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Archive for the ‘necklift’ Category

The Subplatysmal Necklift

Monday, January 2nd, 2017

 

Reshaping the congenitally full neck or one that is drooping due to age is a common facial reshaping/rejuvenation procedure.While the aging neck is frequently thought of as due to loose skin, the naturally full neck is recognized as having deeper tissue problems than just skin. Both the origins of a low hanging neck and the neck lift technique used to treat it, however, must take into consideration all tissue layers from the skin down to the hyoid bone.

submental-incisionsubmandibular-gland-spaceIn the January 2017 issue of the Aesthetic Surgery Journal, a paper was published entitled ‘Subplatysmal Necklift: A Retrospective Analysis of 504 Patients’. In this well illustrated paper the authors go through a step by step surgical approach to all of the reachable subplatysmal structure and report their results on a very large patient series. Through a low submental incision (3 cms from the natural submental skin crease), all subplatysmal neck structures could be well visualized particularly the submandibular glands. The sequence included the initial removal of interplatysmal fat and elevation of the medial borders of the platysma muscle. The submandibular glands were located by following the anterior border of the digastric muscle to the hyoid bone. The gland capsule was opened and the medial half of the gland removed. Botox injections (10 units) were placed into the remaining gland and the gland capsule closed with continuous sutures. If indicated a subtotal resection of the anterior belly of the digastric muscle is also done. Hyoid repositioning can be performed by suture plication of the peri-hyoid fascia at the level of the pulleys of the digastric muscles. Lastly, a corset platysmaplasty is done.

A total of over 400 430 patients underwent this type of subplatysmal necklift. Not all patients had every subplastysmal structure treated with the most common being fat (84%), the submandibular glands (61%) and the digastric muscle. (18%) Complications included temporary weakness of the marginal mandibular nerve (6%) and salivary leak from the gland (2%) No hematomas or infection occurred.

Modification of the subplatysmal structures in neck contouring can include fat, the anterior bellies of the digastric muscles, the submandibular glands and the hyoid bone. Historically subplatysmal neck contouring has been avoided due to concerns of facial nerve injury and creating a salivary gland leak. This paper demonstrates that, while these complications do occur, they do not so at a high rate. Furthermore they are self-resolving issues without permanent sequelae.

This paper demonstrates that the subplatysmal necklift is a safe and effective neck contouring approach. It goes beyond the traditional neck contouring methods of subcutaneous neck liposuction and plastyma muscle plication. For those indicated patients it does volume reduction and creates subplatysmal support that the platysmal muscle alone can not do.

Dr. Barry Eppley

Indianapolis, Indiana

Necklift with Complete Platysmal Transection

Monday, October 24th, 2016

 

One of the most common features of the aging process is sagging of the neck. When more advanced the central neck become a repository for loose skin, fat and and the appearance of platysmal banding. While platysmal banding is part of every aging neck, it is usually only seen well in thinner necks with less subcutaneous fat.

platysmal-neck-bands-dr-barry-eppley-indianapolisMost necklift techniques involve some form of platysmal plication. This is where the split medial edges of the platysmal muscle are sewn together usually after some defatting as well. There have been numerous platysmal suture techniques described but at the core of them all is that is a platysmal tightening method.

In the October 2016 issue of the journal Plastic and Recostructive Surgery an article was published entitled ‘Complete Platysmal Transection in Neck Rejuvenation : A Critical Appraisal’. The authors used a necklift technique of full skin undermining complete platysmal transection and midline platysmal approximation. In 150 consecutive necklift patients operated on over a four year period, results were compared at 3 and 12 months to determine persistence of anterior neck tightness. Patient satisfaction was 100% at three moths which fell to 76% at one year after surgery. Physician assessment, however, showed that only 50% had no anterior neck skin excess and 55% had no recurrence of platysmal bands at the one year assessment period.

There were no major complications with this necklift technique such as nerve damage, large hematomas or skin necrosis. The biggest drawback was the prolonged edema (swelling) that persisted in the neck often out to two months after surgery. Two-thirds (67%) of the patients reported having a ‘hard neck’ for a long time.

