Quick overview
How long does it take?
60-120 mins
What type of anaesthetic is used?
“Twilight” (conscious sedation)
Pre-admission tests
MRSA screen. Further tests according to medical background
Do I have to stay over at the hospital?
Not required. Available on request
Surgical Drains
Not required
Incisions & scarring
Within natural lines of skin creases
Garments
Soft Velcro garment 10-14 days
Cost
From £6,995 for surgery, follow-up, anaesthesia & facility fee
How long before I can…
What is a necklift?
Unhappiness with the neck is one of the most common reasons for both men and women to present to see Jonathan in clinic. We live in a world where “Screen time” predominates. Inevitably we see ourselves looking down reflected in the screen like a mirror – often the least flattering pose which exposes our flabby chins, our wrinkled necks, and our lax jawlines.What makes a natural rejuvenated neck? ‘Strike a pose!’ Do you see a youthful ‘Z’? – that line of triangular contour that emphasises the chin to the ear, the ear to the Adam’s apple, and the shoulder blade. Specifically, jawline and neck rejuvenation is about the restoration of definition, whether in direct gaze into the mirror, oblique light of a casual photograph, or the ultra – posed selfie shoot for the social media page.
It is worth the repeat: Jonathan’s craftsmanship arises from his study of the human face and neck in all its forms, male and female, from around the world, animated and in repose, studied in life and depicted in art. This is combined with his published academic study of human anatomy, structure, and function of the layers of the face and neck.
Jonathan’s approach to the neck will be described to you in clinic as a “layer by layer” strategy, considered in five layers. We begin with the skin. What is the skin quality? Is it crepey and lax or heavy and thick? Would a skin health approach to the intrinsic quality of the skin be all that is required, or provide a combination approach with other techniques? Sun damage to the exposed neck is a common problem, including reflected UV light (from water and snow) up to the exposed neck. This requires treatment for a quality result.
Is there an excess of superficial fat (layer two) or deep fat (layer four)? If the patient has had previous surgery has too much fat been removed and cannot be re-introduced for youthful volume in the right place? Is the superficial (platysma, layer three) muscle lax? What form does that laxity take and can it be treated by ‘closed’ or ‘limited open’ techniques? Finally, to give that sharp under the chin to neck angle in profile, does the deep layer of muscle (layer five) need to be tightened?
Jonathan will combine his craftsmanship of surgery with the artistic principles of light and shadow, definition and shape, to bring the five layers of the neck into youthful balance. ‘Natural repositioning’ of the neck tissues are required to avoid ‘wind tunnel creases’, or lines of tension when looking up and behind, as much as to avoid excesses when looking down at screens. Look at your favourite photos of your face and neck – Jonathan will explain how low facial laxity in the layers becomes continuous with the neck, and where neck lift and facelift intersect…
At the Jonathan Britto clinic natural bespoke restoration of facial features underlines everything we do. No more taut un-natural necklifts! No more unnatural creases! Scars that are well – placed, and as controlled in quality as possible. Meticulous analysis, meticulous technique, and meticulous care, but all delivered with a warm smile and a personal welcome.Time in planning, time in preparation, and time to develop the relationship between patient and surgeon, and with the members of the team, to deliver best care and confident results. A necklift delivered at the age of 40 is not the same as a necklift delivered at the age of 75. The relationship of the neck in shape and definition changes with relation to that in the lower face. The principles are timeless, but the indications, aims, alternatives for procedures, and expectations of outcome are bespoke. If this is your second or third face/necklift – that brings its own challenges for youthful restoration and to negotiate what has gone before.
We will undergo a comprehensive ‘analysis phase’ based on two or three pre-surgical consultations (as many as required), looking at the structure of the face and neck today in comparison to photographs from the past (if available). We will study your skin, offering advice on affordable daily skin health prescribed products that work. Our aesthetician, Karen, will be on hand to mentor and advise your skincare for the best of skin health from season to season. Combination approaches, particularly for the different skin of the neck in relation to that in the face, are common in necklift strategies.
Prepare and repair! Our Lifestyle Medicine physician and consultant anaesthetist, Shyamala, will advise you on how best to prepare for your surgery, and the simple strategies you can incorporate into daily life to facilitate healing in the repair phase of recovery.
You will come to feel part of the team, at the centre of our endeavours to offer the best of service and the best of outcome. We build ‘a partnership of trust’ where we can best understand your aims and your fears and address them with a realistic approach to what is achievable, seeking to minimize the potential risks inherent to all procedures. Our approach is multidisciplinary, and Jonathan leads a team with our patients central to all we do.
I could not be more pleased with the outcome I have had, only 4 weeks in after a lower face and neck lift, I am delighted with the massively improved and natural look that Jonathan Britto has achieved. In addition, his ‘bedside manner’ instilled confidence and certainty that I would be happy with his approach, and I was thankfully proved 100% right!
Verified patient, as seen in Doctify
Benefits
Why consider facelift surgery?
