Deep Neck Contouring through the Ages

Abstract

Deep neck contouring can achieve dramatic results in young and old patients. Both genetic predisposition and aging contribute to the malposition of deep neck structures and a poorly contoured neckline. Depending on the patient's anatomy, deep neck contouring should involve a combination of submental liposuction, platysmaplasty, subplatysmal fat lipectomy, resection of the anterior belly of the digastric muscle, and either cautery or resection of the submandibular glands. Resorption of the facial bony skeleton that occurs with aging affects the ultimate postoperative mandibular contour, and postoperative results thus differ in the young versus old patient. In patients in which there is concern for excess skin laxity, a concurrent facelift is necessary to excise excess neck skin. This article includes a discussion on how a combination of aging and genetics influence a patient's neck anatomy, critical preoperative considerations prior to performing deep neck contouring, intraoperative technique, and adjunct procedures that can further improve a patient's neckline.

Keywords

deep neck contouring - aging - platysmaplasty - digastric resection - submandibular gland - submental liposuction - facelift

Publication History

Article published online:
18 March 2024

• References

• 1 Marten T, Elyassnia D. Deep neck lift: defining anatomical problems and choosing appropriate treatment strategies. Facial Plast Surg 2022; 38 (06) 630-649
• 2 Ellenbogen R, Karlin JV. Visual criteria for success in restoring the youthful neck. Plast Reconstr Surg 1980; 66 (06) 826-837
• 3 Millard DR, Pigott RW, Hedo A. Submandibular lipectomy. Plast Reconstr Surg 1968; 41 (06) 513-522
• 4 Millard Jr DR, Garst WP, Beck RL, Thompson ID. Submental and submandibular lipectomy in conjunction with a face lift, in the male or female. Plast Reconstr Surg 1972; 49 (04) 385-391
• 5 Connell BF. Surgical technique of cervical lift and facial lipectomy. Aesthetic Plast Surg 1981; 5 (01) 43-50
• 6 Connell BF. Contouring the neck in rhytidectomy by lipectomy and a muscle sling. Plast Reconstr Surg 1978; 61 (03) 376-383
• 7 Connell BF. Cervical lift: surgical correction of fat contour problems combined with full-width platysma muscle flaps. Aesthetic Plast Surg 1976; 1 (01) 355-362
• 8 Connell BF, Shamoun JM. The significance of digastric muscle contouring for rejuvenation of the submental area of the face. Plast Reconstr Surg 1997; 99 (06) 1586-1590
• 9 Mejia JD, Nahai FR, Nahai F, Momoh AO. Isolated management of the aging neck. Semin Plast Surg 2009; 23 (04) 264-273
• 10 Feldman JJ. Corset platysmaplasty. Plast Reconstr Surg 1990; 85 (03) 333-343
• 11 O'Daniel TG. Optimizing outcomes in neck lift surgery. Aesthet Surg J 2021; 41 (08) 871-892
• 12 Shaw Jr RB, Katzel EB, Koltz PF. et al. Aging of the facial skeleton: aesthetic implications and rejuvenation strategies. Plast Reconstr Surg 2011; 127 (01) 374-383
• 13 Marten TJ, Feldman JJ, Connell BF, Little WJ. Treatment of the full obtuse neck. Aesthet Surg J 2005; 25 (04) 387-397
• 14 Marten T, Elyassnia D. Short scar neck lift: neck lift using a submental incision only. Clin Plast Surg 2018; 45 (04) 585-600
• 15 Auersvald A, Auersvald LA. Hemostatic net in rhytidoplasty: an efficient and safe method for preventing hematoma in 405 consecutive patients. Aesthetic Plast Surg 2014; 38 (01) 1-9
• 16 Implantech chin implants. Accessed October 15, 2023 at: https://www.implantech.com/product-category/products/facial-implants/silicone-facial-implants/chin-implants/
• 17 Mendelson BC, Tutino R. Submandibular gland reduction in aesthetic surgery of the neck: review of 112 consecutive cases. Plast Reconstr Surg 2015; 136 (03) 463-471