Submental Incision in Deep Plane Facelift + Neck Lift

When Surgeons Combine Deep Plane Facelift With Neck Lift

The decision to add a submental incision (and the work that goes through it) is driven by central neck anatomy assessed at consultation. The combined approach is indicated when one or more of these features is present:

• Visible platysmal banding: the two vertical neck cords visible especially when the patient looks up or animates the lower face. The lateral lift partially relaxes these but rarely eliminates them — direct platysmaplasty does.
• Obtuse cervico-mental angle: a "shallow" or "blunted" chin-to-neck transition (the angle is greater than the ideal 105-120 degrees). Sub-platysmal fat removal and digastric reduction sharpen this angle directly.
• Sub-platysmal fullness: deep neck fat that sits under the platysma muscle and is not removable with liposuction or with the lateral lift alone. Direct access is required.
• Digastric muscle hypertrophy: enlarged anterior bellies of the digastric muscle visible as fullness on either side of the midline under the chin, only addressable via the submental approach.

Roughly 60-70% of deep plane facelift patients in their 50s and 60s benefit from a combined neck lift; younger patients (40s) often have enough platysmal tone that the lateral lift alone produces a satisfactory neck result. The surgeon's pre-op assessment — looking up, looking down, animating the lower face, palpating the platysma — is what drives the decision. This is why surgeon experience matters: the call between "lateral lift alone is enough" and "combined approach is needed" is judgment-driven.

Submental Position and Length: Why Slightly Posterior to the Crease

The natural submental crease (the line where the chin transitions to the neck) seems like the obvious place to put the incision — but most surgeons place the incision slightly posterior (toward the neck, ~5-8 mm) to it, not directly in the crease. The reason is the post-surgical neck contour: as platysmaplasty and fat work tighten the central neck, the soft tissue redrapes upward toward the chin. An incision placed in the original crease is pulled forward by this redraping and ends up sitting on the chin proper, where it's visible from straight-on views. An incision placed posterior to the crease ends up exactly in the new submental shadow after redraping — invisible from any normal viewing angle.

Length is dictated by the work required: a minimal 2.5 cm cut suffices for platysmaplasty alone, 3-3.5 cm for added sub-platysmal fat sculpting, 3.5-4 cm if digastric muscle reduction is included. A common patient question — "can you just make the incision smaller?" — has a real trade-off: a shorter incision than the work requires forces the surgeon to operate through tension on the wound edges, which is one of the strongest predictors of hypertrophic scarring. Surgeons who pride themselves on tiny submental incisions often produce more visible scars than colleagues who make a 3.5 cm incision and close at zero tension.

Orientation is transverse (horizontal, parallel to the natural skin tension lines) — never vertical. Vertical scars in this area heal poorly because they cross natural skin tension lines and are pulled open with every neck movement.

What to Avoid During Healing

The submental incision is one of the easier scars to protect because it's in a low-mechanical-stress area, but a few rules apply:

• Soft diet first 48-72 hours. Aggressive chewing, hard or chewy foods, and large bites tense the platysma directly under the closure. Liquid → soft → normal across the first week.
• Avoid head-flexion (chin-to-chest) for 2 weeks. Sleeping with the chin down, crunches, sit-ups, or extended phone use with the head bent forward all stretch the closure. Most surgeons recommend a small neck pillow that keeps the chin slightly elevated for the first 14 days.
• Chin-strap as prescribed, then off. Many surgeons use a soft chin-strap or compression garment for the first 5-14 days to support the platysmaplasty. Wear exactly as prescribed — over-tightening risks closure necrosis and pressure ulceration.
• No shaving directly over the area until cleared. Most patients can use an electric razor at week 2 and a wet razor at week 3-4. The submental skin is naturally hairless or sparsely-haired in most women.
• Silicone gel twice daily from week 2 through month 6. Same protocol as facial scars — strongest evidence-based scar treatment available over-the-counter.

Sun protection is less critical here than at facial scars because the area is naturally shadowed by the chin, but daily SPF 50 when outdoors is still recommended through month 12 for any prolonged sun or beach exposure.

For more on what protects scars long-term, see our scarless techniques guide and the scarring complications page.

Combined vs Staged: When Each Makes Sense

For most healthy candidates with both indications, combined is the better technical and recovery decision. Staging is the right call only when specific medical or surgical reasons override the default.

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