Many men and women begin their consultation with Jonathan berating the quality of their necks. The conversation may begin with “I’m beginning to look like my mother” and involve a tug at the jawline when looking in the mirror. The basic neck shape is different in men and women. Women have a more triangular neck, where the youthful silhouette is a series of inter – digitating triangles created by the definition of the underlying (‘layer four’) muscular anatomy. Surgical strategies in layers 1,2, and 3 of the neck reveal the definition of the underlying anatomy and provide the youthful appearance we seek. In men it is the same layers, and the same muscle groups, but the anatomy is more rectangular – think “square jaw masculinity” – which continues in the arrangement of the muscle groups of the neck.Some patients come with a clear set of instructions for Jonathan about what they wish to achieve. “I don’t like my turkey neck” is a common refrain, usually involving strategies directed at layer 1 and layer 2 of the neck. Another common request is to “get rid of my double chin” – involving strategies directed at layers, 2, 3, 4, and 5 of the submentum (under the chin). Many patients will have had “mini surgical tweaks” or minimal invasive therapies such as thread lifts before. Some of these may have lasted, many will have not delivered expectations previously. Jonathan’s current analysis and technique will take into account all that has gone before, and an accurate, preferably dated, history is very valuable.
Facial laxity is an important consideration in neck lift analysis – the jawline is compromised by the jowl, and the jowl begins in the face. Many patients have covered their necks with scarves or high collars for years, and would simply like to take advantage of an open neck shirt or blouse.
Some feel that the face and neck they currently wear does not reflect how they feel inside – they hear comments about “looking tired”, “are you unhappy?”, that do not reflect their inner confidence and vitality. The colour and quality of the neck skin is often different from that in the face, and a principal strategy for our team is to unify the quality of the face and neck skin “envelope”.
The range of surgical and non-surgical techniques that are currently available for neck restoration and aesthetics offer a perplexing minefield of choices. Jonathan and his team will guide you through the options with clarity. What is your desired outcome? What recovery time is available to you? How do you approach matters of cost, and how do you perceive matters of risk? There are many horror stories about both surgical outcomes and non-surgical therapies. Which are true? What is the balance of risk, reward, recovery time and cost? All these questions will be answered by Jonathan with clarity, in plain and simple language, and backed up with a written report.
Our patients present to see Jonathan throughout the decades from 30 to 80 years old. They want to ‘look well’, ‘natural’, and ‘good for their age’, and prefer a result without a ‘giveaway’ – no “tell-tale signs” that surgery has taken place. They want to look fresh, young, and balanced, and to feel confident – for neck lifts specifically this means a natural flow between the neck and the unoperated face, or to consider lower face and neck lift combinations.Combination approaches are often considered and requested by patients who have learned of Jonathan’s comprehensive skills. Combination face and necklift techniques come from a ‘family’ of related procedures, many of which Jonathan has had a major hand in developing and presenting to colleagues. Jonathan will often combine specialised face and necklift techniques, with blepharoplasty (eye lift) surgery, or browlift. The aim is to create a naturally balanced face, at rest and in emotional expression, where each “aesthetic unit” of the face moves seamlessly with its neighbour.
Many patients are referred to Jonathan from across the country and internationally who seek restoration from a poor surgical outcome elsewhere. These patients come to the clinic in a state of distress, and regret, and some feel aggrieved because of the costs they have faced. They feel torn between the feeling they cannot continue as they stand, but they are fearful of further surgery and further cost. We are very much aware of the psychological aspects of expectation unmet. Jonathan has worked with psychology teams who are expert in facial appearance from the beginning of his career, and he has built an expert psychology team which is available to all our patients. We never rush our patients, our philosophies and plans are explained in simple language, and we measure our outcomes and are happy to share them.
Jonathan’s team has been at the forefront of developing the “twilight technique” of facial surgery, where patients are kept as comfortable and pain-free as can be – throughout the surgery, but without being completely asleep. This allows for a relaxed patient with the ability to open and close the eyes, or smile, with dynamic facial movement during the surgery for bespoke surgical technique. The ‘twilight technique’ also allows rapid recovery, minimal bruising and swelling, and no post-anaesthetic downtime.
We are at the forefront of measuring our results from necklift surgery. We will ask you to fill out some short pre-operative questionnaires, and then again at set times after the surgery. The ‘QPROM’ questionnaires were developed in the United States and have been recommended by the UK Royal Colleges of Surgeons to be adopted to measure results in aesthetic surgery. Jonathan’s consecutive facelift results are audited independently and ‘blindly’ on a quarterly basis, and are presented in peer review and professional appraisal.
FAQ’s
We understand that it is a big step to consider facelift surgery. It is your face and neck, it is on show, it is deeply personal, and it matters.The consultation is usually a 2-3 step ‘analysis phase’ at either our London or Essex clinics. Alternatively we can arrange a video consultation from the comfort of your own home.
1. Discretionary free-of-charge video-call
Jonathan will enjoy introducing himself to you in a free video-call to discuss your request. It would be very useful if you could send us some selfie photographs (to medsec@jonathanbritto.com; held securely as part of your medical record), which will help inform the conversation.
