[Difficult necks. Diagnosis and treatment. Retrospective study of 145 cases using the method of Feldman]

To identify a neck as difficult seems an easy thing. Nevertheless, we must admit that various clinical situations are represented under this single designation. A clinical and anatomical classification is proposed regarding the surgical strategy presented in this paper. Predominant tissue laxity and predominant fat accumulation are presented as progressive forms. Short platysma muscles and low hyoid bones are presented as constitutional. According to this classification, 145 patients among 438 facial rejuvenations were designated as difficult necks. The surgical strategy was intended, in each case, to address the underlying anatomical features, using a short incision system. A combination of wide skin undermining, fat removal under direct vision and corset platysmaplasty was performed in the 145 patients between November 2003 and May 2008. The average age was 59 years old and medium follow-up at 22 months. There was only 2% of secondary touch up for aesthetic reasons. Difficult necks, as described in this article, responded adequately to the present protocol. The postoperative results on the neck were consistent with the rest of the rejuvenated face and stood the test of time.