Open Neck Lift: Surgical Technique and A Clinical Classification for Cervical Rejuvenation

Abstract

Careful evaluation of the neck and its relationship to the lower third of the face is fundamental to provide appropriate recommendations for procedures. The authors propose a modified Baker “clinical” classification as a more reliable and reproducible evaluative basis for the treatment of the aging neck. A total of 450 patients underwent procedures for cervical rejuvenation between December 2012 and December 2022 by the senior author. These included 9 cases of neck liposuction, 6 isolated neck lifts, 15 minimal access cranial suspension face lifts, 94 face lifts with open neck lifts, and 326 extended R-face and neck lifts. The male-to-female ratio was 1:20. The mean patient age was 59.1 years and the mean follow-up was 14 months (range 11.5–20 months). From the data, a modified Baker clinical classification for the aging neck was formulated along with recommendations for possible solutions. Ninety-four percent of the patients expressed high satisfaction on the Owsley Facelift Satisfaction Survey at 1-year follow-up. The complication rate was 1.78% (8 patients), including 1 hematoma, 1 skin edge necrosis (1 cm), 1 slow healing site (postauricular), 3 limited postauricular/earlobe scar revisions, and 2 mild contour irregularities. Cervical rejuvenation can be achieved by a spectrum of interventions and approaches. A comprehensive preoperative assessment and a clinical neck lift classification are the keys to selecting the correct surgical technique for achieving reliable and consistent results. The authors propose a pragmatic approach for both isolated and integrated neck lift procedures with excellent aesthetic outcomes and minimal complications.

Keywords

cervicoplasty - rhytidectomy - face lift - plastic surgery - neck - platysmaplasty

Copyrights

All artwork/medical illustrations in this manuscript were made by the first author, M.A.A.K.—these images were digitally enhanced by our medical illustrator, Louis Ross.

Previous Presentation

The technique and classification described in this article have been presented at the following conferences: The British Association of Aesthetic Plastic Surgeons Annual Meeting on September 26, 2014; The Pakistan Association of Plastic Surgeons International Annual Meeting, from February 8 to 10, 2015 (where it won the Khalid M. Durrani Gold Medal for best presentation); The Scottish Plastic Surgery Meeting, Dunkeld on November 6, 2015; The Scottish Oral a Maxillofacial Society Annual Conference on October 27, 2016; and the Association of Pakistani Physicians of Northern Europe (APPNE) Annual Meeting in Birmingham, United Kingdom, on November 20, 2021, where it won the second best oral presentation prize.

Consent for Publication

All consents were obtained from the patients for the use of their data and their preoperative, intraoperative, and postoperative photographs to be used for patient counseling, teaching, research, and medical publication purposes.

Publication History

Article published online:
22 July 2024

• References

• 1 Farrior E, Eisler L, Wright HV. Techniques for rejuvenation of the neck platysma. Facial Plast Surg Clin North Am 2014; 22 (02) 243-252
• 2 Shadfar S, Perkins SW. Anatomy and physiology of the aging neck. Facial Plast Surg Clin North Am 2014; 22 (02) 161-170
• 3 Mejia JD, Nahai FR, Nahai F, Momoh AO. Isolated management of the aging neck. Semin Plast Surg 2009; 23 (04) 264-273
• 4 Cardoso de Castro C. The value of anatomical study of the platysma muscle in cervical lifting. Aesthetic Plast Surg 1984; 8 (01) 7-11
• 5 Dedo D. The aging neck. In: Bailey B (ed), Head & Neck Surgery-Otolaryngology. 2nd ed.. Philadelphia: Lippincott-Raven; 1998: 2717-2732
• 6 Baker DC. Lateral SMASectomy, plication and short scar facelifts: indications and techniques. Clin Plast Surg 2008; 35 (04) 533-550 , vi
• 7 Caplin DA, Perlyn CA. Rejuvenation of the aging neck: current principles, techniques, and newer modifications. Facial Plast Surg Clin North Am 2009; 17 (04) 589-601 , vi–vii
• 8 Nahai F. Neck lift. In: Nahai F. ed. The Art of Aesthetic Surgery. St. Louis, MO: Quality Medical Publishing; 2005: 1239-1283
• 9 Connell BF, Shamoun JM. The significance of digastric muscle contouring for rejuvenation of the submental area of the face. Plast Reconstr Surg 1997; 99 (06) 1586-1590
• 10 Ellenbogen R, Karlin JV. Visual criteria for success in restoring the youthful neck. Plast Reconstr Surg 1980; 66 (06) 826-837
• 11 Nahai F, Nahai FR, Ford DT. Applied anatomy of the face and neck. In: Nahai F. ed. The Art of Aesthetic Surgery. St. Louis, MO: Quality Medical Publishing; 2005: 827-896
• 12 Saleh DB, Brierley N, Riaz M. “R” face and neck lift: a modified technique for en-bloc facial rejuvenation. Plast Aesthet Res 2021; 8: 10
• 13 Feldman JJ. Neck lift. St. Louis, MO: Quality Medical Publishing; 2006: 10