Background: The webbed neck is an easily visible deformity by its wide base into the upper trapezius muscle area. While often thought of as just being excess webs of skin there is a broader or elevated trapezius muscle component to them that for most patients precludes a complete correction or a perfectly straight vertical neck line from any form of surgical procedure.
But with that limitation in mind surgery can improve or lessen the severity of the neck webs. The key consideration in the choice of surgical technique for the webbed neck from my perspective is guided by a basic plastic surgery principle….aesthetic surgery always has to consider the tradeoffs for the improvement it can offer and one has to prefer those tradeoffs to the problem they are intended to improve. For many aesthetic surgeries it comes down to the resultant scars and this is very true for the webbed neck. For this significant reason I prefer the posterior approach that keeps the scars away from the sides of the neck where they would be more visible.
The posterior approach can have various geometric shapes of excision and resultant closure lines/pattern. There is no one technique that is conclusively proven to better than another. One indirect webbed neck surgery method is the inverted T pattern using a a central triangular (half diamond) excision with medial flap transposition.
Case Study: This young female desired improvement in her neck webs as she was going to head to college in the fall.
Under general anesthesia and in the prone intraoperative position a horizontal line of the optimal line of pull was marked which was just at her low hairline. A central triangular wedge of scalp was marked and shaved for the excision.
The horizontal and the central inverted V shape incisions were made and the scalp flaps undermined/elevated out to the lateral neck webs. The central inverted V section of shaved scalp was not initially removed until the medial flap movements proved that its excision could be closed by them.
The lateral flaps were transposed medially, the central wedge of scalp excised and a closure done in an inverted T pattern
Her one year results showed sustained improvement in her neck webs. Interestingly she also reported the pendant on her necklace now hangs much lower due to the improved shape of the neck.
From the back view the neck webs showed a similar degree of
improvement. Her horizontal neck scars were hypertrophic and more prominent than I would have liked. (but were not a concern to her)
The indirect inverted T pattern webbed neck technique is effective as it allowed a medial relocation of the neck webs equivalent to the width of the central triangular excision. While effective with sustained results it does have an extended scar line out to the webs. But in a female with longer hair this is an acceptable tradeoff for the improvement obtained.
Key Points
1) Webbed neck surgery has a variety of techniques that can be fundamentally divided into direct and indirect.
2) The indirect approach is behind the webs and can be done by different geometric types of excisional patterns and closures.
3) One indirect approach is the inverted T pattern which is illustrated in this case with a one year postoperative result.
Dr. Barry Eppley
World-Renowned Plastic Surgeon