Overall this necklift technique has a high patient satisfaction rate even out at one year after surgery. An interesting question about platysmal bands is why they recur after being cut. The authors propose that it could be de to either inadequate muscle resection, muscle regeneration or restoration of motor nerve function. Regardless of the mechanism complete transection of the muscle does not permanently eliminate the development of platysmal bands. This study provides clinical evidence that it does not.

necklift-dr-barry-eppley-indianapolisWhat this study shows is, to some degree what all plastic surgeons know, a necklift procedure is not permanent and begins ‘going downhill’ as early as 3 to 6 months after surgery. There is an expected amount of recurrent anterior skin laxity and platysmal bands by one year after surgery despite an aggressive neck contouring technique. Such information is valuable preoperative education information.

Dr. Barry Eppley

Indianapolis, Indiana

OR Snapshots – Direct Necklift

Saturday, October 22nd, 2016

Significant aging of the neck is most commonly treated by a neck lift, also known as a lower facelift. While earlier signs of neck sagging/fullness may be treated by liposuction and other more limited procedures, true neck wattles can only be treated by more traditional and aggressive approaches.

A lower facelift/necklift repositions the hanging neck skin back towards the ear and removes the excess tissue there. This requires incisions to be placed around the ears. Thus the tissue removed results in scars that are placed in relatively inconspicuous locations. This is a fundamental principle of facelift surgery. But men pose unique challenges in facelift surgery because of their often limited hair or short hairstyles around the ears. This makes it hard to hide the facelift scars and, as a result, may also make it difficult to get a good neck lift result.

direct-necklift-wattle-excision-dr-barry-eppley-indianapolisAn alternative technique in older men that have significant neck wattles is the direct neck lift. As the name implies the neck wattle is cut out directly down the center of the neck. The key to doing this surgery with the best scar result is how the pattern of skin and fat is removed. It is not just an elliptical excision of tissue down the center of the neck. If it were there would be dogears (redundant skin) at the top and bottom of the need of the elliptical excision. Rather the skin cutout pattern resembles the shape of a candelabra or urn. This places a smaller horizontal skin excision in the submental area and a larger horizontal skin excision at a lower neck level. This creates an I-shaped closure line in the neck.

The direct necklift is a tremendously powerful procedure for removing neck wattles. It is actually more effective than a traditional fuller neck lift/lower facelift because it removes the neck wattle directly. But it does so at the expense of neck scars and that is its major consideration. Fortunately the beard skin in older men (greater than age 65) heals very well. At this age the direct necklift offers a less invasive procedure with minimal recovery and avoids scars and potential hairline disruption around the ears.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Webbed Neck Surgery

Saturday, April 16th, 2016

 

Background: A webbed neck, medically known as pterygium colli deformity, is a well known but rare congenital neck condition. Skin folds are present along the sides of the neck from the back of the head behind the ears down to the shoulders. The hairline often follows the skin folds in their upper part. It is most commonly seen in Turner’s syndrome but occurs on congenital syndromes as well. The skin folds occur in varying presentations but can be quite pronounced in many cases.

The surgical correction of the webbed neck has evolved from original descriptions of z-plasties done directly along the skin folds. While successfully breaking up the skin folds, such a direct approach leaves unsightly scars that are rarely worth the trade-off.

The posterior approach to the webbed neck is the preferred technique today. This involves removing tissue from the midline of the posterior neck and wide skin undemining out to the skin folds. Closing the posterior neck defect then pulls the skin folds inward. (more posteriorly) A variety of posterior neck excisional patterns have been described from butterfly, M and Z-plasty patterns. While providing definite improvement in the appearance of the skin folds and keeping the scar fairly hidden (with long hair), partial relapse is common with the secondary skin relaxation.

Case Study: This 35 year-old Asian female had a congenital webbed neck from birth. She did not have Turner’s or any other known congenital condition. Her necks webs would be described as mild to moderate. She was teased a lot for her neck webs when she was growing up. Prior to surgery, she shaved the lower portion of her occipital hairline to aid the subsequent surgery.

Webbed Neck Surgery Markings Dr Barry Eppley IndianapolisUnder general anesthesia, the posterior neck was marked with red dots to mark the most tolerated lower extent of the tissue excision and midline closure and a modified T-shaped excisional pattern. The neck webs were vertically marked.

Webbed Neck Surgery tissue excision Dr Barry Eppley IndianapolisWebbed Neck Surgery fascial plication Dr Barry Eppley IndianapolisThe posterior neck skin and fat was excised down to fascia. The skin edges were widely undermined out to the skin folds. The fascia edges could be grasped and mobilized considerably to the midline.

