The suture suspension platysmaplasty neck lift, by creating a permanent artificial “ligament” under the mandible, corrects the deformities of the aging neck with aesthetically pleasing results. In essence, this technique suspends the midline platysma muscle and displaces the lateral platysma muscle under the border of the mandible in a natural way, with excellent patient satisfaction outcomes. The authors present 6 basic anatomic points of neck rejuvenation and emphasize a careful analysis of each to personalize the suture suspension platysmaplasty technique to fit the patient’s needs, allowing the aesthetic surgeon to fully rejuvenate the neck with a long-lasting result.
Key points
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The suture suspension platysmaplasty neck lift creates a permanent artificial “ligament” under the mandible, correcting the deformities of the aging neck.
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The suture suspension platysmaplasty technique suspends the midline platysma muscle and displaces the lateral platysma muscle under the border of the mandible in a natural way.
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Fixation of the suture on the mastoid fascia with the appropriate tension is an essential step in this procedure.
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Extremely careful analysis of the 6 points of neck rejuvenation and customization of the suture suspension platysmaplasty technique according to these points allows the aesthetic surgeon to fully rejuvenate the neck with a long-lasting result.
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This technique is simple, safe, and reproducible, with excellent patient satisfaction outcomes.
Editor Commentary: Vince Giampapa first published his suture suspension technique in 1995. His technique has evolved with the important addition of a submandibular angle loop suture to his suspension technique that improves the aesthetic appearance of the neck while decreasing the tension on the suspension suture. His algorithm is also important in deciding which candidates can be managed by suture suspension alone. Many surgeons add his technique or a variation of it to their neck-lifting procedure to improve the cervicomental angle. Probably many of us wish we had added this procedure when we feel that our postoperative neck contour could have been better.
Introduction
Neck rejuvenation has been one of the most important components in the treatment for the aging face because the neck is frequently the first feature to show the signs of aging. The aging neck is characterized by the development of an obtuse cervicomental angle, elimination of the smooth jawline border, appearance of vertical neck bands, and accumulation of submental fat and excess skin. The ideal neck surgical rejuvenation technique should correct all of these findings with minimal morbidity and short downtime.
Multiple techniques have been described to perform neck lifts as an isolated procedure or in conjunction with a rhytidectomy. In 1973, Guerrero-Santos and colleagues described the muscular lift. Feldman described the corset platysmaplasty in 1989. In 1990, Giampapa and Di Bernardo developed the concept of the suture-suspension neck lift; initially performed in patients with open facelift, and later performed as a closed neck lift approach. Long-term evaluation of the suture suspension technique has shown that this technique gives the patient a long-lasting rejuvenation of the neck, especially in the cervicomental angle.
Suture suspension platysmaplasty is a powerful, versatile, and minimally invasive technique for neck rejuvenation that addresses the aging neck with minimal morbidity and short postsurgical “downtime.”
Introduction
Neck rejuvenation has been one of the most important components in the treatment for the aging face because the neck is frequently the first feature to show the signs of aging. The aging neck is characterized by the development of an obtuse cervicomental angle, elimination of the smooth jawline border, appearance of vertical neck bands, and accumulation of submental fat and excess skin. The ideal neck surgical rejuvenation technique should correct all of these findings with minimal morbidity and short downtime.
Multiple techniques have been described to perform neck lifts as an isolated procedure or in conjunction with a rhytidectomy. In 1973, Guerrero-Santos and colleagues described the muscular lift. Feldman described the corset platysmaplasty in 1989. In 1990, Giampapa and Di Bernardo developed the concept of the suture-suspension neck lift; initially performed in patients with open facelift, and later performed as a closed neck lift approach. Long-term evaluation of the suture suspension technique has shown that this technique gives the patient a long-lasting rejuvenation of the neck, especially in the cervicomental angle.
Suture suspension platysmaplasty is a powerful, versatile, and minimally invasive technique for neck rejuvenation that addresses the aging neck with minimal morbidity and short postsurgical “downtime.”
