Morphological Patterns of Fibrous-Dominant Dorsocervical Humps and a Mesh Technique for the Diffuse Subtype

Fibrous-dominant dorsocervical humps remain a challenging surgical condition because dense collagen structure limits the effectiveness of conventional liposuction and adjunctive energy-based techniques. Current surgical decision-making lacks an objective framework based on the internal structural organization of fibrosis.

To characterize CT-based morphological patterns of fibrous-dominant dorsocervical humps and to introduce a Mesh release technique specifically designed for the diffuse fibrous subtype.

Preoperative axial computed tomography (CT) images from 102 patients were reviewed to evaluate the internal morphology of fibrous tissue. Two distinct patterns were identified: a localized (mass-dominant) fibrous subtype and a diffuse (septal-dominant) fibrous subtype. Diffuse cases underwent three-dimensional CT reconstruction to further characterize the spatial architecture of fibrous septa. Accordingly, a minimally invasive Mesh release technique was developed to achieve multidirectional, cross-plane disruption of the diffuse fibrous network. Clinical outcomes were evaluated using a 4-point esthetic grading scale, and complications were recorded.

Among 102 patients, 65 (63.7%) demonstrated the diffuse fibrous subtype and underwent the Mesh release technique. CT demonstrated widespread fibrous septa without a central fibrous mass, and three-dimensional reconstruction revealed an interconnected, multi-planar fibrous network. The mean operative time was 64.6 ± 12.3 min, and the mean aspirate volume was 269.1 ± 40.9 mL. Good-to-excellent contour improvement was achieved in 90.8% of patients. Postoperative complications occurred in 23.1% of patients, including transient numbness and seroma.

Preoperative CT distinguishes localized and diffuse fibrous subtypes of fibrous-dominant dorsocervical humps. For the diffuse fibrous subtype, the Mesh release technique enables effective cross-plane disruption of the fibrous network while achieving favorable contour restoration.

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