Webbed Neck Surgery fascial plication completed Dr Barry Eppley IndianapolisThe posterior neck fascia was plicated in the midline with large resorbable sutures. This could be seen to bring in the skin folds at the side of the neck significantly.

Webbed Neck Surgery skin closure Dr Barry Eppley IndianapolisThe skin edges were then brought in to the midline and closed in a T-shaped pattern. Prior to the skin closure, multiple quilting sutures were placed from the skin down to the fascia to both eliminate deep space as well as take tension off the skin closure suture line.  Marcaine injections were done along the fascia as well as the greater and lesser occipital nerves to manage immediate postoperative discomfort. The posterior neck incisions were covered only with with tapes.

Webbed Neck Surgery before and after during surgery Dr Barry Eppley IndianapolisThe skin folds were completely eliminated with this webbed neck surgery technique. The neck was changed from wide neck ‘wings’ to an hourglass neck appearance.

Webbed Neck Surgery results Dr Barry Eppley IndianapolisWebbed Neck Surgery left side result Dr Barry Eppley IndianapolisWhen seen the next day after surgery before returning home, her webbed neck condition was completely eliminated. The combination of posterior neck tissue excision and midline fascial plication creates an improved and sustained result in webbed neck surgery.

Highlights:

1) Webbed neck correction requires a posterior neck approach with tissue excision and midline closure to prevent visible scars on the sides of the neck.

2) Midline fascial plication is critical to bring in the sides of the neck (webs) and relieve tension on the posterior midline neck closure.

3) This form of webbed neck surgery uses the same principles as midline platysmal plication in facelift or direct anterior necklift surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Direct Necklift for Large Neck Wattles in Men

Monday, September 28th, 2015

 

Background: Large amounts of weight loss from bariatric surgery or rigid adherence to a diet and exercise program cause the creation of substantial loose skin throughout the body. While much of this loose skin does occur around the abdominal and waistline areas, it does affect other body areas as well. The face and neck is one such area and it appears as a large neck wattle and extreme jowling. The greater the weight loss the more severe the loose skin that appears hanging off of the neck.

The standard treatment for a neck wattle, regardless of its cause is a lower facelift. (necklift) The fundamental principle of a lower facelift (I will call it an indirect necklift for the sake of this article) is that the loose skin in the neck is ‘chased’ back to the ears where it can be removed in a location where the incisions can be fairly well hidden in and around the ears.

The concern in many men about a lower facelift is how well the scars can be hidden based on their beard skin and hair pattern. The bigger the lower facelift that is needed the higher the risk that the incisions will need to be extended beyond the shadowing of the ears where they will be more visible. There is also the issue for some men, particularly older ones, of how extensive the surgery will be and how much recovery will be involved.

Case Study: This 65 year old male had gastric bypass surgery eight years previously with a stable weight loss of 120lbs. As a result of his massive weight loss he developed a lot of loose skin. One of the areas that bothered him considerably was his very large neck wattle. He wanted it gone but was not prepared to go through an extensive lower facelift to do it.

Direct Necklift Excision and Closure intraop Dr Barry Eppley IndianapolisUnder general anesthesia he had a direct necklift performed. A large candelabra pattern of skin and fat was excised down the central axis of the neck. Subplatysmal fat was removed and the split platysma muscle was sewn together from the chin down to the thyroid cartilage. The lateral neck skin flaps were then brought together in a modified H-pattern skin closure.

Direct Necklift after Massive Weight Loss result side view Dr Barry Eppley IndianapolisDirect Necklift result obloque view Dr Barry Eppley IndianapolisHe had his sutures removed in one week and by three weeks after surgery had largely recovered. His large neck wattle had been removed. He did not get a completely sharp cervicomental angle but that may have never been possible with his neck anatomy.

Direct Necklift after Massive Weight Loss result front view Dr Barry Eppley IndianapolisA direct necklift is an alternative to a full lower facelift in men with large neck wattles. It offers a far simpler recovery with fewer risks of complications and at a lower cost. For the older man who can accept midline neck scars, the direct necklift may be acceptable. The neck scars in older men and their beard skin can heal remarkably well in many cases.

Highlights:

1) Large amounts of weight loss often results in excessively sagging neck and facial skin, particularly in older men.

2) The standard treatment of a large neck wattle is a lower facelift with incisional patterns around the ears.

