Does a facelift include a neck lift? Facelift vs neck lift vs combined face and neck lift
Does a facelift include a neck lift? Sometimes, partly, and it depends entirely on what the surgeon means by "facelift". This is one of the most common sources of confusion I encounter with Australian and New Zealand patients, and it is worth clearing up before anyone books an operation, because the facelift vs neck lift question decides what incisions you have, what changes you see, and what you pay.
The short answer is this. A facelift treats the cheeks, the jowls and the folds around the mouth. A neck lift treats the loose skin under the chin, the vertical bands of the neck muscle, and the fat and sagging that produce a "turkey neck". Most facelift techniques pull some of the upper neck skin along with the face, so a facelift alone will improve a mildly loose neck. But a facelift does not include the work under the chin that a genuine neck lift involves, and in a patient with real neck ageing, a facelift on its own leaves the neck behind.
In my practice, most patients over fifty who ask for a facelift actually need a combined face and neck lift, and I plan it that way from the start.
What a facelift actually treats
The word facelift has drifted over the years. When I use it, I mean surgery to the mid and lower face: the cheeks, the jawline and the region around the mouth.
Ageing in this area is driven by the descent of the deep tissue. The cheek fat pads slide downward, the SMAS (the fibrous and muscular layer beneath the skin) loosens, and the ligaments that anchor these structures to the bone stretch. This produces hollowing under the eyes, deep folds from the nose to the mouth corners, marionette lines below the mouth, and jowls along the jaw.
A deep plane facelift, which is the technique I use as standard, releases these ligaments and repositions the cheek and SMAS upward as a single unit. The jowl resolves because the tissue that formed it is moved back onto the jawline. The skin is then redraped without tension. The incisions run from the temple, in the crease in front of the ear, around the earlobe and behind the ear.
What a facelift does not do is address the platysma muscle under the chin, remove deep neck fat, or tighten the skin in the centre of the neck. The pull from the ear incisions reaches the sides of the neck, but it weakens toward the midline.
What a neck lift actually treats
A neck lift is surgery to the region below the jawline. Neck ageing has its own set of causes, and they are different from the face.
The platysma is a thin sheet of muscle that runs from the chest up over the jaw. With age its two halves separate in the midline and the edges become visible as vertical bands. Fat accumulates both above and below the muscle. The skin loses elasticity and hangs. In some people the salivary glands under the jaw and the small muscles under the chin also contribute to fullness.
A neck lift can involve several steps depending on what is present. Fat is removed by liposuction or directly. The platysma is tightened and its edges stitched together in the midline, a procedure called platysmaplasty, through a small incision under the chin. The loose skin is then redraped and the excess removed through incisions behind the ears. I have described the neck problems this addresses in neck lift in Bangkok: fixing jowls, bands and turkey neck.
A neck lift on its own does not lift the cheeks. It improves the jawline from below, but cannot correct a jowl caused by descended cheek tissue.
Facelift vs neck lift: the comparison
FaceliftNeck liftCombined face and neck liftTreatsCheeks, folds beside mouth, jowls, jawline from aboveLoose neck skin, platysma bands, neck fat, jawline from belowAll of the aboveIncisionsTemple, in front of and behind the earUnder the chin, behind the earsTemple, around the ear, under the chinKey manoeuvreRelease and reposition SMAS and cheek fatPlatysmaplasty, fat removal, skin redrapingBoth, in one operationEffect on neckPartial, sides onlyFullFullEffect on cheeksFullNoneFullTypical candidateMid-face ageing with mild neck laxityNeck ageing with a good mid-faceAgeing of both, which is most patients over 50RecoveryAround 2 weeks before flying homeSimilarSimilar; not doubled
Why the face and neck are usually treated together
The face and neck age as one unit. The tissue that descends from the cheek forms the jowl, and the jowl blends into the loose tissue of the upper neck. Treating one side of that boundary and not the other produces a mismatch, and the mismatch is one of the recognisable signs of a bad facelift: a smooth, tight jawline sitting on a loose, banded neck, or a crisp neck under heavy jowls.
There is also a mechanical reason. The platysma in the neck is continuous with the SMAS in the face. When I release and lift the deep plane in the face, the tissue moves better if the neck component has also been released. And the skin of the neck cannot be redraped properly unless the skin of the lower face has been lifted too. The two operations support each other.
