Neck Rejuvenation

Neck rejuvenation example: before and after result of neck lift showing well defined chin with sagging skin removed.

“Your beautiful neck is already complete. It is already there! We just have to remove the wrinkles, and extra fat, the superfluous skin.”

– Mark Domanski, MD

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Hi, I am Dr. Mark Domanski, a board certified plastic surgeon specializing in natural results. Patients from age 20 to 80+ want great looking necks. Trying to figure out the “right treatment for me” is hard because the right treatment for a twenty year old is the wrong treatment for an eighty year old – and vice versa. So I wrote this short summary of various treatments to help educate you. If you are serious about neck treatment, I would look forward to meeting you for a consultation.

Very Truly Yours,
Mark Domanski, MD

ASPS Member
2023 Northern VA Magazine
2021 Northern VA Magazine
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Top Doctor 2021 Washingtonian


Before and after results of our procedures.

Before Image After Image


Neck rejuvenation surgery can be an excellent way to improve signs of aging by removing excess skin, tightening underlying muscles, and repositioning the remaining skin to create a more youthful appearance.

Many professionals look to tighten the jawline, restore youthful facial structure, improve saggy jowels, and obtain a youthful appearance. Necklifts may target certain effects of facial aging such as removing a double chin in the submental area or smoothing nasal labial folds with fat transfer.




The neck has special geometry that makes it the best place in the body for liposuction. When we remove fat from the neck skin, the neck skin tightens up (unlike other parts of the body where the skin can hang). Liposuction uses a cannula, or blunt needle to remove fat from under the skin. First we place a specialized numbing medication called tumescent under the skin. Then, under gentle suction, we remove the fat with the cannula. The procedure can take place in the office without the need for general anesthesia. The procedure takes an hour and can last a lifetime.


Under projection of the chin can also be treated by placing an FDA approved chin implant of porous polyethylene at the bottom of the chin. The implant can be placed through an access point under the chin or inside the lip. Chin implants are frequently combined with a rhinoplasty, as many patients with large noses have small chins. Patients go home the same day and resume normal activity within a week.


Patients who are candidates for the neck lift will often place their hands on the sides of the neck, push upwards in a direction behind their ears, and say “I just want my neck to do this.” We call this the “neck lift sign.” A neck lift is like tailoring: we remove extra skin and then place the crease in an inconspicuous place. For a neck lift, the “crease” or incision lines are behind the ears. A neck lift typically is done with neck liposuction. Patients go home the same day and are often out and about within a week.



Platysmal bands are caused by the most superficial muscle of the neck. The platysma originates on the skin along the lateral aspects of the chin and extends down toward the collarbones. This muscle is missing in the midline. When this muscle pulls, a band of skin is tented up. Thankfully, this muscular action can be relaxed by Dysport of Botox. Treatments take 5 minutes and last for 3 – 4 months.


Under projection of the chin or a soft jawline makes the face blend into the neck. By augmenting the chin or lateral jawline, we restore the natural face-neck border. Traditionally this was accomplished by surgery. However today a popular option is the augmentation of the chin or jaw with a dermal filler. This treatment takes 30 minutes and can last up to a year.


Many patients have skin redundancy, fine lines, and texture issues. However, they are not ready for a neck lift. In such cases, we recommend Radiofrequency (RF) Microneedling. Microneedling is a technique of placing dozens of fine needles under the skin at the same time using a FDA approved device. To rejuvenate the neck, with the help of RF Microneedling device, we apply bipolar electric energy at the frequency of radio waves to produce tissue remodeling and stimulate collagen deposition. We apply topical numbing beforehand to minimize discomfort. Treatments take about an hour. We recommend 3 treatments about a month apart to maximize results.


CO2 laser is a popular modality to treat deeper skin wrinkles. CO2 laser has a wavelength of 10,600 nm and works by being absorbed by water. Newer CO2 lasers use “fractional” technology where only a fraction of the skin is affected by the laser, which surrounding skin helping promote resurfacing and contracture. This contracture reduces lines and wrinkles. CO2 laser requires a topical numbing that is applied in the office for the procedures. Patients will notice redness in the days that follow before the final results are realized.


A chemical peel works by increasing skin turnover and promoting new collagen production. Chemical peels are performed in the office. Skin peeling begins in about 2 days and lasts 2-3 days. The result is a smoothening of fine lines and wrinkles of the skin.


You deserve the peace of mind of choosing a Board Certified Plastic Surgeon.

