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Neck Rejuvenation
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Surgical and Nonsurgical Techniques
Samuel J. Lin, MD, MBA, FACS
Program Director, BIDMC/HMS Plastic Surgery Residency Training Programs
Co-Director, Harvard Aesthetic and Reconstructive Fellowship at BIDMC
Associate Professor of Surgery, Divisions of Plastic Surgery and Otolaryngology
Beth Israel Deaconess Medical Center, Harvard Medical School
Boston, Massachusetts, USA
Sumner A. Slavin, MD
Plastic Surgeon, Chestnut Hill Plastic Aesthetic Surgery A ssociates, Chestnut Hill
Co-Director, Harvard Aesthetic and Reconstructive Fellowship at BIDMC
Associate Clinical Professor of Surgery
Beth Israel Deaconess Medical Center, Harvard Medical School
Boston, Massachusetts, USA
Associate Editor
Vickram J. Tandon, MD
Plastic Surgeon
Boston Center for Plastic Surgery
Boston, Massachusetts, USA
289 Illustrations
Thieme
New York • Stuttgart • Delhi • Rio de Janeiro
Library of Congress Cataloging-in-Publication Data is
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available from the publisher.
© 2024. Thieme. All rights reserved.
Important note: Medicine is an ever-changing science
undergoing continual development. Research and clinical
experience are continually expanding our knowledge, in
particular our knowledge of proper treatment and drug
therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors,
and publishers have made every effort to ensure that such
references are in accordance with the state of knowledge
at the time of production of the book.
Nevertheless, this does not involve, imply, or express any
guarantee or responsibility on the part of the publishers in
respect to any dosage instructions and forms of applications
stated in the book. Every user is requested to examine
carefully the manufacturers’ leaflets accompanying each
drug and to check, if necessary, in consultation with a physician or specialist, whether the dosage schedules mentioned
therein or the contraindications stated by the manufacturers
differ from the statements made in the present book. Such
examination is particularly important with drugs that are
either rarely used or have been newly released on the market. Every dosage schedule or every form of application used
is entirely at the user’s own risk and responsibility. The
authors and publishers request every user to report to the
publishers any discrepancies or inaccuracies noticed. If errors
in this work arefound after publication, errata will be posted
at www.thieme.com on the product description page.
Some of the product names, patents, and registered designs
referred to in this book are in fact registered trademarks or
proprietary names even though specific reference to this fact
is not always made in the text. Therefore, the appearance of
a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the
public domain.
Thieme addresses people of all gender identities equally.
We encourage our authors to use gender-neutral or genderequal expressions wherever the context allows.
Thieme Publishers New York
333 Seventh Avenue, 18th Floor
New York, NY 10001, USA
www.thieme.com
+1 800 782 3488, customerservice@thieme.com
Illustrations: Graeme Chambers and Brenda Bunch
(Chapters 4, 7, and 12)
Cover design: © Thieme
Cover image source: © Thieme
Typesetting by TNQ Technologies, India
Printed in India by Replika Press Pvt. Ltd. 5 4 3 2 1
DOI: 10.1055/b000000386
ISBN: 978-1-62623-963-0
Also available as an e-book:
eISBN (PDF): 978-1-62623-964-7
eISBN (epub): 978-1-63853-605-5
This book, including all parts thereof, is legally protected by
copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without
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This applies in particular to photostat reproduction, copying, mimeographing or preparation of microfilms, and electronic data processing and storage.
Comments
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To my past, current, and future patients who have entrusted me to take care of them to the best
of my abilities. To my family for their constant support of my career and endeavors.
Samuel J. Lin
Although mindful of so many whose positive influences have shaped my education and indeed
my entire life, one stands out –Dr. Robert M. Goldwyn. I met him as a surgical intern. Over time,
he would become my mentor, my colleague, my best friend, and always a father figure. To this
moment, he exemplifies for me everything that is right in what we do as plastic surgeons.
Sumner A. Slavin
I dedicate this book to my mentors and my wonderful family.
To my mentors, the giants of plastic surgery, who continue to inspire me.
T o my parents, Dar ci and Vani a, who supported me to mov e t o another country to advance my career.
To m y husband, Ilton, who alwa y s belie v ed in my dreams ev en when they seemed impossible.
To m y children, Lucas and Bella, who fulfill my life with joy, purpose, and lo v e.
