A Modified, Direct Neck Lift Technique: The Cervical Wave-Plasty

Abstract

Background: Major problems with cervicoplasty by direct skin excision include the subjective nature of skin markings preoperatively and the confusing array of procedures offered. This technique incorporates curved incisions, resulting in a wave-like scar, which is why the procedure is called a "wave-plasty".

Methods: This prospective study includes 37 patients who underwent wave-plasty procedures from 2004 to 2015. Skin pinching technique was used to mark the anterior neck preoperatively in a reproducible fashion. Intra-operatively, redundant skin was excised, along with excess fat when necessary, and closed to form a wave-shaped scar. Patients were asked to follow up at 1 week, 6 weeks, and 6 months after surgery.

Results: The mean operation time was 70.8 minutes. The majority (81.3%) was satisfied with their progress. On a scale of 1 to 10 (1 being the worst, and 10 being the best), the scars were objectively graded on average 5.5 when viewed from the front and 7.3 when seen from the side 6 months after surgery. Complications consisted of one partial wound dehiscence (2.3%), one incidence of hypertrophic scarring (2.3%), and two cases of under-resection requiring revision (5.4%).

Conclusions: In select patients, surgical rejuvenation of the neck may be obtained through wave-like incisions to remove redundant cervical skin when other options are not available. The technique is reproducible, easily teachable and carries low morbidity and high patient satisfaction in carefully chosen patients.

Keywords: Cervicoplasty; Neck; Rejuvenation.

Fig. 1. Various skin excisional techniques

Top left figure is a vertical elliptical incision described in 1903 with a simple closure. Top right is a Z-incision from 1964 (Marino) with a Z-plasty closure. Bottom left figure shows multi-Z-incisions (1971, Cronin and Biggs) with multi-Z-plasties. Bottom right figure is the current wave-plasty technique with wave-like incisions and simple closure.

Fig. 2. Preoperative markings completed

Initially, mark a horizontal submental line, measuring about 4 cm, with point X at the left end of the line. Then draw a vertical midline, approximately 14-16 cm, from the midpoint of the submental line to the sternal notch (marked point Y). Divide the midline into four equal segments, by making three division markings. Mark points A, B, C, D, E, and F using the pinching technique described in Fig. 3. Connect the points to draw the curve X-A-C-E-Y. Draw curve X-B-D-F-Y after further pinching the skin with forceps, in approximately one-centimeter intervals, to assure that the entire length of the wound can be closed under no tension. The left shows a Type I marking requiring Type I closure. The right shows a Type II or Type III marking, where X-A-C is significantly longer than X-B-D, requiring Type II or III excision as shown in Fig. 4.

Fig. 3. Preoperative markings for the wave-plasty

(A) Step 1: Grab redundant cervical skin with smooth tip forceps at the level of the first dividing mark, with tips equidistant from the midline on each side. The skin at the tips of the forceps is marked as points A and B. (B) Step 2: Using the second dividing mark on the midline, mark points C and D by grabbing the excess skin on the patient's left side by placing one forceps tip on the midline and the other on the left side of the neck. (C) Step 3: Mark points E and F by again grabbing excess cervical skin with forceps tips equidistant from vertical midline at the level of the last division mark.

Fig. 4. Variations of closure

Image on the left shows a Type I closure (56.8% of patients) where X-A-C-E-Y and X-B-D-F-Y were simply approximated. Image in the middle is a Type II closure with dog-ear excision from within the submental area (29.7% of patients). Image on the right is a Type III closure. Because X-C is much longer than X-D, additional skin was excised horizontally at the level of the first division in the upper neck in order to close the incision under no tension (13.5% of patients).

Fig. 5. Preoperative to postoperative photographs

A 72-year-old male patient (A) with laxity of cervical skin preoperatively in the front view, (B) laxity preoperatively in the side view, (C) after Type I skin closure, and two months after surgery from the (D) front view, and (E) side view.

Fig. 6. Preoperative and postoperative photos of 65-year-old female

A 65-year-old female. (A) Preoperative front view. (B) Preoperative side view. (C) 6-month postoperative front view. (D) 6-month postoperative side view. (E) 5-year postoperative front view. (F) 5-year postoperative side view.

Fig. 7. Anonymous questionnaire

Anonymous questionnaire mailed to all patients one year after surgery.