This 78-year-old woman had a history of heart problems and required a pacemaker. Otherwise, she was generally healthy just had high blood pressure but had never had a heart attack. She was hopeful to have a full facelift and upper blepharoplasty with concerns primarily related to her neck. To undergo this type of surgery, either general anesthesia or sedation is usually recommended. When patients have pacemakers, the device either has to be turned off with appropriate precautions or the surgeon uses a special bipolar cautery device to control bleeding to avoid interference with the pacemaker. The patient’s cardiologist was not comfortable allowing her to undergo general or IV sedation anesthesia. The patient still was motivated to have improvements. Because a full facelift or neck lift would be very difficult in these circumstances, the patient chose a more limited option. She underwent a direct neck lift which involves an incision in the midline of the neck with direct removal of excess skin fat and improvement in muscle alignment. This was performed with a bipolar cautery device with appropriate precautions but with only local anesthesia. She also had upper blepharoplasty done at a separate procedure just a few weeks later to limit her risks. Although the improvements in her neck are less dramatic than a full facelift, she was quite pleased with the changes.

A direct neck lift is usually not a great option for women as the incision and scar is more noticeable in the neck as women have much smoother skin than men who can hide the scar in their hair-bearing beard. However, with appropriate skin closure techniques, scar management and even future laser treatments to the scar, the scars can be acceptable even in the properly selected patient. Usually an older woman with looser skin.