What Lies Beneath: Carotid Artery Depth and the Safe Use of Hemostatic Nets in Facelift Surgery

Previous studies have demonstrated the effectiveness of the hemostatic net in reducing postrhytidectomy hematomas; however, its safety in relation to the proximity to the carotid vessels is unknown.

The aim of this study was to provide anatomical data on the depth of the carotid artery and its branches along the neck to inform data-based guidelines for hemostatic net placement to decrease the risk of inadvertent vessel injury.

The authors retrospectively studied rhytidectomy patients at a single-academic aesthetic surgery center who had subsequent neck imaging within 10 years. They studied the common, internal, and external carotid arteries bilaterally at the C2 (angle of mandible), C3 (hyoid), and C4 (thyroid cartilage). For each, the distance between the corresponding left and right vessels and vessel depth from the skin were measured.

Thirty-three patients (81.9% female; average age at rhytidectomy = 64.2 years and at imaging = 69.1 years) had images of sufficient quality. At C2-C4, carotid depths ranged from 20.5 to 32.9 mm. The closest artery to the skin along the neck is the internal carotid artery at the level of the thyroid cartilage (C4).

A thorough understanding of the vascular structures in postrhytidectomy neck underlies safe placement of the hemostatic net. Assuming the use of a ⅜ circle suture needle, a 24 mm needle (19 mm chord length) offers greater inherent margin relative to the mean vessel depth at C4 (20.5 mm). However, with a 32 mm needle (25 mm chord length), safe use depends on controlled bite depth and surgical technique (more oblique needle entry) to maintain a safe margin from carotid vessels.