Bolster Equalization Suture Technique (BEST) Neck: Optimization of Skin Redraping Following Necklift Surgery

Abstract

Abstract Background Skin laxity of the neck is a primary concern of patients seeking facial rejuvenation. Traditional methods for redraping neck skin have well-described shortcomings. Objectives The aim of this study was to optimize skin redraping after necklift surgery while reducing risk, and the Bolster Equalization Suture Technique (BEST). Methods At the conclusion of the facelift and necklift, 3 external quilting sutures are placed with protective bolsters. The first suture is placed at the midline, advancing the skin posteriorly toward the hyoid and anchoring the skin to the platysma. The second and third are placed in the cervicomandibular groove over the sternocleidomastoid muscle, advancing the skin posteriorly. Complications such as skin necrosis, skin ischemia, dimpling, hypopigmentation, hyperpigmentation, and scarring were documented. A control group of 20 patients who underwent the same surgery without the BEST was compared to the next 20 patients in which the BEST was applied. Preoperative and postoperative photographs were blindly reviewed by 2 plastic surgeons. The photographs were analyzed for residual central neck skin laxity and cervicomental angle improvement and surveyed according to the pertinent sections of the FACE-Q. Results In necklift patients who received the BEST, cervicomental angle improvement and decreased central skin laxity were statistically significant. Patient perceived age on a visual analog scale was 2.5 years younger in the BEST group. Conclusions The BEST is a safe and efficient method which can be used to improve cervical skin redraping and contour. The BEST creates a more defined cervicomental angle while reducing central skin neck laxity with minimal complications. Level of Evidence: 4