Cervicomental angle - will a deep plane neck lift provide good results in this area?

Question

I was hoping to get some insight from other providers regarding the benefits and downsides of undergoing a deep plane neck lift. I have already done liposuction but that did not have any improvement on my cervicomental angle. I now have a bump that coincides with my digastric muscles. My main question is whether doing work through ear incisions will have a noticable improvement on the angle of my neck. I suppose my other option is to only undergo resection of the digastrics and intervening fat through the submental incision. It would have to be a significant improvement in order to warrant the scars. For example, does the deep plane work through the ear incsions typically provide more of an angle improvement than digastric removal? The ear incisions would be partial (up to the tragus in the front, and half way up the crease in the back).

Carl Truesdale, MD · Answer

The cervicomental angle is what gives the neck its visual sharpness, and it's one of the most surgically responsive areas of the face. A well-executed deep plane neck lift addresses every layer that contributes to a blunted angle: loose platysma, subplatysmal fat, ptotic submandibular gland (sometimes), and the skin envelope.
What makes the deep plane approach different from a standard neck lift is the dissection depth. Rather than just tightening the platysma laterally, a deep plane technique releases the deep cervicomental ligaments and repositions the platysma muscle in its anatomic plane. This gives a sharper angle that holds up over time because we're working with the muscle's natural position, not creating tension that fights gravity.
In my experience the patients who get the most dramatic improvement are those with a heavy platysmal band component or subplatysmal fullness. If the angle is blunted mainly because of skin laxity alone, even a more conservative lift gives good results.
A few practical things to know.
Subplatysmal fat removal is sometimes necessary for the deepest, most defined angles. Not all surgeons do this comfortably because it requires working close to the digastric muscles.
The submandibular gland, if it sits low, may be partially trimmed (selective resection) for a flatter neck contour. This is a more advanced technique and worth asking about specifically.
Hyoid bone position matters and isn't surgically changeable. If your hyoid sits low, the angle has an anatomic ceiling no surgeon can exceed. A consult should include an honest read on this.
Bring lateral photos to consult, ideally chin-up and chin-down. The angle measurements are far more informative from the side than the front.

Philip Wasicek, MD · Answer

Hello, 
To obtain the most improvement in the neck, a deep plane necklift is often the optimal choice. This however, is best evaluated by being seen in-person for a consultation with a board certified plastic surgeon who specializes in these techniques to see what options might be best for you. 
Removing or reducing subplatysmal volume including the submandibular glands, anterior belly of the digastric muscle, and subplatysmal fat will allow the most improvement if they are the culprits. Sometimes a hyoid fasciotomy is necessary to bring the hyoid and angle further up. 
The hyoid can be further elevated from a lateral approach which can further improve the cervicomental angle. 
Best of luck.

Cervicomental angle - will a deep plane neck lift provide good results in this area?

Answers (2)

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