Suture suspension platysmaplasty for neck rejuvenation revisited: Technical fine points for improving outcomes

Background: The suture suspension platysmaplasty technique for neck rejuvenation was introduced more than 13 years ago. Over the years and after a large number of procedures performed for all classes of neck deformities, a number of technical fine points evolved that resulted in even more aesthetically pleasing and predictable results. These technical fine points are presented in detail, and their direct anatomic effects are analyzed. Finally, the points that constitute the youthful neck are redefined with detailed schematic presentation. Anatomic Considerations: All aspects of neck rejuvenation with the suture suspension platysmaplasty are analyzed, with a focus on the changes that occur in terms of the following six key anatomic points: cervicomental angle depth, mandibular border definition, mandibular angle definition, labiomandibular fold prominence (jowling), mental prominence, and neck width. Technical Fine Points: Additional technical fine points have evolved over the past 13 years to optimize the results and produce a more natural appearing and aesthetically pleasing neck: the "angle loop" of the suspension sutures, anatomic suction-assisted lipectomy using appropriate cannulas, application of moderate tension to the interlocking suspension suture to avoid the "overcorrected neck," imbrication of the midline platysma, conservative skin excision, and augmentation of the chin to increase the depth of the cervicomental angle. Conclusion: The interlocking suture technique, by creating an artificial permanent "ligament" under the mandible, corrects the anatomic components of the neck (points 1 to 6) with excellent long-term outcomes and patient satisfaction rates. The additional technical fine points have made the aesthetic results more natural and pleasing, while making the technique more simple, safe, and reproducible.