This article addresses specific questions posed to the author by the editor to elucidate his 40-years experience with neck lift. Surgery of the neck has been, in the author’s hands, for all practical purpose, problem free. However, one needs to understand the issues and apply the proper techniques. By far, it is best to prevent problems than to treat them afterward. Leaving appropriate amounts of subcutaneous fat cannot be overemphasized.
Key points
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The neck is divided into 2 defined segments: (1) the submental, submandibular region, and (2) the region of the neck proper, which includes the structures caudally to this imaginary line.
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The understanding of neck rejuvenation depends entirely on 2 different factors. Alone, neither will produce a good neck. Combine both, and an excellent result is consistently achieved.
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The correction of laxity of tissues in the submental area needs direct surgery in this region and the hammock effect, produced by the bilateral elevation of the midface lift. Only with both can the rejuvenation of this region be achieved.
Editor Commentary: My friendship with Bruno Ristow exceeds 35 years, and I was delighted when he accepted my invitation to contribute to this publication. He followed the questions posed to him and presents a logical template for rejuvenating the neck. He makes the important point of proper rotation of the SMAS/platysma flap following partial transection of the platysma at the level of the cricoid cartilage. His admonition to wait up to 1 year before considering revising the neck is important to consider, because many small issues resolve themselves; larger issues require maturation of the soft tissue (similar to waiting 1 year before performing a secondary rhinoplasty.)
Introduction
When the editor of this issue asked me to share my experience and the concluding thoughts resulting from my nearly 40 years of performing neck rejuvenation, I promptly and happily accepted the invitation. The reasons are simply based on experience; to me the issues have logical and direct answers based on facts. I was prompted with a series of questions to address. However, before I address the questions, I want to emphasize that the understanding of neck rejuvenation depends entirely on 2 different factors. Neither will produce a good neck alone. Combine both, and an excellent result is consistently achieved.
If a fine line is drawn from the jaw neck angle to the earlobe ( Fig. 1 ), the neck is divided into 2 defined segments:
- 1.
The submental, submandibular region
- 2.
The region of the neck proper, which includes the structures caudally to this imaginary line
The correction of laxity of tissues in the submental area, need, aside from the direct surgery in this region, needs the hammock effect, produced by the bilateral elevation of the midface lift. Only then, can the rejuvenation of this region be achieved. The effect of the superficial musculo-aponeurotic system (SMAS) elevation on the right and left midface, gives a strong sling effect to the tissues in the submental region, appropriately described as the hammock effect.
Now, to address specific questions.
Introduction
When the editor of this issue asked me to share my experience and the concluding thoughts resulting from my nearly 40 years of performing neck rejuvenation, I promptly and happily accepted the invitation. The reasons are simply based on experience; to me the issues have logical and direct answers based on facts. I was prompted with a series of questions to address. However, before I address the questions, I want to emphasize that the understanding of neck rejuvenation depends entirely on 2 different factors. Neither will produce a good neck alone. Combine both, and an excellent result is consistently achieved.
If a fine line is drawn from the jaw neck angle to the earlobe ( Fig. 1 ), the neck is divided into 2 defined segments:
- 1.
The submental, submandibular region
- 2.
The region of the neck proper, which includes the structures caudally to this imaginary line
