One of the defining facial features that casts an impression about one’s appearance is the neck, or more specifically the neck angle or neck profile. Whether one is young or old, an obtuse or poorly defined neck angle is not aesthetically desireable. If one is young with a full neck, liposuction alone will increase the neck angle as the skin retracts upward. When one is older, however, a dropping or poor neck angle is associated with muscle and other tissue changes. This is why a facelift, or some variation of it, is needed to make a significant change in the neck angle through a suspension effect of ear to ear skin flaps.
Short of an open facelift approach, there has not been any other method to help tighten the neck and jowl SMAS. The SMAS is an acronym for a layer of tissue above the muscle which most confuse as a facial muscle which it is not. But tightening the loose SMAS can help improve the neck angle. A new device, called the iGuide, has now become available to help create a firmer and more youthful neckline.
The iGuide is an FDA-approved device that is for soft tissue approximation and elevation of subdermis and muscle. It provides a less invasive technique to improve the neck and jawline with minimal incisions (unlike a traditional facelift) while at the same time shortening recovery time. By not doing wide elevation of neck skin flaps, the swelling and bruising is much less and the need for the skin to ‘stick back down’ is eliminated.
The iGuide allows soft tissue to be elevated and defined by essentially creating a ‘neck trampoline’ using dissolveable sutures. Through a series of needle punctures placed along the jawline, a dissolveable suture is weaved back and forth from side to side to create a trampoline-like structure. This suture weave creates a low-tension support which elevated the skin, muscle and the SMAS as a combined soft tissue unit. This suture is not to be confused with different facial rejuvenation techniques in the past that have have used barbed sutures.
From a neck recontouring standpoint, the iGuide has multiple potential uses. For the younger patient with a fuller neck where liposuction alone is not completely satisfactory, a suture weave can provide additional neck angle improvement. For the early signs of neck and jowl aging, a short scar facelift is great for the jowl area but may not always optimally treat the neck angle. The trampoline effect of the suture weave upgrades the surgical outcome.
The iGuide neck contouring system is touted as being able to be done under local anesthesia and that is most certainly true. But that would only be relevant if one was doing an isolated neck procedure which often is not the case. But for those patients interested in a most minimalistic approach, an office procedure under local anesthesia with oral sedation is easily done. Neither the tiny incisions nor the weaving of the sutures requires the use of any sharp needles.
The iGuide provides a clever minimally invasive approach to redefining one’s neckline. As its tagline states, it is ‘The Neck’s Big Thing’. Time will tell whether this technique will find its way into the standard repertoire of successful neck contouring procedures or go the way of the barbed suture.
Dr. Barry Eppley
Indianapolis, Indiana