Front Cover 1
Neck Rejuvenation 2
copyright 
3 
Contributors 4
Contents 6
Facial Plastic Surgery Clinics 
 
9 
Preface 
10 
Anatomy and Physiology of the Aging Neck 12
Key points 12
Introduction 12
Anatomy and Physiology by Anatomic Structure 12
Skin 13
Cervical fascia 14
Superficial cervical fascia 14
Deep cervical fascia 14
Subcutaneous fat 15
Lymphatics 16
Superficial muscular aponeurotic system 16
Platysma 16
Subplatysmal deep compartment structures 17
Subplatysmal fat 17
Digastric muscles 18
Submandibular glands 19
SCM 19
Great auricular nerve 19
Facial nerve 19
Deeper structures 20
Mandible 20
Hyoid 20
Cartilaginous structures 20
Radiographic imaging 20
Summary 20
References 21
Preoperative Evaluation of the Aging Neck Patient 22
Key points 22
Introduction 22
Surgical candidate selection 23
Clinical neck procedure evaluation 24
History 24
Physical Examination 24
Summary 27
References 27
A Progressive Approach to Neck Rejuvenation 28
Key points 28
Overview and history of rhytidectomy 28
Direct Lipectomy 28
Platysma 29
SMAS 29
Deep Plane 29
Subperiostial 30
Short Incision 30
Technique Selection 30
Treatment goals 31
Preoperative evaluation 31
Fat Assessment 31
Skin Quality and Quantity 31
Lower Face and Jawline 31
Patient Health 32
Procedural approach 32
Patient Preparation and Anesthesia 32
Platysma Correction 32
Assessment of Skin and Tissue of Lower Face 33
Deep Plane Dissection 33
Extensive Skin Undermining 33
Direct Observation of SMAS 34
SMAS Techniques 34
Thick strong SMAS tissue 34
Thin strong SMAS tissue 35
Thick weak SMAS tissue 35
Thin weak SMAS tissue 36
Complications 36
Postoperative care 36
Expected recovery 37
Outcomes 37
Summary 40
References 41
Noninvasive Treatment of the Neck 42
Key points 42
Introduction 42
Intense focused ultrasound 43
Treatment goals and planned outcomes 43
Preprocedure planning and preparation 44
Patient positioning 44
Procedural approach 44
Potential complications 45
Postprocedure care/recovery 46
Outcomes 46
Clinical results in the literature 48
Discussion 51
Supplementary data 52
References 52
Neck Skin Rejuvenation 54
Key points 54
Introduction 54
Botulinum toxins 54
Peels and dermabrasion 55
Croton oil peel 55
Plasma skin regeneration 56
Lasers 56
A case of complications in fractional laser resurfacing 59
Case 59
Discussion 59
Neck rejuvenation with the ablative CO2 laser 61
Summary 65
References 65
Thermally Confined Micropulsed 1444-nm Nd:YAG Interstitial Fiber Laser in the Aging Face and Neck 68
Key points 68
Introduction 68
Interstitial Nd:YAG fiber laser–assisted facial contouring 69
Interstitial Nd:YAG fiber laser–assisted neck contouring 72
Interstitial Nd:YAG fiber laser–assisted face and neck lift—treatment method 75
Summary 79
References 79
Adjunctive Procedures to Neck Rejuvenation 82
Key points 82
Introduction 82
Fibrin sealants 82
Fibrin Sealant Procedure 84
Outcomes of Fibrin Sealant 85
Chin augmentation 85
Expanded Polytetrafluorethylene 85
Porous Polyethylene 85
Polyamide Mesh 85
Silicone Rubber 88
Mersilene Mesh 88
Implant Placement Via Intraoral Approach 88
Implant Placement Via Submental Approach 89
Post Procedure 89
Outcomes of Surgical Approaches 89
Submandibular gland ptosis 89
Hyoid bone position 90
Summary 91
References 92
Techniques for Rejuvenation of the Neck Platysma 94
Key points 94
Introduction 94
Treatment goals and planned outcome 94
Preoperative planning and preparation 95
Patient positioning 96
Procedural approach 96
Neck Lift Procedure 96
Direct Excision (Grecian Urn) 97
Adjuvant techniques for neck rejuvenation 99
Neuromodulators 99
Laser Skin Resurfacing 99
Submental Liposuction 100
Potential complications and management 101
Hematoma 101
Flap Necrosis 101
Nerve Injury 101
Incision Irregularities 101
Earlobe Deformities 102
Postprocedural care 102
Rehabilitation and recovery 102
Outcomes/clinical results in literature 102
Summary 103
References 103
The Extended SMAS Approach to Neck Rejuvenation 104
Key points 104
Introduction 104
Treatment goals and planned outcomes 105
Preoperative planning and preparation 108
Patient positioning 109
Procedural approach 109
Potential complications and management 113
Postprocedural care 115
Rehabilitation and recovery 115
Outcomes 118
Summary 119
Supplementary data 119
Further Readings 119
The Deep-Plane Approach to Neck Rejuvenation 120
Key points 120
Introduction 120
Anatomy 123
Evaluation 124
Patient perspective 125
The deep-plane approach to neck rejuvenation 125
Surgical Procedure 125
Anesthesia 125
Patient Preparation 125
Initial Incisions 125
Midface Dissection 127
Subcutaneous plane dissection 127
Deep-plane dissection 127
First reference point: lateral border of orbicularis muscle 127
Second reference point: masseter muscle 128
Nasolabial folds and oral commissure 128
Dimples 128
Assessment of deep facial structures 128
Neck Dissection 129
Incision 129
Preplatysmal and subplatysmal dissection and assessment 130
Platysma imbrication 131
Completion of neck-contouring process 131
Flap Mobilization, Fixation, and Closure 131
Hemostasis 132
Sutures 132
Postprocedure 132
Aftercare 133
Complications 133
Summary 134
Supplementary data 135
References 135
Vertical Neck Lifting 136
Key points 136
Introduction 136
Approaches to Achieve Aesthetic Ideal 136
Bidirectional Technique 137
Bidirectional and Vertical Technique Compared 137
Skin Redraping 137
SMAS-platysma Complex 140
Ligament Release 141
Midline plication 141
Zygomatic-cutaneous ligaments 142
Mandibular cutaneous ligaments 142
Vertical neck lift technique 142
Indications and ancillary procedures 143
Surgical technique 143
Preoperative Marking 143
Anesthesia 145
Incision and Skin Flap Elevation 145
Deep Plane and Prezygomatic Space Dissection 149
Surgical note 149
Release of the Zygomatic Cutaneous Ligaments 150
Release of the Cervical Retaining Ligaments 150
Deep Plane Flap Suspension 151
Surgical note 151
Mandibular Ligament Release 152
Surgical note 152
Lateral Platymsa Suspension in the Neck 152
Surgical note 153
Surgical note 153
Adjunctive Submental Procedures and Platysmoplasty 154
Discussion 155
References 164
Complications/Sequelae of Neck Rejuvenation 168
Key points 168
Introduction 168
Hematoma 168
Induration 169
Skin contour irregularities 169
Nerve injury 169
Infection 169
Persistent platysmal bands 170
Earlobe distortion/pixie ear deformity 170
Ptotic and/or large submandibular gland 170
Hairline distortion 170
Summary 171
References 171
Index 172