What the research shows
The neck ages differently from the face after surgery. On standardized photographs taken more than five years after a facelift, the jowl correction had largely held while the neck angle had lost much of its gain (Jones 2012). Among patients who came back for a second neck lift, returning cords were the most common reason, and the second operation came about ten years after the first (Narasimhan 2016).
The cords come from the muscle pulling. Patients with one side of the face paralyzed had cords only on the working side (Trévidic 2017). In cadaver dissection, the nerve to the central platysma stayed intact after the usual muscle-cutting maneuvers (Sinno 2019), and a recent review names that surviving nerve supply as the main cause of first and returning cords (Sherif 2026).
Surgeons reach the neck in two ways. The open approach uses a short incision under the chin to stitch the muscle edges together down the midline and remove deep fat (Feldman 1990). The closed approach releases the neck ligaments and lifts muscle and skin sideways from the facelift incisions, so the chin incision is rarely needed (Mustoe 2011). In patient-reported scores, selected patients rated their necks highest after closed lifts without liposuction; when fat was suctioned, open techniques scored higher than closed ones (Fiore 2026).
Serious problems are uncommon. Pooled across published series, returning cords, nerve injury and a blood collection under the skin (hematoma) each occurred in fewer than 1 in 50 (Cambiaso-Daniel 2025). Deep neck work on the salivary glands and the digastric muscles carries more temporary nerve weakness than a standard neck lift, which is a trade to discuss before surgery (Chinta 2025). Tranexamic acid, a drug that slows bleeding, reduced bruising, swelling and drain output in face and neck lifts (ElAbd 2025).
Botulinum toxin injections relax the cords for a few months and work best in mild cords with good skin (Sugrue 2019, Jabbour 2017). They do not lift the lower face, loose skin limits them, and the effect wears off (Kane 1999).
Where surgeons disagree
- Cutting the muscle across its full width. One surgeon audited his own full-width transections and found cords back in close to half of necks at one year, with long swelling; he moved to a lateral technique that kept more necks smooth with a shorter recovery (Pelle-Ceravolo 2016, Pelle-Ceravolo 2017). Another surgeon reports no returning cords after overlapping the muscle edges in the midline (Guyuron 2010).
- Open or closed neck. Open-neck surgeons hold that the chin incision gives the most lasting result and open it in every revision (Narasimhan 2016). Closed-neck surgeons avoid it almost entirely (Mustoe 2011). The pooled scores support each approach for a different patient (Fiore 2026).
- Cutting the nerve on purpose. Some surgeons now divide the nerve branch to the central muscle during the facelift. Cords returned in about 1 in 10 at one year, all in patients over 63, with only minor complications (Criollo-Lamilla 2026).
What is new
- Necks treated earlier with fat-dissolving injections, fat freezing, radiofrequency devices or threads were scarred inside, surgery took longer, nearly all needed deep neck work, and contour irregularities were common afterward (O'Daniel 2026). A patient who may want a neck lift later can weigh this before nonsurgical neck treatment.
- Deep neck lifts that reshape the salivary glands, digastric muscles and fat below the muscle are now common, with wide variation in what each surgeon changes (Chinta 2025).
- Toxin placed only where the nerve enters the upper platysma relaxed cords as well as a full grid of injections, with half the needle sticks (Yi 2026).
What is still unknown
- Which technique keeps the neck smooth longest: most reports follow patients for a year or two, and few use objective measures (Chinta 2025, Cambiaso-Daniel 2025).
- How well revision neck lifts work: results are mostly described by the operating surgeon (Şibar 2026).
Key papers
- Feldman 1990: described the corset platysmaplasty, a full-height midline muscle seam that leaves no free edge to form a cord.
- Jones 2012: measured facelift results at five years; the jowl held better than the neck.
- Pelle-Ceravolo 2016: a one-year audit showing that cords and loose skin returned after full muscle transection.
- Trévidic 2017: showed cords come from muscle activity, using patients with one-sided facial paralysis.
- Sinno 2019: showed the nerve to the central platysma survives standard neck lift maneuvers.
- Sugrue 2019: reviewed botulinum toxin for mild cords and the safe injection pattern.
- Cambiaso-Daniel 2025: pooled the rates of returning cords, nerve injury and hematoma after neck lift.
- Fiore 2026: compared patient-rated results of open and closed neck lifts.
- O'Daniel 2026: showed that nonsurgical neck treatments make a later neck lift harder.