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The neck, or more properly the neck angle, is a hallmark of both youth and a well defined jaw line. As one ages, the neck angle will change…it is only matter of how much and when. While the aging neck problem is usually addressed by some form of a facelift, this involves incisions around the ears and excision of redraped skin. This requires disturbing tissues somewhat displaced from the neck problem but it is a tried and true solution.

Direct or non-excisional approaches to neck problems do exist. These are known as a submentoplasty or cervicoplasty. They are done by direct manipulation of neck tissues without remote incisions or the need for skin redraping. In young patients with fatty necks but with good bone support, liposuction alone is often adequate. But the fatty neck alone is not to which I refer for these procedures.

The submentoplasty procedure does involve initial liposuction of the neck to defat it. Then a small incision under the chin (submental) is made. Through this incision further cervical manipulation is done. This can involve direct excision of fat underneath the platysma and/or digastric muscles. Such fat is not removeable by liposuction alone. The platysma muscle is then sewn together with resorbable sutures. In some cases, I may place a neck suspension suture from a point behind the ear from one side to the other for optimal neck angle change and support.

While the submentoplasty is obviously appealing because of its more limited approach, it can be a disappointing procedure for improperly selected or underinformed patients. In my Indianapolis plastic surgery practice, I like to stress the following considerations to patients that I feel are good candidates for this operation. First, the procedure should be considered a delaying tactic or a pushback of time  to the eventual need for an excisional type facelift. Second, the submentoplasty can not produce as good as a result in most patients as that of a facelift. Therefore, if one wants a fairly taut neck angle this is not the way to go. Third, for those with simultaneous jowling as well, the submentoplasty can be combined with a very limited tuck-up facelift. This may require some incisions but those can be kept to a small area around the ear. Lastly, chin and jaw line augmentation with an implant can be very helpful in improving the results of the submentoplasty by extending the front position of the jaw. (which creates the mild illusion of a neck angle that is further back)

The submentoplasty will not work for larger necks that have a lot of skin looseness as is often seen in older patients. In thicker ‘bull necks’ as seen in some men, it will not work well either. Speaking of men, I don’t  find that it is a particularly effective for many of them due to the thicker quality of their neck tissues.

The submentoplasty, or non-excisional anterior neck rejuvenation, procedure falls into the contemporary category of ‘minimally-invasive’ surgery. Like any of these anti-aging techniques, however,  patient selection and expectations are the key to a satisfactory result.

Barry L. Eppley, M.D., D.M.D.

Indianapolis, Indiana

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