Dr. Domanski is one of the few plastic surgeons in the country who is Double-Board Certified, in Plastic Surgery and Otolaryngology-Head & Neck Surgery. That means he holds double credentials to perform face & neck rejuvenation procedures. He consistently delivers natural-looking, high-quality results. But don’t take our word for it, check out our reviews on Google.

At Bluemont Plastic Surgery we specialize in advanced neck rejuvenation. These treatments are designed to turn back the clock and reveal your firmer, more youthful neck.

Dr. Domanski with Patient


Your goals. Your desires. Your timeframe. 

Don’t miss out: request a consultation via email, text, or phone.


Some neck lines are from the overactivity of the platysma muscle. This muscle inserts on the skin and causes skin wrinkling. Horses have a developed platysma muscle over much of their body that they use to twitch the skin to prevent a fly from landing on them. In humans, the platysma muscle is present in the neck as a holdover from evolutionary times long since gone.

Over time, the platysmal bands become more visible.
Platysmal bands are the vertical bands or cords that can form in the neck, often as a result of aging or muscle tension. Dysport (Botox) is injected into the platysmal bands. It works by relaxing the muscles, reducing the appearance of the bands, and resulting in a smoother neck contour. This treatment helps improve the overall appearance of the neck and jawline, providing a more youthful and rejuvenated look.

Candidate: appearance of mild bands in the neck area
Side effects: minimal
Duration: the procedure takes about 20-30 min., the effect lasts 3-4 months
Downtime: 24 hours no exercising & heavy lifting
Cost: $650-900

During the aging process, we frequently observe loss of volume in areas of the neck and face. Hyaluronic Acid based dermal fillers, like Restylane, can help to restore facial volume and enhance neck contour. Chin and jawline filler augmentation involves the placement of dermal fillers to redefine and sculpt the chin and jawline. By strategically injecting fillers along these areas, Dr. Domanski addresses concerns such as sagging skin, volume loss, and lack of definition.

Fillers procedure is highly customizable and can be tailored to complement other neck rejuvenation solutions, such as laser skin tightening or microneedling for enhanced, non-surgical treatment.

Candidate: mild to moderate skin sagging in the chin or jaw area
Side effects: temporary bruising, swelling, and redness typically resolves within a few days
Duration: the procedure including numbing takes about 30-45 min., the effect lasts 9-12 months
Downtime: 24 hours no exercising & heavy lifting, and no facials for a week.
Cost: $850-1800

Kybella is a medication that is injected under the skin for extra neck fat. Kybella requires multiple treatments and can cause swelling before final results are seen. For these reasons, Dr. Domanski often prefers in-office liposuction as a way to slim the neck.

Neck Liposuction targets excess just fat deposits in the neck and under the chin, improving definition with minimal downtime.

During the procedure, a small access point is made, and a thin tube called a cannula is inserted to suction out the excess fat. Chin liposuction can improve the appearance of a double chin, refine the jawline, and create a more defined profile.

Candidate: double chin, or excess fat deposits under the chin that are not responding for a diet, non-smoker or willing to quit smoking
Side effects: some bruising and discomfort that resolves within a few days
Duration: the procedure takes about 30 min–1 hour., the effect is long lasting
Downtime: A chin strap is worn for several days. Patients are able to return to normal activities in a few days.
Cost: $2000-5000

That is surgeon-speak! Platysmaplasty or lower rhytidectomy means neck lift! Neck lift is a surgical option to treat extra skin on the neck. A neck lift is aimed at tightening and lifting the skin around the neck to achieve a more youthful appearance.

During the neck lift, incisions are typically made behind the ears and sometimes under the chin. Through these incisions, Dr. Domanski can remove excess fat via liposuction, tighten muscles banding in the neck and trim loose skin. Some jowls can be treated during a neck lift but many jowls require a facelift. Regardless, a necklift is a powerful procedure to improve the contour of the neck.

• Traditional Neck Lift (Cervicoplasty): This involves making incisions behind the ears and sometimes under the chin to tighten muscles, remove excess fat, and trim sagging skin.

• Mini Neck Lift: A less invasive option that targets mild to moderate neck laxity. It typically involves smaller incisions and focuses on tightening the skin and underlying tissues. Some mini neck lifts can be performed in the office under local anesthesia.

• Neck Lift with Platysmaplasty: Platysmaplasty is a technique used to tighten the platysma muscle, which can help address vertical banding or “turkey neck” appearance.

• Submentoplasty: Similar to a traditional neck lift but with smaller incisions limited to under the chin, often used for patients with minimal excess skin and fat.

