Hello, I'm Dr. Yoosuk Chung, plastic surgeon at The Line Plastic Surgery.
Will a facelift also get rid of my neck lines?
Many patients say, "I'm here about facial sagging, but I'm also bothered by my neck lines. Will a facelift take care of those too?" Since the neck and face are connected, it's natural to assume that treating one will naturally improve the other.
To get straight to the point: Neck lines aren't caused by a single mechanism — there are at least two distinct types. One is horizontal skin creasing, and the other is vertical banding caused by separation of the platysma, a neck muscle. A facelift primarily addresses the SMAS layer in the face. The platysma is connected to the SMAS but is a separate structure, so it can't be assumed that a facelift alone automatically resolves neck lines as well.
Why are there two different types of neck lines?
The horizontal creases across the neck and the two vertical cords that can appear are fundamentally different in origin. Horizontal lines are more like surface creases that form from repeated folding of the skin, while vertical bands are a structural change caused by the platysma — a neck muscle beneath the skin — separating.
The platysma is a thin, broad muscle that runs from the upper chest up to beneath the jaw. In youth, the two sides of the muscle are often joined or overlapping at the center of the neck. As this central connection weakens and separates with age, the inner edges of each muscle become more prominent, appearing as vertical bands[1].
Think of it this way: Horizontal lines are like a crease ironed into fabric, while vertical bands are more like a zipper that's come undone. Creases can be softened somewhat with ironing (surface-level skincare), but an undone zipper won't close no matter how much you iron the surface.
Why does the pattern of neck lines vary so much from person to person?
A classic anatomical study dissecting 50 cadavers found that the central connection pattern of the platysma muscle varies considerably between individuals. In about 75% of cases, the two muscle bellies overlapped only within 1-2 cm below the chin; in 15%, they were joined almost as a single muscle up to the level of the thyroid cartilage; and in the remaining 10%, there was little to no connection at the midline at all[2]. This inherited structural variation is considered one reason why, at the same age, some people develop prominent vertical bands while others show almost none.
In summary, neck lines often involve a mix of a surface-level skin issue (horizontal lines) and an underlying muscular structural issue (vertical bands). Since a facelift primarily addresses the SMAS layer of the face, whether it also addresses changes in the neck's platysma muscle can depend on an individual's anatomy and the scope of the procedure.
Individual variation and things to keep in mind
The inherited connection pattern of the platysma muscle varies from person to person, which can affect how prominently vertical bands appear with age.
Neck lines can also be influenced by posture (such as repeated forward head tilt from "tech neck"), skin thickness, and weight changes, in addition to genetic factors.
Whether your neck lines are closer to a skin issue or a muscular structural issue is best confirmed through an in-person consultation with a specialist.
The studies cited above analyze anatomical structure; they are not clinical trials directly testing the effectiveness of any specific procedure.
Three key takeaways
1. Neck lines can result from at least two distinct mechanisms: horizontal skin creases and vertical bands caused by separation of the platysma muscle.
2. The platysma's central connection pattern is inherited and varies between individuals, contributing to differences in how prominent vertical bands become[2].
3. The SMAS layer addressed by a facelift and the neck's platysma muscle are connected yet distinct structures, so whether neck lines are also addressed requires individual evaluation.
What's causing your neck lines, and what approach would address the areas you're concerned about, is best confirmed through an in-person consultation with a specialist.
By Dr. Yoosuk Chung (Board-certified Plastic Surgeon)
--- Sources
1. Platysmaplasty Facelift. StatPearls, NCBI Bookshelf. NCBI Bookshelf
2. de Castro CC. The anatomy of the platysma muscle. Plast Reconstr Surg. PubMed 7433553
This article summarizes questions around neck lines and their relationship to facelift procedures based on anatomical references and research published on PubMed. Please consult a specialist to confirm your individual condition.