Evaluating the Safety of Deep Procedures in the Neck through a Review of 502 Consecutive Facelifts

Goals/Purpose: Recently, there has been more enthusiasm for performing deep procedures in the neck. Advocates of these procedures deep to the platysma, which may address the subplatysmal fat, anterior digastric muscles, perihyoid fascia, and/or submandibular gland, believe that addressing some or all these structures can improve aesthetic results after face and neck lift. Despite the rising popularity of these procedures, decades-long concerns regarding their safety remain. The goal of this study was to review the senior author’s (F.N.) experience of 502 consecutive facelifts and to specifically evaluate the safety profile of deep procedures in the neck.

Methods/Technique: We conducted a retrospective review of 502 consecutive patients who underwent facelift surgery with the senior author between 2004 and 2018. We collected and analyzed complication data and revision rates.

Results/Complications: Of the 502 facelift patients included, nearly all (92.0%) were women, average age was 61.7 ± 7.2 years old, and average BMI was 23.5 ±3.6. Two hundred ninety-five (58.7%) patients underwent primary, 186 (37.1%) underwent secondary, 19 (3.8%) underwent tertiary, one (0.2%) underwent quaternary, and one (0.2%) underwent quinary rhytidectomies. Overall, 245 patients (48.8%) underwent an open approach to the neck. Superficial procedures of the neck that were performed included midline platysma plication (76.7%), platysma myotomy (30.5%), removal of interplatysmal fat (15.1%), liposuction (8.0%), and platysma resection (1.8%). Subplatysmal procedures such as resection or plication of anterior digastric muscle (4.0%) and resection of submandibular gland (2.8%) were less commonly performed. In total, eight (1.6%) patients suffered a major complication (e.g., hematoma, parotid leak, DVT, or temporary neuropraxia) and four (0.8%) underwent a revision procedure. Of the 29 patients who underwent a deep procedure in the neck, no patient suffered a subplatysmal hematoma, sialocele, permanent nerve injury, dry mouth or “radical neck” appearance.

Conclusion: In the senior author’s experience, nearly half of all rhytidectomy patients required an open approach to the neck, and of all the patients who had an open procedure of the neck, over 10% had a deep, subplatysmal procedure. Despite the controversy surrounding the safety of subplatysmal procedures during face and neck lift surgery, our retrospective review of the senior author’s experience suggests that these techniques may be safe and effective. When performing these procedures, it is imperative to not only execute surgical precision, but also to possess a comprehensive understanding and awareness of the anatomy of the deeper structures of the neck and possible pitfalls.