The Short Neck: Challenges and Techniques

Establishing a pleasant cervical contour in short-neck patients is of one the most difficult challenges for a facial plastic surgeon. Subplatysmal volume reduction, platysma tightening, and skin distribution adequately coupled with the middle third facelift are the pillars of the surgical approach. Additionally, treating the small chin, which is frequently observed in these patients, improves the overall result. In this paper, an objective method to define short-neck patients is offered. The applied surgical anatomy of the neck is revised. Innovative strategies to treat the supra and infrahyoid subplatysmal structures are presented, including the sternohyoid muscles plicature and the use of the interplatysmal/subplatysmal fat flap. A novel chin augmentation technique, using a subperiosteal en bloc fat graft is also introduced. A modified deep plane approach is described, including a continuous suture of the middle third fasciocutaneous flap. A combined lateral platysma tensioning with the sternocleidomastoid rejuvenation is demonstrated. Lastly, the hemostatic net is revisited as a critical approach to resolve the defying skin accommodation.