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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.

NEXT: Surgeons Weigh In

 

Surgeons Weigh In

Dr. JaconoThe hyoid suspension neck lift described in the article addresses a common frustration among neck lift patients and their surgeons, according to facial plastic and reconstructive surgeon Andrew A. Jacono, M.D., at the New York Center for Facial Plastic and Laser Surgery in New York City and Great Neck.

“The biggest problem with face and neck lift surgery is recurrence of platysmal laxity and bands often within the first year to three years after surgery. There have been a lot of studies published over the course of the last decade to try and address this problem,” Dr. Jacono tells Cosmetic Surgery Times.

“This is a great study that documents the outcomes from securing the platysma to the peri-hyoid cervical fascia. I initially learned of this technique at plastic symposia from various speakers, and have incorporated it into my practice over 10 years ago,” Dr. Jacono says. “In my practice I have noticed that it has improved the longevity of my neck lift results.”

Dr. MoellekenPlastic surgeon Brent Moelleken, M.D., associate clinical professor of surgery at the Geffen School of Medicine at UCLA and not a study author, says the paper is very interesting in that it looks at another approach for reducing the platysma’s activity in older patients by tying down the platysma to a deeper layer.

“While it is certainly innovative, I would love to have seen a comparison with botulinum toxin A, the usual way that we treat neck banding refractory to corset platysmaplasty treatments,” Dr. Moelleken tells Cosmetic Surgery Times. “I would also love to have seen the effects during swallowing and facial expression — critical elements of the platysmal appearance.”

The platysma muscle, which spans from the collar bone to the jaw line, is a functional muscle, he says.

“Patients are often under the impression that this muscle will be completely smooth. Still with a well done facelift, neck lift and corset platysmaplasty, the neck is much smoother,” Dr. Moelleken says. “The platysma muscle is still alive, so still animated. That is a normal part of how the muscle works. The study included most patients receiving both a facelift and a submental platysmal tightening, so the effect of the hyoid fascia suspension alone can’t be easily separated from the effect of the facelift, presumably with upward elevation of the SMAS platysmal complex. Nevertheless this is a very interesting approach to the continued problem of platysmal banding after corset platysmaplasty”

Disclosures: Drs. Jacono and Moelleken report no relevant disclosures.

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