Deep neck surgery
Objectives: Understand the aging neck and its management
Introduction: The aging neck is quite different than the aging midface and brow. The distinct features include prolapse of underlying fat, muscles and glands. These findings may be superimposed on mandibular structural variants such as retrogenia and vertical ramal height deficiencies. Customized approaches must include a through approach to the neck and its structures.
Materials / method: All patients undergoing facial rejuvenation consults have an in depth assessment of their soft tissues, skin and underlying bone and dentition. Asymmetries are noted especially in lip position, dimensions and shape alterations relative to the underlying dental arch and any discrepancies. The neck is examined for submandibular gland prolapse, anterior digastric size and position, subcutaneous and sub-platysmal fat, hyoid position and platysmal banding as well as skin condition.
Results: All patients with structural deficiencies of the jaws are treated with osteotomy, implants or fat grafting at the time of deep neck or facelift surgery. Deep plane facelifts were performed in most patients and deep neck surgery is carried out in up to 35% of patients. Removal of sub-platysmal fat almost always requires removal of other sub-platysmal structures. Assessment of the neck intraoperatively requires experience. Ligasure gland resection has reduced the rate of salivary leaks to nearly zero.
Conclusion: A detailed understanding of the lower jaw and dentition is essentially in refining a treatment plan when doing deep neck surgery. Differentiating sub-platysmal fat from subcutaneous fat is essential for treatment planning. Shaping of the mandibular border requires SMAS platysmal flap adjustments laterally and gonial angle and mandibular border augmentation with fat. Deepening of the mandibular neck border can be accentuated by careful sub-mandibular fat contouring.
