2024, double the 1 percent growth in facelifts.
At FACES+ in San Diego, Dr. Steven R. Cohen treats the neck as a separate anatomical problem rather than an extension of the face.
Four layers, four causes
A loose or heavy neck can come from any combination of the following:
Skin that has lost elasticity through age, sun or weight loss.
Fat, either just under the skin or deeper beneath the platysma muscle.
Muscle, when the platysma separates and forms the vertical bands many people notice as they age.
Glands, when the submandibular salivary glands descend and create fullness under the jaw that no amount of weight loss changes.
Each cause needs a different fix, which is why a neck treated with one tool so often disappoints.
Matching the treatment to the layer
When excess fat sits just under the skin and the skin still has good tone, FACES+ can use jawline and neck liposuction to sharpen the profile with little downtime.
When muscle bands are the issue, a platysmaplasty tightens the platysma to smooth the vertical lines and redefine the angle under the jaw.
When skin has loosened, the practice performs a lower rhytidectomy, the traditional neck lift, working through incisions behind the ears and under the chin to lift and tighten skin, fat and muscle together.
When deep fat or prominent glands cause the fullness, FACES+ offers deep neck and submandibular gland reduction. Surface liposuction cannot reach tissue under the muscle, so patients who have tried it without success are often in this group.
The practice states that every neck lift Cohen performs is customized to the individual. In practice that means the surgeon decides which layers to treat before choosing a procedure name.
Why the neck changes the whole result
A refreshed face above an unchanged neck looks mismatched. The reverse is also true: a sharper jawline can make a face read years younger without any work above it. Cohen evaluates the neck in every facelift consultation and treats all its layers where needed, which FACES+ describes as a core part of its California facelift approach.
The neck also suits patients, men among them, who want a firmer jawline without the broader change of a full facelift.
Recovery
FACES+ tells neck lift patients to expect swelling and bruising in the first week and to wear a compression garment for one to two weeks. Most return to light activity after 10 to 14 days. The final contour takes several months to appear as swelling subsides and tissues settle.
Who is a candidate
The practice describes good candidates as people with substantial loose skin in the neck from aging, weight loss or genetics. Patients with fullness but firm skin may do well with liposuction alone. Heavy vertical bands, a “turkey neck” and jowls that spill below the jawline tend to need surgery.
What to ask
Bring one question to any consultation: which layers of my neck cause what I see? A surgeon who can answer that layer by layer will also be able to tell you whether liposuction alone would leave loose skin, whether you need gland or deep fat reduction, and whether your neck should be treated with your face or on its own.
Cohen is a board-certified plastic surgeon, a clinical professor at UC San Diego, and a member of Newsweek’s America’s Best Plastic Surgeons list. FACES+ has practiced in San Diego since 1999.
