Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Nov;23(4):264-73.
doi: 10.1055/s-0029-1242178.

Isolated management of the aging neck

Juan D Mejia  1 , Farzad R Nahai, Foad Nahai, Adeyiza O Momoh
Affiliations

Isolated management of the aging neck

Juan D Mejia et al. Semin Plast Surg. 2009 Nov.

Abstract

The contour of the neck is a very important determinant of facial aesthetics. Precise knowledge of neck anatomy is essential for adequate planning and execution of this procedure. There are three anatomic and surgical planes involved in the management of the aging neck; the superficial plane (subcutaneous fat), the intermediate plane (platysma muscles and the fat between the two muscles), and the deep plane (subplatysmal fat, the anterior belly of the digastric muscles, and the submandibular glands). These planes need to be thoroughly evaluated in the preoperative assessment and dealt with according to each patient's needs. Even though this article focuses on isolated management of the aging neck, careful evaluation of the neck and its relationship to the lower third of the face is fundamental. If there is significant jowling and descent of the neck-face interface, an isolated neck-lift procedure will not address that problem and will lead to a suboptimal result. In these patients, a face and neck lift is a more appropriate operation.

Keywords: Neck lift; SMAS; cervicomental angle; platysma.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(Left) Lateral view of a patient with an obtuse cervicomental angle. (Right) Patient with a desirable cervicomental angle.
Figure 2
Figure 2
Surgical planes of the neck.
Figure 3
Figure 3
Cardoso de Castro's anatomic classification of the platysma muscles.
Figure 4
Figure 4
Submental triangles.
Figure 5
Figure 5
(Left) Evaluation of the location of the submental neck fat by pinching the submental area at rest. (Right) Subcutaneous versus subplatysmal fat is assessed by pinching the submental area during contraction.
Figure 6
Figure 6
(A, B) Preoperative photos of 49-year-old patient. (C, D) Postoperative photos 9 months after neck lift. Skin redraping is demonstrated after superficial fat liposuction and platysma plication through a submental incision. No neck skin was excised.
Figure 7
Figure 7
(Above) Elevation of the platysma muscles to expose the deep fat, the digastric muscles, and the submandibular glands. (Below) Tangential excision of the anterior belly of the digastric muscle preserving half of the thickness of the muscle.
Figure 8
Figure 8
Vectors of platysmal tightening. Arrows demonstrate both vertical and horizontal vectors.
Figure 9
Figure 9
An occipital hairline incision is best suited for individuals with excessive or massive skin redundancy, especially in the lower neck.
See this image and copyright information in PMC

References

    1. Nahai F. In: Nahai F, editor. The Art of Aesthetic Surgery. St. Louis, MO: Quality Medical Publishing; 2005. Neck lift. pp. 1239–1283.
    1. Connell B F, Shamoun J M. The significance of digastric muscle contouring for rejuvenation of the submental area of the face. Plast Reconstr Surg. 1997;99:1586–1590. - PubMed
    1. Ellenbogen R, Karlin J V. Visual criteria for success in restoring the youthful neck. Plast Reconstr Surg. 1980;66:826–837. - PubMed
    1. Nahai F, Nahai F R, Ford D T. In: Nahai F, editor. The Art of Aesthetic Surgery. St. Louis, MO: Quality Medical Publishing; 2005. Applied anatomy of the face and neck. pp. 827–896.
    1. Nahai F, Bryce A. In: Aston SJ, Steinbrech D, Walden J, editor. Aesthetic Plastic Surgery. New York: Elsevier; 2009. Deep plane procedures in the neck. pp. 231–242.

SUGGESTED READINGS

    1. Feldman J J. Corset platysmaplasty. Plast Reconstr Surg. 1990;85:333–343. - PubMed
    1. Fuente del Campo A. Midline platysma muscular overlap for neck restoration. Plast Reconstr Surg. 1998;102:1710–1714. discussion 1715. - PubMed
    1. Guerrerosantos J. Neck lift. Simplified surgical technique, refinements, and clinical classification. Clin Plast Surg. 1983;10:379–404. - PubMed
    1. Nahai F. Reconsidering neck suspension sutures. Aesthet Surg J. 2004;24:365–367. - PubMed