The surgery involves making skin incisions just in front of the ear and then extending these incisions around the earlobe into the scalp. The skin of the cheek is then loosened from the underlying tissue to allow its tightening. The superficial muscle layer (smas) is first reinforced and this is followed by a pulling back of the cheek skin and removal of any excess tissue. In the neck area, excess fatty deposits are removed and the platysma muscle is tightened which in turn improves the contour of the neck. All of the incisions are meticulously sutured and a light compression dressing is applied. Healing and recovery after this lengthy procedure is 2 to 3 weeks.