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Book Details
Abstract
Very focused reviews examine the relevant options in rejuvenating the aging neck. Options in treating the aging neck include non-invasive, minimally invasive, and open surgical approaches. The geometry of the neck, as a simple yet non-hollow cylinder, is examined anatomically and through procedures specific to this unique area. Topical treatments for the aging skin, advances in non-invasive and minimally invasive technologies using various injectables and energy sources, and a range of open procedures that consider all of the internal components of the aging neck are presented. A special Techniques section poses questions to an international group of surgeons who respond with their preferred techniques and approaches and outcomes for such situations as defatting the heavy neck, approach to young versus older neck, use of fibrin glue, and more. Guest Editor Malcolm Paul, who works in academia, private practice, and with technologic companies, leads this review.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Necklift | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Contents | v | ||
| Forthcoming Issues | ix | ||
| Preface\r | xi | ||
| Anatomy of the Neck | 1 | ||
| Key points | 1 | ||
| The neck and its divisions | 1 | ||
| Anterior | 1 | ||
| Posterior | 2 | ||
| The muscles of the neck | 2 | ||
| The Platysma | 2 | ||
| The Sternocleidomastoid | 3 | ||
| The Trapezius | 3 | ||
| The Suprahyoid Muscles (Which Function to Elevate the Hyoid) | 4 | ||
| Digastric | 4 | ||
| Mylohyoid | 4 | ||
| Geniohyoid | 4 | ||
| The Infrahyoid Muscles (Which Function to Depress the Hyoid) | 4 | ||
| Sternohyoid | 4 | ||
| Sternothyroid | 4 | ||
| Thyrohyoid | 4 | ||
| Omohyoid | 4 | ||
| The lymph nodes | 4 | ||
| The submandibular gland | 5 | ||
| Blood supply of the neck | 5 | ||
| Arteries | 5 | ||
| Veins | 5 | ||
| Facial vein | 5 | ||
| Superficial veins | 5 | ||
| Anterior jugular veins | 6 | ||
| Significant nerves in the neck | 6 | ||
| Great Auricular Nerve | 6 | ||
| Cutaneous Cervical Nerve | 6 | ||
| Greater Occipital Nerve | 6 | ||
| Marginal Mandibular Nerve | 6 | ||
| Nonsurgical Neck Laxity Correction | 7 | ||
| Key points | 7 | ||
| Introduction | 7 | ||
| Neuromodulators | 7 | ||
| Dermal fillers | 8 | ||
| Energy-based technologies | 8 | ||
| Broad Band Light or Intense Pulsed Light | 8 | ||
| Radiofrequency | 8 | ||
| Laser | 8 | ||
| Micro-Focused Ultrasound with Visualization | 9 | ||
| Summary | 9 | ||
| Nonexcisional, Minimally Invasive Rejuvenation of the Neck | 11 | ||
| Key points | 11 | ||
| Introduction | 11 | ||
| Aesthetic cervical anatomy of the neck | 12 | ||
| Cutaneous Cervical Layer | 13 | ||
| Subcutaneous Cervical Layer | 14 | ||
| The Cervical Platysmal Layer | 14 | ||
| Subplatysmal Aesthetic Structures | 15 | ||
| Anatomic, nonexcisional management of the neck | 15 | ||
| Cutaneous Layer | 15 | ||
| Chromaphore-based pathologies | 15 | ||
| Melanin-dyschromia | 15 | ||
| Vascular or hemoglobin-based cervical rejuvenation | 16 | ||
| Epidermal and dermal nonchromophore-based lesions | 18 | ||
| Dermal and Subdermal Tightening Devices and Technologies | 18 | ||
| The Subcutaneous Cervical Layer | 20 | ||
| Preplatysmal fat | 20 | ||
| Platysma and cervical muscular layer | 26 | ||
| Medial platysma bands | 26 | ||
| Laxity treatment of oblique cervicomental angle in the lax neck | 27 | ||
| Prominent digastric muscles | 28 | ||
| Prominent submandibular glands | 28 | ||
| References | 29 | ||
| Progressive Tunnelizations in Neck Face Lift Detachment | 33 | ||
| Key points | 33 | ||
| Introduction | 33 | ||
| Technique Fundamentals | 36 | ||
| Physiology | 36 | ||
| Patient selection | 37 | ||
| Surgery description | 37 | ||
| Preoperative Marking | 37 | ||
| Anesthesia | 37 | ||
| Neck Treatment | 37 | ||
| Cervical Liposuction | 37 | ||
| Incision and Detachment | 37 | ||
| Retroauricular Region | 38 | ||
| Treatment of the SMAS | 40 | ||
| Discussion and summary | 40 | ||
| Supplementary data | 40 | ||
| References | 40 | ||
| Lore's Fascia a Strong Fixation Point for Neck Rejuvenation Procedures | 43 | ||
| Key points | 43 | ||
| Technique | 43 | ||
| Managing Aging Necks | 43 | ||
| What incisions do you typically use in the thin neck and the heavy neck in both young and older patients? | 43 | ||