2. Face-to-face consultation
If you would like to receive a detailed written analysis, with a quote for treatment, Jonathan will meet you in clinic for a face-to-face appointment. You are welcome to bring a friend or family member for support. The medical history and physical analysis in the privacy of the consulting room is an essential part of making the treatment plan. After this meeting you will receive a detailed plan and a written quote, together with a suite of information about our ‘twilight’ surgeries, relevant comments from prior patients, and some insights about the psychology and holistic care that is part of our commitment to you.
3. Face-to-face or remote catch up…
Jonathan recommends that you open a “procedure diary” on your phone, into which you can drop any questions that occur to you throughout the day, and after receiving the clinic letter and information from your face-to-face consultation.
This third conversation is to answer any questions you have, and to allow Jonathan to ask you about any reflections he has had to refine your care.
…. Step 4…..
In truth, our door is always open, and Jonathan will be very happy to see you face-to-face or remotely if you have further questions about your requested procedure.
Consultation fees: £295 is charged prior to Step 2
Data Security:
Please be aware we use a data security software to encrypt any correspondence that we send you which includes your personal data. These emails may fall into your junk folder, so following your consultations please keep a regular check on this folder.
If you wish to receive unencrypted, ‘open’ email to your inbox – please can be requested via an online, ‘one click’ consent form.
After necklift surgery, and combinations, Jonathan recommends a minimum of two weeks away from work. Many patients in today’s world will work partly from home and remotely, and may consider an early return starting with 2 to 3 hours per day. The repair phase is important, and rest is a vital part of this.Swelling and bruising are an inherent part of necklift and are usually not perceptible to regular social contacts after two weeks. Return to driving is at at 2 weeks. Stitches and staples are removed between two and three weeks. Return to the gym is between 4 to 6 weeks with a gentle increase, and return to swimming at six weeks. You can shower at 48 hours. Sleeping position is best on your back with three pillows for gentle elevation to reduce swelling.
Every surgical procedure carries inherent risk, and risk events may happen despite every person in the team performing without error. In the ‘analysis phase’, Jonathan will discuss matters of risk for each type of procedure, backed up with a concise and clearly written document of risk. Jonathan is proud to run a practice that is low risk for patients, and, when a risk event rarely occurs, to provide a comprehensive open – door service to resolve matters.
Yes.Much depends upon how well the original surgery was done. This will be discussed with Jonathan in the “analysis phase”. He would point out what the original surgery has achieved well, and what has deteriorated, or was not done well in the first surgery. The impact of all this on the aims and indications of the proposed necklift, on the alternatives available, and on the risks and responsibilities and expectations of outcome are all comprehensively discussed. Jonathan has undertaken many secondary face and necklifts, and we are happy to discuss the various risks and the happy outcomes that have been achieved for our patients.
Necklifts, like the facelifts to which they are closely related, require a layer by layer analysis and technique. The aim is to reshape, to restore definition to the jawline, deep muscle structure and shoulder – blade: the ‘Z’ of triangular youthfulness. Banished are the ‘double chin’ and the ‘turkey neck’. Necklifts are a family of procedures and no single technique fits all – bespoke assessment and experience in technique will combine to provide the ideal plan.
Jonathan recommended a neck and jawline lift. When I went to see Jonathan and described the problem he was very understanding. I could tell he was very thorough and keen to ensure I got the right treatment for my specific issue. After three consultations we settled on a treatment plan. I loved that Jonathan put me completely at ease. We had a laugh, I felt like I could tell him anything and when he made his recommendation for the neck and jawline lift, it made absolute sense.
The whole process was so easy. We arrived early in the morning. My husband dropped me off and went shopping and then came back to collect me after the surgery. I felt very welcome. Paolo the anaesthetist was great and everyone, from the receptionist to the nurses, made me feel at ease. Jonathan came to talk to me prior to surgery too, so I felt totally relaxed and there was no need for apprehension. I was amazed when the bandage was removed three or four days after the surgery. There was no visual bruising at all, just a tiny bit behind my ears which my hair covers. I was so pleased. I haven’t told anyone about the surgery except my husband and daughter. No-one has noticed I have had surgery, other than the fact that I don’t wear scarves anymore! A testament to Jonathan’s skill only a week after surgery!
I really couldn’t recommend the team enough. It has been the easiest process. I have always felt supported and secure before, during and after the surgery. At no time throughout the process did I feel uneasy or worried that something might go wrong. I was just so amazed at how good and comfortable it has all been. I simply cannot praise the team enough. It is clear that the team are the right ones – they get on so well and work together so seamlessly. That comes across to the patients in everything they do.
Verified Patient
Procedures take from 90 – 120 minutes as a daycase procedure. Most necklifts are undertaken under ‘twilight anaesthesia’ which makes for rapid and comfortable recovery, with reduced downtime. Plan for 7-14 days off work with a return to exercise at 4-6 weeks.
