Malcolm D. Paul, MD, FACS, Editor

Although the approach to the upper and principally the middle third of the aging face has evolved to the appreciation of the need to address both volumetric and vector-based changes, surgical options in rejuvenating the neck have been mainly subtraction of skin, fat, gland, and muscle and repositioning of skin and platysma muscles. Assessing the aging neck begins with the observation of the cutaneous covering of the neck from the mandibular border to the clavicles. The next task is to understand the basic structure of the neck and its contents. The geometry of the neck is a simple cylinder. However, this cylinder is not hollow and therein lies the requirement for a template of procedures to address the anatomy hidden beneath the skin of this cylinder.

This issue of Clinics in Plastic Surgery examines many of the relevant options in rejuvenating the aging neck. Beginning with a thorough description of the clinical anatomy of the neck with an emphasis on correlating anatomy to procedure risks, this edition continues with

• 1.
  

  Topical treatments for improving the aging skin.

  
  
• 2.
  

  Advances in noninvasive and minimally invasive technologies using various injectables and energy sources to improve the quality of the skin envelope and tighten the collagen fibers within the dermis and within the fibrous septae between the superficial cervical fascia and the skin.

  
  
• 3.
  

  A techniques article to detail a range of open surgical procedures that address all of the internal components of the aging neck. There will be some overlap to the middle third of the face as some techniques utilize the continuity of the SMAS with the superior fibers of the platysma muscles to rejuvenate the neck by repositioning the SMAS and platysma as one or multiple flaps.

Authors for this issue were provided with a series of questions asking how they work with different types of anatomy in doing neck lifts. Each author either followed the question-and-answer format or provided a very brief, succinct description of their approach(es) and outcomes on their specific surgical technique(s), focusing on how they do it and why in order to offer surgeons options to help them assess their own surgical procedures and results. Not unexpectedly, there are many ways to approach the anatomical changes that one encounters in the aging neck. The authors describe their techniques from minimal access approaches to recontouring the neck to classical wide dissections from multiple access incisions, with both extremes describing their management of lax skin, compartmental lipodystrophies, platysma muscle bands, and their approach to the submaxillary gland and anterior belly of the digastrics muscles. Since it is mandatory that every option have a risk: reward ratio that clearly favors the reward(s), each author has been asked to describe the frequency of sequelae and complications that they have encountered and how they have been managed.

My goal in suggesting this topic to the publisher of Clinics in Plastic Surgery was to provide current safe and predictable options in cosmetic medical and surgical solutions for the aging neck. Of course, the public interest over the past several years in less invasive procedures with a faster recovery, allowing a quicker return to work and social obligations, must be judged with an eye toward providing a meaningful, sustainable solution to the aging neck. Certainly, some patients will be satisfied with a maintenance program with small steps while others will want a result that will last an average of 5 to 10 years. Understanding what our patients want has always been a cornerstone to having satisfied patients. Having said this, I believe that:

WHEN YOU BUY QUALITY, YOU ONLY CRY ONCE.