Treatment of the male neck

Published on 22/05/2015 by admin

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CHAPTER 21 Treatment of the male neck

Thomas M. Biggs, Jose Luis Martin Del Yerro Coca

Introduction

“Look Doc, I don’t want a facelift, just fix this,” is the expression heard probably three or four times a year by surgeons doing facial rejuvenation surgery. The patient says this as he grasps the tissue underneath his chin with a forefinger and a thumb. In most instances the patient is the husband or a close friend of a woman who has had the complete facial rejuvenation procedures, including face, neck, brow and eyelids, probably accompanied by fat injections, as well as surface treatment of the skin. He knows that he does not want that extensive amount of surgery, but he does want resolution of the problem under his chin which he feels is obtrusive.

History

In the evolutionary process of facial rejuvenation surgery, we have come a tremendous distance in the last several decades. Early on it was a matter of an incision with undermining and stretching of the skin so as to minimize the redundancy that was a result of gravity and loss of volume. As the twentieth century ended and the newer concepts came upon us, we became more conscious of the multifaceted nature of facial aging and the role loss of volume played in the aging process. We became aware of skin surface irregularities and skeletal defects both unimproved with skin stretching. These revelations resulted in specific treatments for each situation, with each case being a separate problem. This unique approach to every case could be summarized by the comment that, “No key fits every lock.”

The male neck was a specific problem that was unsuccessfully addressed until 1970 when the treatment of the male “Turkey gobbler neck” was introduced at the ASAPS meeting in Los Angeles. It was at that time the operation that will be described in this chapter was presented to the world.

Physical evaluation

As we learned in the second year of medical school, the history and physical is an extremely significant aspect in the treatment of any and all problems that prompt a person to seek medical care. The chief complaint was the statement made by the patient having to do with why he or she has sought consultation. The history of present illness is a discussion of the problem itself along with its origin and its development, as well as the various aspects of its effect on the patient’s wellbeing. The past history has to do with previous medical problems including whatever surgery or less invasive procedures may have been introduced in the treatment of the specific chief complaint. A family history and review of systems are essential in that they may play a role in better understanding of the chief complaint, or they may play a role as subsequent examinations evolve.

The physical examination itself, which is a general examination in most instances, will focus more specifically upon the problem outlined in the present illness. It is this particular situation that the examination of the neck reveals the anatomy about which the patient is concerned. This involves redundant skin, laxity of the neck muscles and the presence or the lack of presence of subcutaneous and or subplatysmal fat. All these structures are those which will be addressed in the subsequent description of the operation. These are the structures prompting the patient’s chief complaint, “I don’t want a facelift, Doc. Just fix this.”

Anatomy

The preoperative markings

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