3) A direct necklift offers a ‘simpler’ approach to large neck wattles in older men than a standard lower facelift.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study – Webbed Neck Correction with Otoplasties

Sunday, March 8th, 2015

 

Webbed Neck in Turner's SyndromeBackground: The webbed neck deformity is a congenital skin fold disorder that runs along the sides of the neck to the shoulders. Known technically as the pterygium colli deformity, it is known to occur in a large number of medical conditions but the most common are the genetic conditions of Turner’s and Noonan syndrome as well as Klippel-Feil syndrome. At birth there are smaller loose folds of skin on the sides of the neck but with growth the webs expand outward ultimately making it look like there is little to no neck.

Surgical correction of the webbed neck deformity is a very different form of a neck lift. It is challenging because of the thickened fascia that comprises the band and a low hairline that extends down along the webs. The most common surgical techniques are the use of modified Z-plasties. A Z-plasty is placed with the midline arm down the length of the web. The subcutaneous fibrous band is excised, the shortened trapezius muscle is released, and the hair-bearingskin flap is cut out. The anterior skin flap is rotated and advanced to join its mirror image flap from the opposite side of the neck at the posterior midline. Any remaining skin dog-ears near the shoulder are corrected with additional small Z-plasties.

An alternative technique is a purely posterior neck approach using a Butterfly correction technique. In this method, a butterfly-shaped portion of redundant skin is excised posteriorly and the lateral, superior and inferior flaps joined in a double Y midline suture line or even that of an X pattern closure. The Butterfly technique avoids the unnatural hairline and noticeable scars characteristic of a lateral Z-plasty method but does so with often a less than complete correction of the webs.

Case Study: This 9 year-old female who had Turner’s syndrome had large neck webs that completely obscured any visible neck. They extended from behind her ears out to her shoulders She also had protruding ears due to a lack of antihelical folds.

Webbed Neck and Otoplasty Correction resultUnder general anesthesia she underwent an initial Butterfly correction technique for her webbed neck in the prone position. At the same time, otoplasties were performed through postauricular incisions using permanent horizontal mattress sutures to create antihelical folds. Four months later she underwent a second stage webbed neck correction where a large posterior Z-plasty was performed using the previous scars from her first procedure to gain further reduction in the webs and to relocate the low hairline.

She had substantial improvement in her webbed neck and ear deformities. There remained some slight medial neck bands but there were no visible scars. All scars were in the occipital hairline and on the posterior neck.

Case Highlights:

1) Webbed neck deormities are most commonly seen in congenital conditions such as Turner’s syndrome.

2) Traditional webbed neck surgeries use z-plasties along the sides of the neck which can result in visible scarring.

3) A two-stage approach to correction of the webbed neck results in no visible scars along the sides of the neck or shoulders.

Dr. Barry Eppley

Indianapolis, Indiana

Update on the Corset Platysmaplasty Neck Lift

Sunday, November 30th, 2014

 

The neck is one of the primary reasons that patients present for some form of faciial rejuvenation. It is not rare that such aging patients only wants a ‘necklift’ and not a fuller ‘facelift’, even though they rarely understand the difference between these two procedures or facial rejuvenation concepts. There are a wide variety of neck remodeling procedures that are currently available with vary in their degree of invasiveness and extent of the surgery.

corset platysmaplasty indianapolisIn the December 2014 issue of the journal Plastic and Reconstructive Surgery, an article was published entitled ‘Neck Lift My Way: An Update’. In this paper, a  renowned neck lift expert provides his experience over a 38 year period with over 500 neck lifts done in the past ten years with his techniques. Such an intense experience with one procedure is always worthy of deep consideration to apply to one’s own experience. He reviews eight fundamental features of his learned neck lift techniques based on the original corset platysmaplasty.

A submental incision with open access to the neck was used 93% of the time in his ten year series. The incision was almost always placed directly in the submental skin crease. Electrocautery was used for some of the neck skin flap elevation and all of the defatting and subplatysmal work. Hematomas and seromas were very rare (1% or less) and drains were used occasionally up to a week after surgery. Conversely injury to the marginal mandibular nerve was not rare and occurred to some degree in almost 10% of the cases. It usually resolved by four months after surgery but in some cases took longer.

The management of loose neck skin was managed primarily by lateral excision in the occipital region in most cases. The postauricular incision is extended high up behind the top of the ear and well behind the occipital hairline after being trimmed. There are still some cases in which no skin is removed but this requires a patient with good skin tone with little means to camouflage a scar behind the ear.

