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Facial Plast Surg 2021; 37(02): 168-175
DOI: 10.1055/s-0041-1725109
Original Article

The Difficult Neck Patient—Practical Management: A Personal Approach

Kristian Haynes Hutson
1   Department of Otolaryngology, Lewisham and Greenwich NHS Trust, London, United Kingdom
,
Alwyn Ray D'Souza
1   Department of Otolaryngology, Lewisham and Greenwich NHS Trust, London, United Kingdom
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Abstract

With increasing global trends in aesthetic surgery, the facial plastic surgeon will undoubtedly encounter a variety of patient types including those with more unfavorable underlying anatomy. The “difficult” neck represents a cohort of individuals that exhibit both anatomical and patient-related factors that may limit overall surgical improvement. Anatomical issues that contribute to the difficult neck include excessive fat (“heavy” neck), ptosis of deep structures, obtuse cervicomental angle, and abnormalities of the underlying skeletal framework, such as a low set hyoid and inadequate chin projection. It is important that these factors are recognized and highlighted preoperatively, and that surgery is tailored appropriately to the individual. Although satisfactory results can be achieved, these may be ultimately limited, and it is important that patients understand this. We will present a review of current thinking alongside our own practice in the identification and management of these “difficult neck” patients.

Keywords

difficult neck - platysma - lipectomy - rejuvenation


Publikationsverlauf

Artikel online veröffentlicht:
06. März 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Ellenbogen R, Karlin JV. Visual criteria for success in restoring the youthful neck. Plast Reconstr Surg 1980; 66 (06) 826-837
    CrossrefPubMedGoogle Scholar
  • 2 McCollough EG. The McCollough facial rejuvenation system: a condition-specific classification algorithm. Facial Plast Surg 2011; 27 (01) 112-123
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 3 Baker DC. Lateral SMASectomy, plication and short scar facelifts: indications and techniques. Clin Plast Surg 2008; 35 (04) 533-550 , vi
    CrossrefPubMedGoogle Scholar
  • 4 Dedo DD. “How I do it”—plastic surgery. Practical suggestions on facial plastic surgery. A preoperative classification of the neck for cervicofacial rhytidectomy. Laryngoscope 1980; 90 (11 Pt 1): 1894-1896
    CrossrefPubMedGoogle Scholar
  • 5 Zins JE, Menon N. Anterior approach to neck rejuvenation. Aesthet Surg J 2010; 30 (03) 477-484
    CrossrefPubMedGoogle Scholar
  • 6 Kurban RS, Bhawan J. Histologic changes in skin associated with aging. J Dermatol Surg Oncol 1990; 16 (10) 908-914
    CrossrefPubMedGoogle Scholar
  • 7 Bonta M, Daina L, Muţiu G. The process of ageing reflected by histological changes in the skin. Rom J Morphol Embryol 2013; 54 (Suppl. 03) 797-804
    PubMedGoogle Scholar
  • 8 Weihermann AC, Lorencini M, Brohem CA, de Carvalho CM. Elastin structure and its involvement in skin photoageing. Int J Cosmet Sci 2017; 39 (03) 241-247
    CrossrefPubMedGoogle Scholar
  • 9 Rohrich RJ, Pessa JE. The retaining system of the face: histologic evaluation of the septal boundaries of the subcutaneous fat compartments. Plast Reconstr Surg 2008; 121 (05) 1804-1809
    CrossrefPubMedGoogle Scholar
  • 10 Larson JD, Tierney WS, Ozturk CN, Zins JE. Defining the fat compartments in the neck: a cadaver study. Aesthet Surg J 2014; 34 (04) 499-506
    CrossrefPubMedGoogle Scholar
  • 11 Renaut A, Orlin W, Ammar A, Pogrel MA. Distribution of submental fat in relationship to the platysma muscle. Oral Surg Oral Med Oral Pathol 1994; 77 (05) 442-445
    CrossrefPubMedGoogle Scholar
  • 12 Liang MD, Narayanan K, Davis PL, Futrell JW. Evaluation of facial fat distribution using magnetic resonance imaging. Aesthetic Plast Surg 1991; 15 (04) 313-319
    CrossrefPubMedGoogle Scholar
