Isolated Neck Lift
Alan Matarasso
Sammy Sinno
DEFINITION
The appearance of neck aging can occur as early as the late 30s.
Differences in the quality of skin above and below the mandible can contribute to neck aging independently. The neck changes may occur prior to facial aging, which can be particularly disconcerting to patients.
Recent advances allow the neck to be rejuvenated in a spectrum of methods that include neck lift, minimally invasive surgical procedures (submentalplasty and liposuction), and nonsurgical methods depending upon the indications and goals.
The most comprehensive treatment of the aging neck requires an isolated neck lift.
ANATOMY
The youthful neck is characterized by a distinct mandibular border with the relative absence of jowls, subhyoid depression, visible thyroid cartilage bulge, distinct border to the sternocleidomastoid (SCM) muscle, and a cervicomental angle between 105 and 120 degrees (FIG 1).1
The aging neck is manifested by attenuation of retaining ligaments from the medial platysma, which leads to platysma edge shortening and banding. Additionally, there can be accentuation of preplatysmal or subplatysmal fat, laxity of skin with texture changes, hypertrophy of the digastric muscles, and hypertrophied and/or ptotic submandibular glands.
Treatment options vary based on individualized patient assessment of key anatomic landmarks and treatment goals.
 FIG 1 • Relevant neck anatomy. |
PATIENT HISTORY AND PHYSICAL FINDINGS
Ideal candidates for an isolated neck surgery procedure are those who want to address neck rejuvenation without the need to concomitantly treat the midface with a face-lift.
During the initial consultation, it is essential to evaluate the patient’s goals and expectations and to reconcile them with the surgeon’s evaluation and treatment plan. Furthermore, it is important to discuss relevant procedures that may play a role in enhancing the result of neck surgery, such as chin augmentation, buccal fat pad removal, salivary gland treatment, skin quality enhancement, or midface treatments.2,3
When evaluating the patient and discussing the surgical options, the patient should be educated on the algorithm to discuss the surgical treatments available to treat the various soft tissue components of the aging neck.
More advanced cases of the aging neck are treated with a neck lift that encompasses liposuction as indicated and submentalplasty along with wide skin flap undermining, elevation, and skin excision.
Less severe cases can be treated with minimally invasive surgical procedures, including liposuction for fatty necks or submentalplasty that applies liposuction and midline platysma muscle treatment.
Nonsurgical methods including Ultherapy (Ulthera, Mesa, AZ), among other “tightening” energy-based systems, Kybella (Allergan, Weston, FL), and Botox (Allergan, Weston, FL) can be used to improve the appearance of the neck skin, fat, and muscle, respectively, albeit with a different result than a surgical procedure.
IMAGING
No imaging other than routine preoperative clearance imaging is needed.
SURGICAL MANAGEMENT: NECK LIFT
Preoperative Planning
A traditional neck lift encompasses improvement in the area from the jawline down to the clavicle.
The quality and quantity of skin are noted.
If patients desire improvement in the jowls as well as the neck, an “extended” neck lift can be considered, which addresses the same areas as neck surgery and incorporates improvement in the jowl region. This is accomplished by extending the neck lift incision slightly cephalically toward the tragus, which allows jawline skin advancement, SMAS tightening, and jowl liposuction.Related posts:
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