With the increased focus on the neck and chin in the era of selfies and social media, neck contouring continues to be an in-demand procedure. Full correction of the neck typically requires both submental and postauricular incisions, but the postauricular incisions can be unsightly and painful. This article introduces a viable alternative for the patient.
A case series of appropriate candidates undergoing a novel neck lift technique (the single incision minimally invasive neck lift) is described. Participants include men and women with an age range of 30–70. The surgical technique incorporates shifting of the typical submental incision used in a full neck lift to a cervicomental incision, and when accompanied by wide undermining, the postauricular incisions are avoided entirely.
Among the 20 patients in this case study, photographs show that it is possible to achieve results commonly associated with a full neck lift but without the postauricular incisions typically associated with a full neck lift.
The single incision minimally invasive neck lift allows the surgeon to offer an effective procedure for appropriate candidates who want to treat excess fat, a sagging platysma muscle and loose, misplaced skin in the submental region without postauricular incisions typically utilized in a traditional full neck lift.
Neck contouring continues to be a very sought-after procedure in the era of social media and selfies.1 Awareness of these procedures via marketing and social media generates interest within the Millennials (born 1981–1996, age 22–37 years in 2018) and Generation X (born 1965–1980, age 38–53 years in 2018) communities, whereas traditionally, patients who consider neck lifts fit within the Baby Boomers (born 1946–1964, age 54–72 years in 2018) age bracket.2
With this changing demographic come different expectations. In addition to seeking out completely noninvasive procedures, they are considering minimally invasive procedures. Deciding factors include length of work and/or social down time, placement and concealment of incisions, number of incisions, and the risk–reward benefit of undergoing the procedure.
To meet the demand of these changing expectations, surgeons must innovate to attract this clientele. In the past, a full neck lift was necessary to achieve long-lasting results. However, younger patients may be more reluctant to have an invasive procedure that requires both submental and postauricular incisions.
During a cosmetic surgery consultation, the Pythagorean theorem and Euclidean geometry3 are used as a guide to determine appropriate candidates who will achieve the same results as a traditional neck lift with a novel type of “mini” neck lift. This case series discusses the single incision minimally invasive (SIMI) neck lift and how consistent reproducible results are achievable through 1 incision instead of 3.
PATIENTS AND METHODS
This case series includes 20 consecutive patients who underwent a SIMI neck lift. The patients provided informed consent, and several patients allowed the primary surgeon and author (JLK) to record the procedure on Snapchat and Instagram as is standard in the author’s practice. Patients also agreed for their photographs to be used in this case study and for marketing purposes.
Patients with “misplaced” midline neck skin, without a great deal of excess skin, were considered candidates for this modified neck lift. The 20 patients included in this study underwent surgery between May 2015 and August 2018 (approximately 3.5 years). They were fairly evenly divided between males and females (11 women and 9 men) with an average age of 55 (range 30–70) years (Table 1).
In the preoperative holding area, the patient is marked. A 3–4 cm line is drawn on the radial side of the left index finger and then superimposed on the junction of the horizontal and vertical surface of the neck (the cervicomental angle) in a transverse direction. Using this technique allows the surgeon to feel for that junction, thus ensuring that the incision is placed in the most hidden, concave surface of the cervicomental angle of the neck, within the neck’s natural shadow (seevideo, Supplemental Digital Content 1, which shows appropriate preoperative marking of the ideal SIMI neck lift candidate, intraoperative technique, and reproducible postoperative results. This video is available in the “Related Videos” section of the Full-Text article on PRSjournal.com or at http://links.lww.com/PRSGO/B71).
The lateral extent of the neck dissection is marked along the edge of the sternocleidomastoid, with the superior most dissection marked along the jawline and the inferior most dissection marked along the base of the neck. The 3–4 cm incision allows full access for complete dissection of these areas.
In the operating room, the patient is given a standard dose of 1 g of cefazolin and SCDs are placed. This is a procedure that can be done under both conscious sedation and general anesthesia.
A stab incision is made in the center of the transverse preoperative marking in the cervicomental angle of the neck with a # 15 blade. A total of 250 ml of tumescent solution is infiltrated under low flow. Tumescent solution consists of saline and 1 amp of epinephrine (no lidocaine) if under general or 50 ml of 1% lidocaine and 1 amp of epinephrine if performed under conscious sedation. After infiltration, 7–10 minutes is allowed to elapse for maximum vasoconstriction.
Liposuction with a 3-mm cannula is performed along the entirety of the neck, extending to the sternocleidomastoid and especially along the jawline to reduce any jowling that is present. After liposuction, the remainder of the transverse neck incision is completed.
Under direct visualization with a lighted retractor, the neck skin is elevated bilaterally to the sternocleidomastoid, anteriorly toward the chin, and inferiorly toward the base of the neck. Because there are no postauricular incisions in the SIMI neck lift, the surgeon must widely undermine and reposition the misplaced skin.
After elevation and hemostasis, the medial edges of the platysma are delineated in preparation for the corset platysmaplasty as described by Feldman.4 Any subplatysmal fat is excised down to the level of the digastric muscles. A 4–0 PDS is run from the superior aspect of the platysma to the base of the neck and back up in a running horizontal mattress fashion to minimize the appearance or palpation of a midline ridge.
Any excess fat present just posterior to the chin or attached to the undersurface of the skin flap is directly excised. One 10 French round drain is brought through a separate stab incision behind either earlobe and placed across the entire neck. Only one drain is used and is sewn into place with leftover 4–0 PDS used in the corset platysmaplasty.
The cervicomental incision is closed with 6–0 fast absorbing gut along the skin edges in a baseball stitch fashion (simple continuous or running suture technique). No dermal stitch is required. The patient is placed into a postoperative head and neck garment and transferred to the recovery room. Patients are sent home with an extra garment and an already filled prescription of pain medication, antiemetics, and silicone scar cream. The silicone scar cream can be applied 2 weeks after procedure and is recommended to further minimize the appearance of the scar by increasing collagen production.5
The patient is seen the next morning (postoperative day one) to remove the drain. Showers commence the next morning after drain removal. The garment is worn all of the time during the first week except during showers and then only at night for several more weeks.
Because the only incision is closed with absorbable stitches, the patient does not have to return for suture removal, other than the drain stitch on postoperative day 1. The patient returns for a checkup and postoperative photographs at 2 weeks and 3–4 months.
Twenty patients underwent a SIMI neck lift. These were primary cases. Patients who were considered candidates for the SIMI neck lift were those with excess fat and skin to the neck and reflect the SIMI neck lift pathway in the decision tree found in Figure 8.
The only observed complication was an immediate postoperative hematoma that was noted in the recovery room. The patient was brought back to the operating room, and the operative site was explored through the existing cervicomental incision. No vessel was identified other than generalized ooze. Hemostasis was achieved without the need for additional incisions, and the patient had an uncomplicated recovery from that point onward.
One patient had residual submental fat remaining after his SIMI neck lift. Dissolution of the fat with deoxycholic acid was offered, but the patient was happy with his result and declined.
Each figure shows results at 3–4 months postoperative. The impetus for doing a SIMI neck lift, or why a SIMI neck lift was more appropriate than another technique, is clarified with each before and after result.