| What is your approach to defatting the heavy neck? Which fatty layers do you resect (ie, subcutaneous, interplatysmal, subp ... | 45 | ||
| How does the presence of visible platysma muscle bands alter your approach? Do you undermine, plicate, transect, and partia ... | 45 | ||
| Discuss Submaxillary Gland Reduction | 48 | ||
| Do you partially resect the anterior bellies of the digastric muscles? | 48 | ||
| Do you think there is a need to drain necks? | 48 | ||
| Do you use fibrin glue in the neck? | 48 | ||
| Sequelae and complications | 48 | ||
| Supplementary data | 49 | ||
| References | 49 | ||
| Restoring the Neck Contour | 51 | ||
| Key points | 51 | ||
| Some remarks on the anatomy of medial fibers of platysma muscle | 52 | ||
| SMAS | 54 | ||
| Complications | 54 | ||
| Summary | 55 | ||
| References | 55 | ||
| Open Neck Contouring | 57 | ||
| Key points | 57 | ||
| Introduction | 57 | ||
| What incision(s) do you typically use in the thin neck and the heavy neck in both young and older patients? | 57 | ||
| What are your indications for limiting your access incisions to the submental area or the lateral approach? In which cases ... | 58 | ||
| What is your approach to defatting the neck? Which fatty layers do you resect (ie, subcutaneous, interplatysmal, subplatysm ... | 58 | ||
| How does the presence of visible platysma muscle bands alter your approach? Do you undermine, plicate, transect, partially ... | 60 | ||
| Submaxillary gland reduction | 61 | ||
| Do you partially resect the anterior bellies of the digastric muscles? | 61 | ||
| Do you believe there is a need to drain necks? | 61 | ||
| Do you use fibrin glue in the neck? | 63 | ||
| Expected sequelae of your technique and complications that you have observed and how you treated them | 63 | ||
| Timing for any revisions of a neck lift | 63 | ||
| References | 63 | ||
| The LOPP—Lateral Overlapping Plication of the Platysma | 65 | ||
| Key points | 65 | ||
| The LOPP neck lifting | 65 | ||
| Incisions | 65 | ||
| Undermining and Defatting | 66 | ||
| Tightening the Platysma with an Overlapping Plication | 67 | ||
| Submandibular Gland Treatment | 67 | ||
| Digastric Muscle and Other Subplatysmal Structures | 68 | ||
| Platysmal Bands | 68 | ||
| Medial Plication Versus Lateral Plication | 69 | ||
| Complications | 72 | ||
| Summary | 72 | ||
| References | 72 | ||
| Total Neck Rejuvenation Using a Modified Fogli Approach and Selective Resection of Anterior Platysmal Bands | 73 | ||
| Key points | 73 | ||
| Introduction | 73 | ||
| Aesthetics and history | 74 | ||
| The anatomic and functional platysma | 74 | ||
| Clinical evaluation of the platysma | 74 | ||
| Planning the submental incision | 75 | ||
| Defining the anterior sternomastoid muscle | 76 | ||
| Results and complications | 77 | ||
| Summary | 80 | ||
| Supplementary data | 80 | ||
| References | 80 | ||
| Neck Contouring | 81 | ||
| Key points | 81 | ||
| Incision | 81 | ||
| Defat and fat grafting | 81 | ||
| Muscles | 81 | ||
| Submaxillary gland | 82 | ||
| Skin | 82 | ||
| Drains | 83 | ||
| Complication | 83 | ||
| Suggested readings | 83 | ||
| Managing the Components of the Aging Neck | 85 | ||
| Key points | 85 | ||
| Introduction/Overview | 85 | ||
| Preoperative planning | 86 | ||
| Operative technique | 87 | ||
| Complications | 92 | ||
| Scarring and Hematoma in Neck Lift | 92 | ||
| Deep Vein Thrombophlebitis or Pulmonary Embolism in Neck Lift | 93 | ||
| Seromas in Neck Lift | 94 | ||
| Infections in Neck Lift | 94 | ||
| Skin Ischemia in Neck Lift | 94 | ||
| Facial Nerve Injury in Neck Lift | 96 | ||
| Recurrent Platysma Bands After Neck Lift | 96 | ||
| Postoperative management | 96 | ||
| Summary | 97 | ||
| References | 98 | ||
| Multidimensional Evaluation and Surgical Approaches to Neck Rejuvenation | 99 | ||
| Key points | 99 | ||
| Overview | 99 | ||
| Obesity | 100 | ||
| Bulging Digastric Muscle | 100 | ||
| Salivary Gland Ptosis | 100 | ||
| Cervical Spine Degeneration | 100 | ||
| Mandible Skeletal Support | 101 | ||
| Preoperative planning | 101 | ||
| Surgical technique | 101 | ||
| Lateral and Anterior Approach | 101 | ||
| Lateral Approach | 102 | ||
| Neck Fat and Neck Bulge | 103 | ||
| Cervicoplasty | 106 | ||
| Sequela and complications | 106 | ||