Subplatysmal fat extraction was performed in most patients in this series. (80%)  The anterior digastric muscles are rarely now sutured or manipulated. If a submandibular gland bulge is present, the superficial lobe of the gland is removed. A corset plastysmaplasty was performed in 90% of the patients running a suture from the chin down to the cricoid and then back up.  (2-0 PDS) A ‘tuckster suture’ is also used running from the fascia behind the ear, towards the midline and then turns back to the ear where it is tied. Its purpose is to help contour the submandibular area.

Many plastic surgeons feel that the best result of any neck lift comes when it is part of an overall facelift to get the best neck and jawline contouring results. The neck lift techniques described and shown in this paper contradict this belief. Clearly, patient education is key to clarify what an independently done neck lift can and can not do as it relates to aging issues above the jawline.

This paper provides a long-term review and technical pearls based on the original ‘corset plastymaplasty’ which was published years ago. The procedure remains somewhat ‘complex’ and time consuming to do but when carefully applied it produces veryt long-lasting and satisfying results.

Dr. Barry Eppley

Indianapolis, Indiana

Fat Compartments in the Neck – Implications for Neck Contouring Surgery

Monday, May 5th, 2014

 

Neck Fat Removal Dr Barry Eppley IndianapolisFat in the neck is one of the major contributors to its shape. Large amounts of fat create full and/or droopy necks and work against a pleasing neck angle and profile. As a result, the removal of fat is part of just about every neck contouring procedure from liposuction to necklifts. The neck is usually defatted by liposuction at the supraplatysmal level but may also undergo direct excision at the subplastymal level in other neck contouring operations. (e.g., submentoplasty)

In the quest for optimal neck contouring and maximal fat removal, it is helpful to know where the fat compartments are in the neck and their contributions to the overall fat volume. This would help to understand what type of neck changes can be done and what procedures may be needed to fo them.

Neck Fat Compartments Dr Barry Eppley IndianapolisIn the May 2014 issue of the Aesthetic Surgery Journal, a study was published entitled ‘ Defining the Fat Compartments in the Neck – A Cadaveric Study’. In this study the anatomic compartments of the neck and their quantity and relationships were evaluated in cadaver heads by dissection. Supraplatysmal fat was found between the skin and the platysma muscle, and it was divided into suprahyoid and infrahyoid fat. Subplatysmal fat was found deep to the platysma and between the inner edges of the anterior digastric in the midline ad was also divided into suprahyoid and infrahyoid compartments. Lastly, the very deep fat below the anterior digastric muscles was identified as its own compartment.

Their findings shows that roughly 50% of the fat in the neck was in the supraplastysmal space. The subplatysmal fat accounted for roughly 25% and the remaining 25% was around the submandibular gland. The very deep fat was minute, accounting for only 1% of all neck fat.

Submentoplasty Dr Barry Eppley IndianapolisWhat this study shows is that the most commonly treated area of the neck for fat removal done by liposuction is the supraplatysmal space…and this accounts for only half of all neck fat. This means that many patients may not be able to achieve optimal neck contours with liposuction alone. In some cases the subplatysmal neck fat needs to be removed for a more significant neck contour improvement.

Dr. Barry Eppley

Indianapolis, Indiana

Options in Contemporary Surgical Neck Rejuvenation

Sunday, December 8th, 2013

 

The neck, like the face, ages although it does so in a more simplistic fashion. With the neck it is only a matter of loss of the neck angle due to loose skin, fat accumulations and midline muscle separation. But with different degrees of neck aging at different times in life, the type of neck rejuvenation procedure that is needed changes. There are a variety of aesthetic neck procedures which include liposuction, submentoplasty, formal neck lifts (lower facelifts) and direct neck lifts.

Neck Liposuction Dr Barry Eppley IndianapolisThe reduction of neck fat by liposuction works best in younger people (under age 45 or so) who have good skin tone. One of the main principles of liposuction is that skin retraction is needed after fat removal to see its effects. However, in some older people with more loose neck skin that do not want a necklift, some good improvements can be seen with Smartlipo (laser liposuction) which does a good job with skin tightening. Liposuction in the neck must be aggressive (taking fat right off of the underside of the skin) to be most effective.

