The Goals of Cervicoplasty

Nobody truly escapes the ravages of time and in the age of Zoom meetings, many patients have been mortified by the appearance of their necks. There is a nonsurgical solution, which many “selfie” savvy individuals employ, (lighting and posing), however for those nonexperts, who feel stigmatized by their “turkey necks”, a necklift is an option, which will provide a long term solution, with less expense and maintenance than nonsurgical “cures”. First of all, it’s important to inventory what features are associated with an old neck.

1. Submental fat accumulation can be “treated” with Kybella, CoolSculpting, RF but the extent of skin shrinkage is unpredictable;
2. Mandibular jowls are actually part of facial aging, however may be found adjacent. Microliposuction and Kybella have been proposed but have the potential for nerve injury as well as irregular contours;
3. Platysmal bands are the muscle “cords”, which men use to shave their necks, horses to flick flies off but serve mostly to frustrate because of their association with age. Botox (Nefertiti necklifts ) PDO thread lifts cycle frequently and biodegradable implants have been matched and discarded because the long term outcomes, cost and perception of value were disappointing;
4. Submandibular glands are salivary glands, lying under the jaw bone, which can be temporarily but effectively reduced with the use of Botox;
5. Shortening of the vertical height = “tech neck” is the regrettable consequence of both aging (loss of intervertebral disc height, reduction of the anatomical cervical curve) as well as occupational & recreational overuse of computers, which dip our chins towards our chests. Osteopenia affects both men and women and is largely a function of genetics. That being said, everyone has the ability to nurture what nature has given us by the judicious use of weight lifting, exercise (yoga and pilates) and avoidance of injury.

Goals:

1. Restoration of the submental hollow in my hands requires direct tangential excision of pre and occasionally postplatysmal fat. This is accomplished via an incision below the chin and is more complete than liposuction or nonsurgical means;
2. Elimination of the troublesome platysmal bands does require incisions both around the ears as well as under the chin. The platysma is a large muscle originating on the jaw bone and terminating on the chest. In youth, the medial (inner) borders are united, whereas in age they splay, creating the “bands”. Tightening the skin alone will not control these deeper muscular structures, which must be trimmed and tightened, laterally to control recurrence;
3. Harmonizing the mandibular jowls with a neck, which is arguably “younger” often mandates including a lower facelift +/- Botox of the submandibular glands. Some surgeons advocate removal of these, however the sequela of dry mouth are not to be recommended;
4. Retexturizing the prominent horizontal neck wrinkles, reducing the red-brown dyschromias, which are both consequences of solar dermal elastosis (too much sun exposure) may require staged laser and/or RF.

Patients are relieved to learn that the discomfort from necklifts is mild to moderate and centers around the incisions behind the ears, where the greatest amount of tension is developed, after redraping the loose neck skin. According to the individual’s tolerance, pain medications may be required for 3-7 d; many patients prefer to take Tylenol. There is a significant amount of wound care, including drains and head dressings, which are placed for 24 & 36h respectively. We schedule post op visits at 1, 3, 7 & 10 d, at a minimum and are always available to field questions.

There is a current trend for face and necklifts under local with oral sedation, however my preference is to schedule them under IV sedation, as the presence of an endotracheal tube (General Anesthesia) makes the technical performance of a necklift more difficult. The practice ambulatory surgical suite is accredited by AAAASF, staffed by Board Certified Anesthesiologists and a carefully curated corp of Registered Nurses and Certified Surgical Technicians. Every contingency for safety, comfort and excellent outcomes is anticipated and provided.