Munique Maia
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Contents
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Videos ........................................................................ xiv
Foreword ...................................................................... xv
Preface ....................................................................... xvii
Acknowledgments ............................................................ xviii
Contributors ...................................................................xix
1. Neck Anatomy .............................................................. 1
Jeremie O. Piña and Sumner A. Slavin
1.1 Cervical Triangles
.............. 1
1.5.2 Lesser Occipital Nerve . . . . . . . . . . . 5
1.5.3 Spinal Accessory Nerve. . . . . . . . . . . 6
1.2 Fasciae of the Neck............. 1
1.6 Retaining Ligaments of the Face
1.2.1 Superficial ..................... 1
1.2.2 Deep.......................... 2
1.2.3 Infrahyoid Muscle Fascia . . . . . . . . . 2
1.2.4 VisceralFascia.................. 2
1.2.5 Prevertebral Fascia . . . . . . . . . . . . . . 2
1.2.6 CarotidSheath.................. 2
1.3 Platysma and Lower Lip ........ 3
1.7 Subplatysmal Fat............... 7
1.8 Anterior Digastric and
1.9 The Facial Nerve and
and Neck
...................... 6
Mylohyoid Muscles
Lower Lip
...................... 8
............. 7
1.4 Critical Structures Surrounding
Neck Muscles
1.4.1 External Jugular Vein . . . . . . . . . . . . 4
1.4.2 Other Superficial Veins. . . . . . . . . . . 4
.................. 4
1.5 Sensory Distribution in the Neck 4
1.5.1 Great Auricular Nerve. . . . . . . . . . . . 4
1.9.1 Mandibular and Cervical Nerve
Branches....................... 8
1.10 Conclusion .................... 9
References .................... 9
2. Neck Rejuvenation: Evaluation and Management ...................... 11
Jose Foppiani and Samuel J. Lin
2.1 Introduction
2.1.1 Demographic of Neck Lift/
Rejuvenation Procedures . . . . . . . . . 11
2.1.2 Criterion for a Youthful
Aesthetically Pleasing Neck . . . . . . . 11
2.1.3 Criteria for an Aging Neck . . . . . . . . 12
................... 11
2.2 Neck Evaluation................ 12
2.2.1 Skin........................... 13
2.2.2 Adiposity ...................... 13
2.2.3 Platysma....................... 13
2.2.4 DigastricMuscle ................ 13
2.2.5 Submandibular Gland. . . . . . . . . . . . 13
2.2.6 Chin........................... 13
2.3 Neck Rejuvenation
Procedures
.................... 13
vii
Contents
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2.3.1 Nonsurgical Procedures. . . . . . . . . . 14
2.3.2 Surgical Procedures . . . . . . . . . . . . . 16
2.4 Conclusion .................... 21
2.5 Expert Commentary by
Dr. Slavin
...................... 21
References .................... 21
3. Management of the Aging Neck ......................................... 23
Munique Maia and Alan Matarasso
3.1 Introduction
3.2 Patient Analysis ............... 23
3.3 Patient Selection and
Preoperative Planning
3.4 Operative Procedure ........... 24
3.4.1 Surgical Technique . . . . . . . . . . . . . . 24
3.5 Postoperative Care ............ 25
3.6 Complications ................. 26
3.7 Ancillary Procedures and
Nonsurgical Treatments
................... 23
......... 24
........ 26
3.9 Case Examples................. 27
3.9.1 Case1......................... 27
3.9.2 Case2......................... 27
3.9.3 Case3......................... 27
3.9.4 Case4......................... 27
3.9.5 Case5......................... 27
3.10 Expert Commentary by
Dr. Slavin
...................... 27
3.11 Expert Commentary by
Dr. Lin
........................ 27
References .................... 32
3.8 Conclusion .................... 27
4. The Use of Platysma Window for Neck Contouring .................... 35
Rod J. Rohrich, Justin Bellamy, and Nelson A. Rodriguez-Unda
4.1 Patient Considerations,
Indications, and
Contraindications
4.1.1 Who Is a Candidate? . . . . . . . . . . . . . 35
4.1.2 PlatysmalBands................ 35
4.1.3 TheCentralNeck................ 35
4.1.4 Contraindications . . . . . . . . . . . . . . . 36
.............. 35
4.2 What Technique to Use and
......................... 36
Why?
4.3 Technique: A Stepwise Summary 36
4.4 How to Avoid Bad Results/
Common Pitfalls
............... 37
4.5 Case Example ................. 39
4.5.1 Goals.......................... 39
4.5.2 Approach...................... 39
4.6 Expert Commentary by
Dr. Slavin
...................... 39
4.7 Expert Commentary by
Dr. Lin
........................ 39
References .................... 41
viii
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