Preface: Neck Rejuvenation ix

Mark M. Hamilton and Mark M. Beaty

Anatomy and Physiology of the Aging Neck 161

Scott Shadfar and Stephen W. Perkins

This article discusses the surgically relevant anatomic and physiologic tenets of the aging neck. Procedures performed to rejuvenate and contour the aging neck can be challenging. A thorough understanding of the underlying neck anatomy, as well as the physiology associated with aging, is critical for surgical planning, execution, and achieving aesthetically pleasing outcomes. These topics are reviewed and used as the foundation for a discussion of various other techniques.

Anatomy and Physiology of the Aging Neck 161

Scott Shadfar and Stephen W. Perkins

This article discusses the surgically relevant anatomic and physiologic tenets of the aging neck. Procedures performed to rejuvenate and contour the aging neck can be challenging. A thorough understanding of the underlying neck anatomy, as well as the physiology associated with aging, is critical for surgical planning, execution, and achieving aesthetically pleasing outcomes. These topics are reviewed and used as the foundation for a discussion of various other techniques.

Preoperative Evaluation of the Aging Neck Patient 171

J. Regan Thomas and Tatiana K. Dixon

The appearance of the neck plays an important role in terms of the patient’s overall facial appearance. Facial rejuvenation procedures incorporate rejuvenation and improvement of the neck’s appearance as a key component. Preoperative evaluation of the aging neck determines the type of rejuvenation procedures that will be required. There are key components of the neck that should be evaluated, assessed, and documented. Subsequently, appropriate treatment modalities may be incorporated into the operative or treatment plan. Key components include evaluation of the mandibular margin, hyoid position, condition of the skin, soft tissue adipose, and the status of the platysmal muscle layer.

A Progressive Approach to Neck Rejuvenation 177

Mark M. Beaty

The progressive approach to neck and facial rejuvenation is a comprehensive method for evaluation and correction of common aging changes seen in the lower face and neck. The surgical results are natural in appearance, as the rejuvenation method chosen is specifically and continuously adjusted for optimal results throughout the evaluation and surgical process. The increased burden on the surgeon to master a variety of techniques and to develop the judgment needed to decide in a progressive manner which is the most appropriate for use in each patient is more than compensated for by improved results and greater patient satisfaction.

Noninvasive Treatment of the Neck 191

Robert W. Brobst, Maria Ferguson, and Stephen W. Perkins

A video of Ulthera treatment accompanies this article

Emerging trends in neck rejuvenation include the incorporation of nonsurgical treatment modalities as an offering to those patients desiring minimal downtime and accepting of mild results. Intense focused ultrasound is a promising technology for treatment of the neck. It is rapidly growing in clinical use and undergoing further investigation to determine optimum treatment parameters and make its outcomes more predictable.