Blanchard asks:

I am a 58 year old female with history of weight loss of 135 pounds. I had a very successful abdominoplasty (removal of 10 pounds of skin) and breast reduction with lift. I am scheduled for an arm lift soon and would like to have my loose skin removed from under my neck. My PS tells me there is so much skin there that I would end up with big wrinkles behind my ears so he suggests an incision down the front of my neck. I will be a long incision. Is this normal? I am concerned.

It is quite common to have moderate turkey gobbler deformity or significant loose skin in the neck area after losing weight.  Today frequently, patients who have undergone lap band surgery or gastric bypass surgery and have lost a good deal of weight, 50 to 100 pounds, have resultant moderate laxity to the neck skin area.

Remedy for this particular problem is somewhat complex.  Some surgeons will approach the solution differently.  One good answer is to simply perform a standard neck lift/facelift to significantly improve the neck issues.  This can be performed at the same time as a platysmaplasty which requires an incision in the submental crease which is just behind the chin area and minimally visible.  A large percentage of patients who undergo this procedure in an expert fashion will have resolution of concerns to the neck area, but there is always a possibility of persistent laxity in the neck area.  Staging of the procedure is also a consideration.  Many patients undergo standard facelift/neck lift with submental approach platysmaplasty will not require further treatment of the neck area, but some do and when they do a vertical scar in the neck area, also known as a t-neck, can be utilized and decided upon at that time which is essentially at a later time.  So in essence, a vertical scar is not essentially required or necessary but indeed might be depending on the particular anatomy and circumstance.

David Q. Santos, MD

Seattle Facial Plastic Surgeon