What Is the Difference Between Open and Closed Neck Lifts, and Which Should You Choose? Results, Recurrence, and Recovery

Key summary. Neck lifts fall into two types. The open approach uses an incision under the chin to work directly on the platysma, the thin muscle layer of the neck. The closed approach uses only incisions in front of the ears and pulls the tissue from the side. A meta-analysis pooled patient-reported satisfaction scores (FACE-Q) from 9 studies covering 847 patients. When liposuction was also performed, the open approach had significantly higher neck satisfaction (81.5 vs. 77.5, p=.022). However, the highest score of all combinations (neck, 86.6 points) came from the closed approach without liposuction. The authors did not read this top score as proof that the technique itself is better. They said it more likely reflects selection bias, because patients with milder conditions may have chosen the closed approach in the first place.

What this article covers

• Comparison criteria: incision and access method (open vs. closed), whether liposuction is added, patient-reported satisfaction (FACE-Q), and recurrence and revision surgery
• Cautions: a difference in satisfaction scores may come from the technique or from which patients chose it (selection bias), and the two need to be told apart. Almost no studies measured scores before surgery, so the actual size of the "improvement" is unknown
• Evidence status: one meta-analysis comparing open and closed satisfaction (9 studies, 847 patients) and one systematic review of revision neck lifts (5 studies, 188 patients). Both were read in full. Because this is a surgical procedure, it is not subject to medical device approval by the Ministry of Food and Drug Safety (MFDS)

Key points

1. Definition: The open approach uses an incision under the chin to cut and suture the platysma directly, for example with a midline platysmaplasty. The closed approach uses only incisions in front of the ears and pulls the tissue from the side, anchoring it to the mastoid (the bone behind the ear).
2. Who it suits: The closed approach is usually considered when sagging and banding (vertical neck cords) are mild and the skin is still elastic. The open approach is usually considered when banding, a double chin, or a drooping submandibular gland is pronounced.
3. What to check, in order: the surgeon's qualifications and experience → whether the plan is open or closed, and why → whether the midline platysma will be treated (this is directly linked to recurrence) → what you are told about the possibility of revision surgery.

01What Exactly Is a Neck Lift?

A neck lift is surgery to improve sagging of the neck and under-chin area and vertical banding (platysmal bands). There are two main types, depending on how the surgeon reaches the tissue. The open approach goes in through an incision under the chin (submental incision). The surgeon exposes the platysma directly, then folds or cuts it at the midline and sutures it (midline platysmaplasty). Fat removal and treatment of the submandibular gland can be done in the same operation. The closed approach does not use an under-chin incision. Through incisions in front of the ears only, the surgeon pulls the platysma from the side and anchors it to the fascia over the mastoid (the bone behind the ear). Fat under the chin is suctioned indirectly from the side when needed.

02How Effective Is It in Studies, and How Often Does the Problem Come Back?

The values above were verified on 2026-09-19 from the full text. The finding that "the closed approach without liposuction came first" should not be read as "that approach is the best." The authors stated directly that this result "is likely due to selection bias." A closed approach without liposuction is usually offered to patients with milder conditions, meaning less sagging and fat and good skin elasticity. The open approach with liposuction is used for harder cases with pronounced banding, fat, and sagging. In other words, the score gap may reflect which patients had each surgery in the first place rather than which surgery worked better. On top of that, almost no studies measured scores before surgery. Most of the 9 studies measured satisfaction only after surgery, with no preoperative baseline. The results therefore show how satisfied patients were after surgery at one point in time, not how much they improved. In the risk-of-bias assessment, 4 of the 9 studies (44%) were rated high risk, and only 1 (11%) was rated low risk.

Some findings concern recurrence and revision surgery. A literature review on revision necklifts cites a study in which banding recurred in 76% of primary-surgery patients who had lateral fixation alone, without midline platysmaplasty (the core technique of the open approach). In the group that also had midline platysmaplasty, new banding appeared in only 1 of 13 patients. Revision surgery was often needed an average of 7–11 years later. The main reasons were recurrent banding, recurrent submental sagging, and submandibular gland ptosis. The review pooled 5 retrospective case series (188 patients), so the evidence level is low (all Level IV). Complications after revision surgery were mostly temporary (transient nerve palsy and hematoma), and no permanent injuries were reported.

03What to check before the procedure

04Choosing by situation

• Mild banding and sagging with good skin elasticity → consult about a closed approach (without liposuction), but check whether any "ranks first in satisfaction" claim accounts for selection bias
• Prominent banding, or submental fat or submandibular gland ptosis → consult about an open approach (including midline platysmaplasty)
• You want less incision and a lighter recovery but have banding → use the difference in recurrence rates (with or without midline platysmaplasty) as the basis for re-confirming the approach during consultation
• You are also considering sagging across the whole face → consult and compare alongside facelift and mini facelift

05Common misconceptions

"The open approach always produces better results": When liposuction was also performed, the open approach scored significantly higher in neck satisfaction. However, the closed approach without liposuction actually recorded the highest score. This data does not support the idea that "the more incision, the better."

