Neck Lifting Variations

59.1 Introduction

The importance of the neck cannot be overstated in the evaluation and treatment of the aging face. Many patients seeking facial rejuvenation report concerns regarding neck skin laxity manifesting as the classic “turkey waddle,” platysmal banding, and deep horizontal neck lines as a top priority. In order to achieve an optimal result, both in terms of surgical outcome and patient satisfaction, it is essential to understand the aging process of the neck, properly analyze each individual patient, understand the patient’s goals and expectations, and to correctly select the surgical technique with which to correct the patient’s pathology.

Over the past century there has been a dramatic evolution of techniques used to correct the aging face and neck. Early teaching and techniques for facial rejuvenation involved simple skin excisions through incisions placed in natural pre and postauricular creases, extensive undermining, and lipectomy [1–3]. The flaps were all subcutaneous in nature and rejuvenation was accomplished through resection of skin. This began to change in the later half of the twentieth century with major innovations in understanding of facial anatomy, its changes with age, and new surgical

H. Mittelman ( )

Associate Clinical Professor, Stanford University, Mittelman Plastic Surgery, 810 Altos Oaks Drive, Los Altos, CA 94024, USA

e-mail: hmittleman@yahoo.com

J.D. Rosenberg

Assistant Professor, Department of Otolaryngology, Mount Sinai School of Medicine,

Annenberg 10th Floor, One Gustave L. Levy Place, Box 1189, New York, NY 10029, USA

e-mail: jrosenberg@gmail.com

techniques. A widely heralded achievement was the development of the “Skoog Flap.” Zimbler [4] described Skoog’s work, published in 1968, where he developed a subplatysmal flap and dissected without detaching the overlying skin. This flap also incorporated the superficial fascia of the lower third of the face which Skoog termed “buccal fascia.” The platysma and fascia were undermined anteriorly to the nasolabial and commissure-mandibular grooves and the flap was repositioned posteriorly and affixed to the parotidomasseteric and mastoid fasciae. In 1976, Mitz and Peyronie [5] discovered a fascial layer which invested the mimetic facial musculature and was distinct from the underlying parotidomasseteric fascia. This fascia was called the superficial musculoaponeurotic system (SMAS) and is the basis for SMAS rhytidectomy. Today, approaches to face/neck lifting range from “limited” techniques including multivector face/neck lifts to aggressive, subSMAS procedures.

Coupled with nearly a century of evolution in rhytidoplasty techniques is a long history of evolving techniques addressing the submental region. Bourguet [2] discussed submental lipectomy and transection of platysmal banding. Subsequently, there have been many techniques used to address the aging platysma, such as varieties of midline plication/imbrication, horizontal wedge resection, corset platysmaplasty, interlocking cervicomental suture suspension, and the use of expanded polytetrafluoroethylene (ePTFE) cervical slings [6–8]. Techniques used to address submental adipose tissue initially involved lipectomy while cervicofacial liposuction was a subsequent innovation. The treatment of skin redundancy has involved various approaches such as allowing postoperative adherence and redraping, vertical elliptical skin excision with simple versus Z-plasty, W-plasty, and double advancement flap closure.