For these reasons, a combined face and neck lift is my most common operation. It is one anaesthetic, one recovery, and one set of incisions that share the same paths behind the ear. The recovery is not doubled by adding the neck, and I discuss the typical schedule in how long to stay in Bangkok after a facelift and when it is safe to fly.
Where the lower facelift fits
A lower facelift is a term you will see used differently by different surgeons, which does not help anyone.
Usually it means a facelift focused on the jawline and jowls, with less work in the upper cheek, and often with some neck skin tightening from the ear incisions. In practice it is a facelift that stops short of full mid-face repositioning. Some surgeons use "lower facelift" to mean a facelift plus neck lift. Others use it to describe a limited, short-scar lift.
If a surgeon offers you a lower facelift, ask exactly what will be done to the cheeks, whether the platysma will be treated, and whether there is an incision under the chin. Those three answers tell you which operation it really is.
When a facelift alone is enough
Some patients genuinely do not need neck work. They tend to be younger, often in their forties, with early jowling and folds beside the mouth but a neck that is still firm, with no bands and no excess fat under the chin. For them a facelift alone treats what is present, and the slight pull on the upper neck skin from the ear incisions is sufficient. I see no reason to make an incision under the chin in a neck that does not need it.
I wrote about timing in best age for a facelift. The neck usually follows the face by some years, which is why the younger the patient, the more likely a facelift alone is appropriate.
When a neck lift alone is enough
The reverse also happens. Some patients, particularly men, have a well-preserved mid-face with good cheek volume and no significant jowl, but a neck that has aged early: bands, a full under-chin, and loose skin. Genetics, weight changes and sun exposure all contribute. For these patients a neck lift alone, sometimes with platysmaplasty and liposuction, is the right operation. Adding a facelift would be surgery for its own sake.
How I decide in consultation
When I assess a patient, whether in person or by video, I look at the face and neck separately and then together.
For the face I look at cheek position, the depth of the folds beside the mouth, and the size of the jowls. For the neck I ask the patient to grit their teeth, which makes platysma bands stand out, and I look at the angle between the chin and the neck, the amount of fat under the chin, and how the skin behaves when the head turns. I also look at the chin itself, because a small chin makes the neck look worse than it is and is sometimes better addressed with a chin implant than with more neck surgery.
Then I ask what bothers the patient most. "My jowls" with a good neck is a facelift. "My neck" with a good face is a neck lift. "This whole area", which is most common, is both. And a patient with minimal laxity in both is told to wait or do nothing, because neither operation would justify the scars and the recovery.
Cost and practical considerations for Australians and New Zealanders
A face and neck lift costs more than a facelift alone, but usually less than two separate operations, and it involves one trip, one anaesthetic and one recovery. I have written about the general cost comparison in facelift in Thailand: the complete guide for Australians and New Zealanders. Medicare does not cover purely cosmetic surgery, and since 1 July 2023 Australians need a GP referral before a cosmetic surgery consultation; that visit is a good opportunity to have blood pressure and general health checked before you travel.
Frequently asked questions
Does a facelift include a neck lift?
Not fully. Most facelifts pull the upper neck skin from the ear incisions, which improves mild laxity at the sides of the neck. A facelift does not tighten the platysma muscle, remove deep neck fat or treat the midline of the neck. Those require a neck lift, usually through an incision under the chin.
What is the difference between a facelift and a neck lift?
A facelift treats the cheeks, the folds beside the mouth and the jowls. A neck lift treats loose skin under the chin, vertical muscle bands and neck fat. They can be done separately or combined, and the combined operation is most common in patients over fifty.
Is a lower facelift the same as a neck lift?
No, though the terms overlap. A lower facelift usually means a facelift focused on the jawline and jowls, with some pull on the upper neck. A true neck lift includes work on the platysma muscle and fat under the chin. Ask any surgeon exactly what will be done rather than relying on the name.
Is a face and neck lift a longer recovery than a facelift alone?
Slightly, but not doubled. Swelling and bruising in the neck add some discomfort, and a supportive garment is worn for a period, but most patients still return home around two weeks after surgery and follow a similar timeline to a facelift alone.
Do I need a chin implant as well as a neck lift?
Sometimes. A small or receding chin makes a mild neck problem look worse. In those patients a modest chin implant, placed in the same operation, can improve the profile more than extra neck surgery would.
This article is general information, not medical advice. Whether you need a facelift, a neck lift or both depends on your own anatomy, and I can only advise after seeing you. If you would like to discuss the facelift vs neck lift question for your own face, you are welcome to book a video consultation.
