The neck wattle is one of the most bothersome of aging facial features, particularly for the older male. Men are often much more concerned about their turkeyneck than they are about the bags and hanging skin around their eyes. That neck wattle not only flops around but really stands out in a shirt and tie as it hangs down onto the collar. It is an unfortunate sign of a man’s age.
The traditional and most effective correction for the neck wattle, at any age, is a facelift. While highly successful, some men seek out a less invasive approach with a quicker recovery. The direct necklift may be an attractive alternative provided one is willing to accept a central neck scar. Such a necklift scar usually does better in a male than a female due the improved scar results that occur in bearded skin.
While the direct necklift involves the simplistic concept of a vertical cutout of central neck skin, the operation is actually more sophisticated and involves numerous nuances in technique. Not only is skin removed but the attached underlying fat down to the platysma muscle is removed as well. With a very wide diastasis of the platysma muscle, all subplatysmal fat down to the strap muscles can also be removed from under the chin down to the thyroid cartilage. The intramuscular platysmal gap is then closed by a vertical row of muscle plication sutures. These maneuvers help to compliment the skin closure in getting a much improved and often dramatic change in the neck angle that not even a full facelift can approximate.
Despite the striking improvement in the neck angle with these deeper tissue steps, the outward appearance of the neck scar is also critically important. While there may be some horizontal scars from the closure under the chin and in a lower horizontal skin crease above the sternal notch, the most important and visible scar is the vertical one. Historically, the vertical necklift scar is done as either a straight line or a straight line with a central z in the middle of it.
The problem with a vertical neck scar is that it runs perpendicular to the horizontal skin tension lines in the neck and is under tension. This poses the risk of hypertrophic scar formation. This is why in some cases a z-plasty is made in the central area of the scar. An alternative option that I have explored for vertical necklift closure management is a running broken line closure of a symmetrical fashion. Known as a running w-plasty, this is a common scar revision technique that can also be called a ‘zipper line’. This breaks up the tension along the scar line and reduces the risk of poor scar outcomes.
In the cutout design of a vertical necklift, the edges of the excision are marked and then a running w-plasty pattern drawn on the outside of it. The skin is then incised along the marks and the deeper portions of the necklift carried out in the usual fashion. This creates a saw tooth-edge appearance along the skin margins.
At closure, the limbs of the skin edges is interdigitated to create the zipper line closure. This requires a meticulous closure with fine sutures done under loupe magnification.
The zipper necklift is another option for direct neck wattle removals. It appears to be a good choice when the skin excess is not significant enough to require horizontal excision and closure extensions under the chin and in a low skin crease…if only a completely vertical excision is needed. It could also serve as an option for hypertrophic neck scar management should that be necessary from a previous direct necklift.
Dr. Barry Eppley
Indianapolis, Indiana