The hyoid suspension neck lift
The hyoid suspension neck lift, a surgical procedure focused on attaching the platysma to the hyoid, restores a youthful shape to the neck. Results last a decade or more, are reproducible and the procedure consistently corrects the range of cosmetic neck concerns, from early neck laxity to significant laxity and skin excess, according to a recent study.
Mequon, Wis., plastic surgeon N. John Yousif, M.D., who says on his website that he developed the procedure, was lead author of the review of 110 patients operated on in the last seven years.
The anterior platysmal bands become more visible with aging, not just because of gradual laxity of the underlying muscle support, but also anterior displacement of the muscle, from the platysma’s repetitive contractions. Eventually, active anterior displacement becomes the platysma’s position at rest, according to the authors.
The hyoid neck lift involves closely anchoring the platysma to the deep cervical structures — making it part of those structures. The skin, then, redrapes and recontours to the new, more youthful neck shape.
Essential parts of the neck lift technique include removing excess fat; attaching the platysma to the hyoid fascia, so that it follows the deep cervical structures, and suturing it above and below the connection; as well as undermining the skin, which allows the skin to redrape to the new position of the sutured platysma. While overlying fatty tissue hides the platysma before surgery, the authors write that attaching the platysma to deep structures and wide skin undermining is needed to achieve elements of an aesthetic neck.
In the study, 11 of the 110 patients had hyoid suspension neck lift alone; the others had the neck lift with a combination of other facial procedures, including facelift.
The authors illustrate cases where patients experienced notable improvement. Whether at rest or in activation, the anterior platysma isn’t visible post-surgery. Even a patient with significant skin laxity before the surgery had stable results five years later. In one illustrated case, the patient extended the neck to show that even then the platysma maintains its position in the deep underlying cervical structures.
Only nine of the patients were male. Interestingly, two of the three patients who experienced postoperative hematoma in the study had drainage and control surgery post neck lift. Both patients who returned for surgery were male. Within a couple of weeks post-surgery, three patients developed submental seromas requiring serial in-office aspirations. Two of those went back to surgery half a year later to have subcutaneous scarring resulting from the seromas removed. The platysmal bands recurred in one patient, during the study period, after the suture failed. But there were no reports of permanent nerve injury, skin loss due to vascular compromise, changes in vocal resonance or problems with swallowing, according to the study.
According to the authors, the hyoid suspension neck lift allows surgeons to achieve results that have been difficult to get with a single operation.
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