• Neck Lift with Neck Contouring: Combines surgical techniques with non-surgical treatments like radiofrequency or laser therapy to enhance neck contour and skin texture.

Candidates: moderate to severe skin sagging in the chin or jaw area with a prominent neck band, non-smoker or willing to quit smoking
Side effects: Swelling, bruising, for about a week. It will feel tight, but look natural.
Duration: the procedure takes about 2-4 hours, the effect lasts 10 years or more
Downtime: 1-2 weeks
Cost: $9,000-$25,000

This is the most important question to ask. We find that downtime, budget, and goal are the primary considerations patients use when deciding their treatment. In general, the more subtle the result, the less downtime and the lower the cost. The more dramatic results require more time off and are often worth their premium. Ultimately this is an individual decision and we help patients decide for themselves.


A double chin can be treated with a chin implant, neck liposuction, or surgical fat reduction during a neck lift.

Both are effective. However, Dr. Domanski’s patients often prefer neck liposuction because there is only one recovery time while kybella requires multiple treatments.

Neck liposuction is performed through access points under the chin and behind the ears. We include a scar cream as part of the package because we want to invest in your optimal results.

Chin liposuction costs between 2,000 and 5,000 depending on the amount and choice to perform the procedure under local or general anesthesia.

We find that many patients between age 20-45 are optimal candidates for chin liposuction. After age 45, some extra skin issues begin to take hold, so we often recommend adjuvant treatments in addition to chin liposuction at this age.

Chin liposuction removes the fat cells between the skin and platysma. Because these fat cells are removed, they are never coming back. The results are long lasting and durable.

Chin liposuction is frequently performed in the office setting under local anesthesia.

We recommend patients shower with hibiclens the two days prior to procedures. Having any prescriptions picked up before the day of the procedure is helpful. Arranging for a ride home afterwards is important.

Unlike areas of the abdomen, chin liposuction frequently cases the neck skin to tighten up and redrape, resulting in a tighter neck.

We recommend patients shower the day afterwards. Exercise can be resumed in a couple of days.


If you are otherwise healthy, and have extra skin in your neck, you are a great candidate. When you meet with Dr. Domanski, he will review your medical history and degree of skin laxity. If you are not a great candidate, he will tell you.

A neck lift is frequently combined with a facelift, eyelid lift, or fat injection to the cheeks.

Neck lift results are long lasting, but the conveyor belt of time does not stop! Touch ups are possible, but we see many patients very satisfied for at least 10 years.

First, a word about terminology: Scars happen in a kitchen accident. In plastic surgery, we have incision lines. To minimize downtime and maximize healing, we provide a scar cream as part of our surgical package because our practice invests in your results.

A neck lift procedure costs between 9-25 thousand dollars. This total amount would include facility and anesthesia fees. Total cost depends on the complexity of the case and required time. Post-operative care by Dr. Domanski is included in the surgical fee.

Thread lifts were developed as a way to have med spas providers such as emergency medicine doctors, nurse practitioners and dermatologists perform neck rejuvenation. Because these physicians are not surgeons, they can not perform a true neck lift. Thread lifts can look good initially, but the thread dissolves (sometimes within a month) and patients are left looking exactly like they did before. We frequently see patients who have had a thread lift elsewhere who are looking for durable results.

This depends on where the fillers were placed. Often we are able to design a neck lift to not interfere with prior filler treatment.

We have many satisfied neck lift patients between the ages of 40 and 80+.

Dr. Domanski prides himself on minimal pain after surgery. He has a specific protocol using long acting numbing medicine and over the counter medications to minimize pain while minimizing narcotics. Some of our patients take NO narcotics after surgery.

Neck lifts are performed either in a hospital or at a certified surgery center.

We are committed to good results. However, surgical vs nonsurgical results are different. RF microneedling tightens skin with reduced downtime. Liposuction reduces fat under the skin. Some treatments like liposuction and RF microneedling are like cinnamon and honey: they go well together.

The best surgeon for your friend may not be the best surgeon for you. You need a surgeon who you feel comfortable with, explains what can be expected, and who will be there for you if it is a level 10, 9, or level 8 result. Dr. Domanski is board certified by the American Board of Plastic Surgery and serves as Chief of Plastic Surgery at Inova Alexandria Hospital.

Despite numerous attempts by some to promise what they can not deliver, we do not see a way to get around the following truth:
The more invasive (surgery), the more the downtime (1-2 weeks), the more the results (lifelong). 😉

A neck lift takes 2-5 hours depending on the extent of the procedure and the patient.

“Be Yourself,
Everyone Else Is Taken.”

– Oscar Wilde


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