As with face, the ageing neck is the result of number of factors. These include skin laxity, platysmal laxity and deposition of submental or submandibular fat to varying degrees. In addition to loss of ligamentous support of the lower face exacerbates these neck changes. Developmental factors such as ptosis of the chin and submaxillary gland and significant weight loss will exacerbate these signs of physical ageing. These findings are present in varying degrees in the patient with neck ageing and the degree to which these are present dictates the surgical approach ie the surgical approach has to be individualised according to the patients concerned; but almost always the neck rejuvenation procedure/ neck lift is complementary to a surgical procedure done for Facial rejuvenation. The different procedures done for Neck rejuvenation are –
SUCTION LIPECTOMY -- Not only do patients who undergo suction lipectomy benefit from the removal of submental and submandibular fat, but their result also depends on the avid and unique ability of neck skin to retract once it is undermined. Over resection of the fat is avoided. Post operatively a compression dressing consisting of an elastic chin strap is recommended for use continuously for 5 days and then at night for 2 weeks. Contour change will continue to improve as edema resolves during next few weeks. The final post operative result may be obvious only after few months.
LIPECTOMY WITH PLATYSMAPLASTY -- Submental lipectomy with anterior platysmaplasty in the middle aged patient and in the young patient with suspected platysmal fat or in the patient with suspected platysmal laxity is an excellent approach for the patient requesting profile change only. As with submental liposuction alone these procedures depend on the inherent ability of the neck skin to avidly contract. In all variations the neck skin is undermined either with a liposuction cannula or directly through the submental incision, freeing it from the platysmal muscle and allowing the skin to contract. The platysma is then dealt with separately. Usually a Fieldman Corset Platysmaplasty is used. The medial border of the platysma are plicated with a continuous monofilament suture that is run up and down the the midline of the neck until the desired contour is achieved. No manipulation of the lateral border of the platysma is performed. After completion of platysmaplasty, the skin is redraped over the new neck contour. Complications like haematoma, seroma, neck irregularities due to overzealous fat liposuction are rare complications.
MODIFIED NECK LIFT -- for those patients with marked skin excess or excessive skin laxity, open procedures are needed because adequate skin contraction is unlikely to occur. This is generally the older population. The standard procedure requires a preauricular and postauricular incision ie standard face lift approach. This allows the surgeon more control and predictability of skin redraping and a more consistent result at the expense of additional operating room time. Modified facelift incisions are used around the ear. The preauricular incision is needed in these patients because of significant amount of skin excess and the need to redistribute upper neck and lower face skin anteriorly. In the neck, dissection is taken on anterior surface of the platysma muscle once the neck is reached. The remainder of the operation is similar to the isolated platysmaplasty. After the dissection is completed and the platysmaplasty has been performed, neck skin is redraped in the postauricular area. Suction drains are used for 1-2 days to help in drainage and obliterate dead space.
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