"The approach with the highest satisfaction score is the most effective": As the surgeons themselves stated, this ranking may reflect which patients chose each approach in the first place (selection bias), not the effectiveness of the technique. Also, most studies did not measure scores before surgery. They cannot show how much patients improved and are only a snapshot of satisfaction after surgery.

"With a closed approach, there's no need to worry about recurrence": One study reported banding recurrence rates as high as 76% when only lateral fixation was performed without midline platysmaplasty. Reducing incisions and preventing recurrence are separate issues.

06In summary

Choosing between an open and a closed necklift depends less on "which one is superior" and more on "which approach my degree of banding and sagging requires." Satisfaction scores were higher for the open approach when combined with liposuction. The closed approach without liposuction recorded the highest overall score, but the surgeons themselves said this likely reflects milder cases choosing that approach, not a better technique. On recurrence, the clearest finding is that whether the midline fascia is addressed strongly affects banding recurrence rates. In consultation, first ask which approach will be used. Then ask whether the midline fascia will be addressed and, if not, why not.

07Frequently Asked Questions

What is the difference between an open and a closed necklift?

The direction of access itself is different. The open approach uses an incision under the chin to suture the platysma directly at the midline, while the closed approach uses only incisions in front of the ears to pull and fix the tissue from the side. Because of this difference, the two approaches also differ in how much fat and submandibular gland tissue can be addressed and in recurrence rates.

Is an open or a closed necklift better?

There is no clear-cut answer. When liposuction was also performed, the open approach scored significantly higher in neck satisfaction (p=.022), but the closed approach without liposuction actually recorded the highest overall score. However, the surgeons themselves stated that this ranking may reflect patient selection (selection bias) rather than the superiority of the technique itself.

Does a neck lift prevent recurrence once it is done?

No. Recurrence depends heavily on how the tissue was sutured. In primary surgeries without midline platysmaplasty, band recurrence rates as high as 76% have been reported, while when it was performed, only 1 in 13 patients had a recurrence. Revision surgery itself is often needed an average of 7 to 11 years later.

Is revision neck lift surgery risky?

Generally not. Across 188 patients (5 case series), most complications after revision surgery were temporary (transient nerve palsy, hematoma), and no permanent damage was reported. However, keep in mind that all of this evidence comes from small, level IV retrospective studies.

Should a neck lift be done together with a facelift?

This article does not conclude that either option is better. The answer depends on where the sagging is (the whole face or mainly the neck) and how severe it is, so this is a question to compare directly during a consultation. For more details, see Facelift information.

08Pre-consultation checklist

• □ I have checked the operating surgeon's qualifications and surgical experience
• □ I have been told whether the open or closed approach will be used and why that approach is recommended
• □ I have confirmed whether midline platysmaplasty (platysma muscle treatment) will be performed and the likelihood of recurrence
• □ I have asked for the basis of claims such as "No. 1 in satisfaction" (which patient group it refers to)
• □ I have been informed about the possibility of revision surgery and when it might be needed
• □ I have received written information about expected complications (hematoma, nerve injury, etc.) and how they are handled

09Glossary

• Observational study: A study that only observes outcomes without any intervention. It is rated as a lower level of evidence than controlled studies.
• Retrospective study: A study that goes back and analyzes past medical records after the fact. Its evidence tends to be weaker than studies designed in advance to follow what happens going forward.
• Risk of bias: The degree to which flaws in a study's design make it hard to take the results at face value.
• Meta-analysis: An analytical method that statistically combines the results of multiple individual studies to reach a single conclusion.
• p-value: A number indicating how likely it is that a difference between two groups arose purely by chance. A value smaller than 0.05 is usually taken to mean "unlikely to be chance (statistically significant)."
• Selection bias: A distortion that occurs when people with certain characteristics are more likely to choose a particular treatment to begin with, so differences in outcomes reflect differences between the people rather than the effect of the treatment.

10Sources and verification date

• PMC13398994: verified 2026-09-19. FACE-Q meta-analysis of open vs. closed neck lift, 9 studies and 847 patients, all observational studies. States no conflicts of interest and no research funding.
• PMC13183683: verified 2026-09-19. Systematic review of revision neck lift, 5 studies and 188 patients, all level IV. States no conflicts of interest.
• The studies above are materials for understanding how the procedure works and the state of the evidence; they do not guarantee any specific clinic, surgeon, or outcome.

11Editorial responsibility and interests

• Written by: Korea Beauty Report Editorial Team, editorial responsibility: Korea Beauty Report Editorial Team
• Review scope: The editorial team prepared this content from published research and public data. It was not separately reviewed by a medical professional and does not replace individual diagnosis or treatment.
• Interests: No clinics in this article have a contractual or advertising relationship with us
• First published: 2026-09-26, last materials check: 2026-09-26