Indications for platysmaplasty
Neck rejuvenation with suture suspension platysmaplasty is indicated for virtually any patient with signs of neck aging. Obtaining benefits from this powerful surgical technique are both old and young patients with the following:
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Obtuse cervicomental angle
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Absence of smooth jawline border
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Presence of vertical neck bands (platysma bands)
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Accumulation of submental fat and excess of neck skin
Suture suspension platysmaplasty neck lift could be performed alone or in conjunction with facelift ( Fig. 1 ). This is especially important in patients who, for medical or economic reasons, do not wish to undergo a facelift at the same time of a neck lift. Additionally, performing neck rejuvenation without the traditional preauricular facelift incision is appealing to the male patient population.
An appropriate candidate for this procedure should meet several of the following criteria:
- 1.
Poorly defined cervicomental angle
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Poorly defined submandibular border
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Absence of laxity in the midface structures (because no tightening of the underlying superficial musculoaponeurotic system fibers and facial muscles in the midface is accomplished through this procedure)
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Mild to moderate amount of jowling and neck fat (those with large amounts of neck and jowl fat will find some soft tissue irregularities if this procedure is used alone in lieu of a facelift)
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Unwillingness or inability to undergo a full facelift
Although the suture suspension surgical technique seems to fit a wide range of patients with an aging neck, there is a specific group of patients that will not fully benefit from it: those patients with severe midface laxity and severe jowls will not achieve the desired and expected results with this technique alone ( Tables 1 and 2 ). This specific subgroup of patients requires concomitant midface lifting (preauricular incision) to address the excess of skin and adipose tissue at the lower face/neck junction (severe jowls) that would mask the results of suture suspension neck lift.
| Anatomic Finding | Neck Type Classification | |||
|---|---|---|---|---|
| I | II | III | IV | |
| Midface | No laxity | Mild | Moderate | Severe |
| Jowls | None | Mild | Moderate | Severe (prominent) |
| Submental fat accumulation | Mild | Moderate | Moderate | Severe |
| Platysma laxity | Mild | Moderate | Moderate | Moderate to severe |
| Treatment | Suture suspension platysmaplasty or SAL alone | Suture suspension platysmaplasty | Suture suspension platysmaplasty | Facelift + suture suspension platysmaplasty |
| Anatomic Point | Description | Correction of the Deficiency |
|---|---|---|
| 1 | Cervicomental angle |
|
| 2 | Mandibular border definition |
|
| 3 | Mandibular angle definition |
|
| 4 | Labiomandibular fold prominence (“jowls”) |
|
| 5 | Mental prominence (chin) |
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| 6 | Anterior neck width |
|
Systematic neck evaluation for suture suspension platysmaplasty neck lift
The outcomes of any neck rejuvenation surgical technique rely importantly in the careful preoperative assessment of the neck deformities associated with aging. We have carefully described 6 basic anatomic points of the neck rejuvenation. These 6 anatomic points must be carefully and systematically analyzed to personalize the suture suspension platysmaplasty to perfectly fit the patient’s needs and therefore achieve an outstanding and desired aesthetic outcome.
Our 6 basic anatomic points for the neck rejuvenation are the following:
- 1.
Cervicomental angle
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Mandibular border definition
- 3.
Mandibular angle definition
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Labiomandibular fold prominence (“jowls”)
- 5.
Mental (chin) prominence
- 6.
Anterior neck width
Description of the 6 key anatomic points of neck rejuvenation
Point 1: Cervicomental Angle
The cervicomental angle is one of the fundamental determinants of the youthful neck ( Fig. 2 ). The cervicomental angle is usually between 105° and 120°. Change of this angle to a more obtuse one is an early and strong sign of neck aging. Cervicomental angle depth is limited by the patient’s anatomy. To evaluate the neck with the patient in an interactive manner, we suggest taking a long cotton swab, or something long and thin, and pressing against the neck line to show how deep the cervicomental angle is (ie, the distance between the anterior-most tip of the mentum and the thyroid cartilage). This maneuver done in front of the mirror will show the patient the amount of realistic improvement expected from a neck lift. In people with a narrow neck, even the best neck lift may not yield a dramatic improvement if the patient’s expectations are unrealistic.
