Some neck folds are caused by the platysma, a thin muscle that lies just under the skin. These folds do not require surgery; they can be treated with botulinum toxin. In a neck-lift sagging skin folds are lifted and removed with an incision behind the ear. It is rarely necessary to cause a scar at the hairline on the back of the head. Sometimes an additional incision just behind the chin is necessary.
A neck-lift may be combined with a liposculpture of the fat below the chin. When the neck angle (the angle between the inferior surface of the jaw and the neck proper) is too obtuse, the position of superficial neck muscles can be modified.