Submentoplasty Dr Barry Eppley IndianapolisSubmentoplasty is a less well known neck procedure for younger patients (under age 50 or so) that have both excessive neck fat and a loose or separated platysma muscle. Done through a submental incision under the chin, neck fat (above and below the platysma muscle) is done (by liposuction as well as direct fat excision) as well as muscle tightening/plication is done to create a more defined neck angle result. It can be a hard decision to determine who is best served by liposuction alone or whether the platysma muscle should be tightened after subplatysmal fat is removed by direct excision.

Facelift Dr Barry Eppley IndianapolisThe lower facelift or necklift, in the traditional sense, is for patients with more advanced loose neck skin/neck wattles/ turkeynecks (generally age 55 and older)  who need substantial neck skin tightening and resuspension. Most people aren’t that a ‘facelift’ is really a neck-jowl lift or a necklift. These are often interchangeable terms. But the concept of a facelift has changed…from the development and marketing of a limited jowl lift to a full blown extended facelift. Thus facelifts today can now be from as early as age 40 to any advanced age.

Male Direct Necklift Dr Barry Eppley IndianapolisThe most uncommonly performed neck rejuvenation procedure, a direct necklift, is done almost exclusively in older men . (65 years or older) Many older men do not want a formal facelift/necklift for either recovery or hairline concerns. It involves a direct excision of neck skin and fat as well as muscle tightening with the tradeoff of a midline scar. (which usually does quite well in the beard skin of men) Because of scar concerns, direct necklifts are not done in younger patients and rarely in even older women.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: The Direct Necklift for the Older Male Neck Wattle

Tuesday, December 3rd, 2013

 

Background: The neck sags with age due to the development of sagging skin and fat and the separation of the neck muscles which exposes the subplatysmal fat. These neck changes can become really pronounced as one reaches the sixth and seventh decades of life. This is the time that many men take notice of their growing neck wattles and may finally want to have it removed.

The standard method of neck rejuvenation in older patients, male or female, is the facelift. It is a procedure that is better described as a neck-jowl lift for it only affects the lower third of the face. It does so by using incisions around the ears and into the hairline for redistributing the loose neck skin up towards the ear where it could be removed. Good   scar placement around the ears depends on careful placement, adequate hair density and the willingness to accept a certain period of recovery due to the extent of the skin undermining.

Many older men, however, do not want an extensive procedure with a prolonged visible recovery. They may also not have the hairline to support the extent of incisions needed around the ears to get the neck adequately lifted and tightened. An alternative necklifting technique is the direct necklift. As the name implies, it is the direct excision of the neck wattle.

Case Study: This 76 year-old male wanted to get rid of his neck wattle but didn’t want to have an ‘extensive’ facelift to do it. His turkeyneck had been growing and he didn’t like the flap of skin that he was seeing when he tilted his chin down. Even with his goatee, the neck skin could not be hidden.

Direct Necklift Incision pattern Dr Barry Eppley IndianapolisDirect Neck Lift plastysmal muscle separationImmediately prior to surgery, a ‘cadelabra’ design was marked in the middle of the neck for the amount and pattern of skin and fat to be removed. Under general anesthesia the marked skin and fat was removed. This exposed the platysmal muscles which were widely split. (arrows in picture) The muscle edges were sewn together and the skin closed in an I-beam pattern with the horizontal portion in the submental crease superiorly and low horizontal skin crease inferiorly. The only dressing applied was antibiotic ointment.

Male Direct Necklift result Dr Barry Eppley IndianapolisThe sutures were removed one week later with minimal swelling and bruising. The neck wattle was completely removed and the neck angle was well defined. By six weeks later the redness of the scars had faded considerably and had blended in well with the surrounding skin. No scar hypertrophy of the vertical portion of the scar had yet developed. (although three to four months after surgery is a better time to judge whether this minor complication will occur)

The direct necklift is a very effective alternative to a facelift for the turkeyneck in older men. It is a short cut to a rejuvenated neck angle that does so at the price of neck scars. But these scars heal exceptionally well in the beard skin of the older male neck.

Case Highlights:

1) Neck sagging, often called a turkeyneck, is common in older men (> 65 years old) as they age.

2) Many older men want to have their neck wattle removed but don’t want to do a facelift to do it.

3) A direct necklift provides a fairly simple technique to remove the turkeyneck that has neck scars that are very acceptable in the beard skin of older men.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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