  • 13 Vistnes LM, Souther SG. The platysma muscle. Anatomic considerations for aesthetic surgery of the anterior neck. Clin Plast Surg 1983; 10 (03) 441-448
    CrossrefPubMedGoogle Scholar
  • 14 de Castro CC. The anatomy of the platysma muscle. Plast Reconstr Surg 1980; 66 (05) 680-683
    CrossrefPubMedGoogle Scholar
  • 15 Jacono AA, Malone MH. The effect of midline corset platysmaplasty on degree of face-lift flap elevation during concomitant deep-plane face-lift: a cadaveric study. JAMA Facial Plast Surg 2016; 18 (03) 183-187
    CrossrefPubMedGoogle Scholar
  • 16 Guyuron B. Problem neck, hyoid bone, and submental myotomy. Plast Reconstr Surg 1992; 90 (05) 830-837 , discussion 838–840
    CrossrefPubMedGoogle Scholar
  • 17 Guyuron B. MOC-PS(SM) CME article: genioplasty. Plast Reconstr Surg 2008; 121 (Suppl. 04) 1-7
    PubMedGoogle Scholar
  • 18 Joshi N, Hamdan AM, Fakhouri WD. Skeletal malocclusion: a developmental disorder with a life-long morbidity. J Clin Med Res 2014; 6 (06) 399-408
    PubMedGoogle Scholar
  • 19 Feldman JJ. Neck lift my way: an update. Plast Reconstr Surg 2014; 134 (06) 1173-1183
    CrossrefPubMedGoogle Scholar
  • 20 Ramirez OM. Cervicoplasty: nonexcisional anterior approach. Plast Reconstr Surg 1997; 99 (06) 1576-1585
    CrossrefPubMedGoogle Scholar
  • 21 Knize DM. Limited incision submental lipectomy and platysmaplasty. Plast Reconstr Surg 1998; 101 (02) 473-481
    CrossrefPubMedGoogle Scholar
  • 22 Zins JE, Fardo D. The “anterior-only” approach to neck rejuvenation: an alternative to face lift surgery. Plast Reconstr Surg 2005; 115 (06) 1761-1768
    CrossrefPubMedGoogle Scholar
  • 23 Smith RM, Papel ID. Difficult necks and unresolved problems in neck rejuvenation. Clin Plast Surg 2018; 45 (04) 611-622
    CrossrefPubMedGoogle Scholar
  • 24 Marten T, Elyassnia D. Management of the platysma in neck lift. Clin Plast Surg 2018; 45 (04) 555-570
    CrossrefPubMedGoogle Scholar
  • 25 Farrior E, Eisler L, Wright HV. Techniques for rejuvenation of the neck platysma. Facial Plast Surg Clin North Am 2014; 22 (02) 243-252
    CrossrefPubMedGoogle Scholar
  • 26 Feldman JJ. Surgical Anatomy of the Neck. Neck Lift. 1st ed.. Stuttgart: Thieme; 2006: 106-113
    Google Scholar
  • 27 Fuente del Campo A. Continuing medical education examination-facial aesthetic surgery the hammock platysmaplasty. Aesthet Surg J 1998; 18 (04) 246-252
    CrossrefPubMedGoogle Scholar
  • 28 Prabhat A, Dyer II WK. Improving surgery on the aging neck with an adjustable expanded polytetrafluoroethylene cervical sling. Arch Facial Plast Surg 2003; 5 (06) 491-501
    CrossrefPubMedGoogle Scholar
  • 29 Yousif NJ, Matloub HS, Sanger JR. Hyoid suspension neck lift. Plast Reconstr Surg 2016; 138 (06) 1181-1190
    CrossrefPubMedGoogle Scholar
  • 30 Sullivan PK, Freeman MB, Schmidt S. Contouring the aging neck with submandibular gland suspension. Aesthet Surg J 2006; 26 (04) 465-471
    CrossrefPubMedGoogle Scholar
  • 31 Singer DP, Sullivan PK. Submandibular gland I: an anatomic evaluation and surgical approach to submandibular gland resection for facial rejuvenation. Plast Reconstr Surg 2003; 112 (04) 1150-1154 , discussion 1155–1156
    CrossrefPubMedGoogle Scholar
  • 32 Labbé D, Giot JP, Kaluzinski E. Submental area rejuvenation by digastric corset: anatomical study and clinical application in 20 cases. Aesthetic Plast Surg 2013; 37 (02) 222-231
    CrossrefPubMedGoogle Scholar
  • 33 Connell BF, Shamoun JM. The significance of digastric muscle contouring for rejuvenation of the submental area of the face. Plast Reconstr Surg 1997; 99 (06) 1586-1590
    CrossrefPubMedGoogle Scholar
  • 34 Frodel JL, Sykes JM. Chin augmentation/genioplasty: chin deformities in the aging patient. Facial Plast Surg 1996; 12 (03) 279-283
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 35 Cuzalina LA, Koehler J. Submentoplasty and facial liposuction. Oral Maxillofac Surg Clin North Am 2005; 17 (01) 85-98 , vi
    CrossrefPubMedGoogle Scholar