Surgical treatment of the aging neck

To obtain consistently successful results, surgical treatment of the aging neck must be based upon a comprehensive anatomic diagnosis, using an appropriate sense of cervicofacial aesthetics and taking into account the relative contributions of each structural component of the deformity. The degree to which the projection and contour of the anterior mandible, redundancy of cervical skin, presence of excess submental fat, hyoid bone position, and configuration of the platysma muscles affect the appearance of the neck should be determined preoperatively to develop an effective surgical plan. Experience has shown that extensive incisions in the region of the anterior neck and transection of the platysma should be avoided. Depending upon the specific findings, any combination of a group of procedures may be required, including cervical rhytidectomy, submental suction-assisted lipectomy, chin augmentation, and midline imbrication of the platysma muscles. The indications, limitations, and possible complications of each procedure are described, and some technical considerations are discussed.