| Summary | 106 | ||
| References | 107 | ||
| Neck Rejuvenation With Suture Suspension Platysmaplasty Technique | 109 | ||
| Key points | 109 | ||
| Introduction | 109 | ||
| Indications for platysmaplasty | 110 | ||
| Systematic neck evaluation for suture suspension platysmaplasty neck lift | 111 | ||
| Description of the 6 key anatomic points of neck rejuvenation | 111 | ||
| Point 1: Cervicomental Angle | 111 | ||
| Point 2: Mandibular Border Definition | 111 | ||
| Point 3: Mandibular Angle Definition | 113 | ||
| Point 4: Labiomandibular Fold Prominence (“Jowls”) | 113 | ||
| Point 5: Mental Prominence (Chin) | 113 | ||
| Point 6: Anterior Neck Width | 114 | ||
| Suture suspension platysmaplasty neck lift surgical technique | 114 | ||
| Preoperative Management | 114 | ||
| Anesthesia | 114 | ||
| Suction-Assisted Lipectomy of the Neck | 114 | ||
| Management of Platysma Muscle | 114 | ||
| Placement of the Interlocking Suture Suspension (“Artificial Ligament Placement”) | 115 | ||
| The Submandibular Angle Loop Suture | 115 | ||
| Skin Excision | 115 | ||
| Management of Submandibular Glands | 116 | ||
| Specific Management of the Key 6 Anatomic Points of Neck Rejuvenation | 117 | ||
| Surgical correction of point 1: cervicomental angle | 117 | ||
| Surgical correction of point 2: mandibular border definition | 118 | ||
| Surgical correction of point 3: mandibular angle definition | 118 | ||
| Surgical correction of point 4: labiomandibular fold prominence (“jowls”) | 120 | ||
| Surgical correction of point 5: mental prominence (chin) | 120 | ||
| Surgical correction of point 6: anterior neck width | 121 | ||
| Postoperative Care | 121 | ||
| Complications | 121 | ||
| Prolonged Tightness of the Neck | 121 | ||
| Wound Dehiscence | 121 | ||
| Hematoma/Seroma | 122 | ||
| Prolonged Skin Contracture | 122 | ||
| Asymmetry of the Mouth | 122 | ||
| Longevity of suture suspension platysmaplasty neck lift | 122 | ||
| Advantages of the suture suspension technique for neck rejuvenation | 123 | ||
| Summary | 123 | ||
| References | 123 | ||
| Rejuvenation of the Aging Neck | 125 | ||
| Key points | 125 | ||
| Introduction | 125 | ||
| What incision(s) do you typically use in the thin neck and the heavy neck in both young and older patients? | 126 | ||
| What are your indications for limiting your access incisions to the submental area or the lateral approach? In which cases ... | 126 | ||
| What is your approach to defatting the neck? Which fatty layers do you resect (ie, subcutaneous, interplatysmal, subplatysm ... | 127 | ||
| How does the presence of visible platysma muscle bands alter your approach? Do you undermine, plicate, transect, partially ... | 127 | ||
| Discuss submaxillary gland reduction | 128 | ||
| Do you partially resect the anterior bellies of the digastric muscles? | 128 | ||
| Do you feel there is a need to drain necks? | 128 | ||
| Do you use fibrin glue in the neck? | 128 | ||
| Briefly mention expected sequelae of your technique and complications that you have observed and how you treated them | 128 | ||
| Mention your timing for any revisions of a neck lift | 129 | ||
| Reference | 129 | ||
| Serendipity in Ultimate Neck Lift Correction | 131 | ||
| Key points | 131 | ||
| Why is a neck lift like a kiss? | 132 | ||
| Surgical approach | 132 | ||
| Complications and revisions | 134 | ||
| References | 138 | ||
| Neck Lift Technique | 139 | ||
| Key points | 139 | ||
| Managing aging necks under level 1 anesthesia: the lifestyle lift | 139 | ||
| What incision(s) do you typically use in the thin neck and the heavy neck in both young and older patients? | 139 | ||
| Thin Neck | 139 | ||
| Thick Neck | 140 | ||
| What is your approach to defatting the heavy neck? Which fatty layers do you resect (subcutaneous, interplatysmal, subplaty ... | 140 | ||
| How does the presence of visible platysma muscle bands alter your approach? Do you undermine, plicate, transect, partially ... | 140 | ||
| Tighten Platysmal Bands | 140 | ||
| Open Approach | 140 | ||
| Discuss submaxillary gland reduction | 142 | ||
| Do you partially resect the anterior bellies of the digastric muscles? | 142 | ||
| Do you think there is a need to drain necks? | 142 | ||
| Do you use fibrin glue in the neck? | 142 | ||
| Sequelae and complications of neck lift | 142 | ||
| Index | 145 |