Optimizing Outcomes in Neck Lift Surgery

Abstract

Abstract Background In certain patients there is an imbalance between the volume of the anterior neck and the mandibular confines that requires reductional sculpting and repositioning of the hyoid to optimize neck-lifting procedures. Objectives A quantitative volumetric analysis of the impact of the management of supraplatysmal and subplatysmal structures of the neck by comparing surgical specimens was performed to determine the impact of reduction on cervical contouring. Methods In 152 patients undergoing deep cervicoplasty, the frequency of modification of each surgical maneuver and the amount of supraplatysmal and subplatysmal volume removed was measured by a volume-displacement technique. Results The mean total volume removed from the supraplatysmal and subplatysmal planes during deep cervicoplasty was 22.3 cm3 with subplatysmal volume representing 73% of the total. Subplatysmal volume was reduced in 152 patients. Deep fat volume was reduced in 96% of patients by a mean of 7 cm3, submandibular gland volume in 76% of patients by a mean of 6.5 cm3, anterior digastric muscle volume in 70% of patients by a mean of 1.8 cm3, perihyoid fascia volume in 32% of patients by a mean of <1 cm3, and mylohyoid volume in 14% of patients by a mean of <1 cm3. The anterior digastric muscles were plicated to reposition the hyoid in 34% of cases. Supraplatysmal fat reduction was 6.3 cm3 in 40% of patients. Conclusions The study provides a comprehensive analysis of the impact of volume modification of the central neck during deep cervicoplasty. This objective evaluation of neck volume may help guide clinicians in the surgical planning process and provide a foundation for optimizing cervicofacial rejuvenation techniques. Level of Evidence: 4