Direct anterior neck skin excision for cervicomental laxity

Skin and platysma muscle laxity in the cervicomental area is a surgical challenge. Several approaches are possible, including an extended facelift, platysmaplasty, and liposuction. Severe cases are difficult to treat, and a direct approach might sometimes be indicated. The aim of this study was to evaluate the outcomes and clarify the indications for a direct approach with anterior neck skin excision.

Patients undergoing anterior neck skin excision were recruited retrospectively and prospectively. Subjective and objective assessments by the patients and their surgeon were made pre- and postoperatively. Cervicomental skin is excised with a Z-plasty to leave the horizontal limb hidden in the cervicomental angle. This is a local anaesthetic office procedure.

Surgery was performed on 17 patients in our unit over a 10-year period. Indications included patient choice, expense, unsuitability for general anaesthesia, and previous failure of facelift procedures. Ellenbogen-Karlin scoring criteria for the cervicomental angle showed a mean improvement from 0.6 to 3.3 points out of 5. There were no wound infections or flap necroses and no revisional surgery was required. Three patients underwent steroid injections for scar hypertrophy.

The procedure is simple, quick, safe, and effective at restoring the cervicomental angle but leaves a potentially very problematic scar.