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.
Key points
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Preoperative evaluation of the aging neck patient determines the type of rejuvenation that will be required and the degree of improvement attainable.
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Key anatomic components that should be evaluated are the condition of the skin, amount of soft adipose tissue, mandibular margin, hyoid position, and status of the platysmal muscle layer.
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Chin augmentation in conjunction with other submental plastic procedures can profoundly help improve the overall cervical facial appearance.
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To maximize patient safety and successful wound healing in this elective procedure, it is imperative to consider systemic or complicating medical factors such as whether the patient is a diabetic, on blood thinners, or a smoker.
Introduction
Facial rejuvenation procedures are of increasing interest to the public. The neck and submental regions are of particular concern to the perspective patient in that both aesthetic and anatomic variations as well as aging changes are easily identifiable and not readily camouflaged. Facelift surgery and the multiple surgical variations of that procedure, as well numerous nonsurgical treatments, are frequent objectives of many aesthetic patients. Successful results of these procedures and treatments depend heavily on appropriate preoperative evaluation and thus, appropriate patient selection, surgical planning, and technique utilization.
Growing general acceptance and popularity of these treatments and procedures have been due to enhanced safety and results, which are in turn related to appropriate preoperative evaluation. It has been suggested that when analyzing the face or neck, it may be easier to describe what detracts from beauty rather than what is beautiful. Cervical and neck appearance must display traits associated with youthfulness in order to be typically seen as beautiful. From the time of the early Greeks, proportions and relationships have been described to help analyze the most aesthetic appearance of the face and neck. Back then, a smooth neck was seen by most as aesthetically attractive. Various classifications have been suggested to help identify and categorize neck appearance and potentially assist in developing a treatment plan. These categories or classes usually range from a youthful smooth neck appearance through increments of skin laxity, platysma banding, fat accumulation, chin projection, hyoid bone position, and cervicomental angle.
The appearance overall of the aging neck is a complex combination of several anatomic structures. The appearance of the skin of the neck often provides insight into the patient’s aging process. Both structural and functional changes occur in the skin with aging. Key factors include the intrinsic changes related to aging itself and the degree of photoaging from concomitant chronic ultraviolet light exposure. The typical aesthetic observations include dyspigmentation, laxity, wrinkling, telangiectasias, and a leathery appearance.
Ultimately collagen becomes stiff and is less elastic with the clinical signs of wrinkles and laxity becoming evident in the patient desiring neck rejuvenation. The most successful results in the aging neck patient are typically in patients in whom the aging process has been less severe, who have favorable mandible chin projection, a higher hyoid anatomic position, and are minimally obese. Changes in neck appearance over time are typically the result of multiple factors including UV exposure and damage, genetic predisposition, and tissue aging alterations. Chronologic age is an unreliable determinant in that these factors impact the patient’s anatomy and appearance over a wide spectrum of time ( Figs. 1 and 2 ). The wise and experienced surgeon also utilizes an insightful physiologic evaluation of the patient. This should incorporate the patient’s expectations and potential for acceptance of realistic results prior to accepting him or her for treatment.
Introduction
Facial rejuvenation procedures are of increasing interest to the public. The neck and submental regions are of particular concern to the perspective patient in that both aesthetic and anatomic variations as well as aging changes are easily identifiable and not readily camouflaged. Facelift surgery and the multiple surgical variations of that procedure, as well numerous nonsurgical treatments, are frequent objectives of many aesthetic patients. Successful results of these procedures and treatments depend heavily on appropriate preoperative evaluation and thus, appropriate patient selection, surgical planning, and technique utilization.
Growing general acceptance and popularity of these treatments and procedures have been due to enhanced safety and results, which are in turn related to appropriate preoperative evaluation. It has been suggested that when analyzing the face or neck, it may be easier to describe what detracts from beauty rather than what is beautiful. Cervical and neck appearance must display traits associated with youthfulness in order to be typically seen as beautiful. From the time of the early Greeks, proportions and relationships have been described to help analyze the most aesthetic appearance of the face and neck. Back then, a smooth neck was seen by most as aesthetically attractive. Various classifications have been suggested to help identify and categorize neck appearance and potentially assist in developing a treatment plan. These categories or classes usually range from a youthful smooth neck appearance through increments of skin laxity, platysma banding, fat accumulation, chin projection, hyoid bone position, and cervicomental angle.
The appearance overall of the aging neck is a complex combination of several anatomic structures. The appearance of the skin of the neck often provides insight into the patient’s aging process. Both structural and functional changes occur in the skin with aging. Key factors include the intrinsic changes related to aging itself and the degree of photoaging from concomitant chronic ultraviolet light exposure. The typical aesthetic observations include dyspigmentation, laxity, wrinkling, telangiectasias, and a leathery appearance.
Ultimately collagen becomes stiff and is less elastic with the clinical signs of wrinkles and laxity becoming evident in the patient desiring neck rejuvenation. The most successful results in the aging neck patient are typically in patients in whom the aging process has been less severe, who have favorable mandible chin projection, a higher hyoid anatomic position, and are minimally obese. Changes in neck appearance over time are typically the result of multiple factors including UV exposure and damage, genetic predisposition, and tissue aging alterations. Chronologic age is an unreliable determinant in that these factors impact the patient’s anatomy and appearance over a wide spectrum of time ( Figs. 1 and 2 ). The wise and experienced surgeon also utilizes an insightful physiologic evaluation of the patient. This should incorporate the patient’s expectations and potential for acceptance of realistic results prior to accepting him or her for treatment.
