Complete excision of anterior digastric - can this cause long term issues?

Question

I am about to undergo a neck lift with complete excsion of the anterior digastrics and I am concerned about long-term issues. All my research says that the anterior digastric is removed tangentially and only 95% is removed. I am concerned that conpletely removibg the anterior belly of my digastrics (non-tangentially, complete cross section) will cause issues with the sling mechanism and the posterior digastric will become loose or slip. Is this a valid concern, or is it completely fine long-term to remove 100%?

Carl Truesdale, MD · Answer

Anterior digastric muscle handling during a neck lift is one of those technical decisions where the literature genuinely disagrees, but most experienced deep plane neck surgeons (myself included) favor a more conservative approach: partial reduction or subtotal resection rather than complete excision.
Why complete excision can cause issues:
Functional role: the anterior digastric helps with mouth opening, hyoid elevation during swallowing, and stabilizing the suprahyoid musculature. Removing it entirely can occasionally cause subtle changes in swallowing mechanics. Most patients adapt, but a minority report long-term mild dysphagia or 'off' sensation when chewing or swallowing tough food.
Cosmetic role: the digastric muscle contributes to the natural anatomic contour beneath the chin. Complete removal can create an over-hollowed submental area that looks unnatural in some patients, especially thinner faces.
Compensatory tension: when the digastric is removed, surrounding muscles (mylohyoid, geniohyoid) can develop compensatory tension or hypertrophy over time. This shows up as a tight or banded sensation under the chin months to years after surgery.
Adhesion/scar risk: any extensive submental dissection carries scar risk, and complete digastric removal involves more dissection than partial reduction.
What most experienced surgeons do instead:Partial myectomy &mdash; trimming the bulk of the muscle without complete removal. This addresses cosmetic fullness without sacrificing function. Combined with platysmaplasty and any necessary fat work, the cosmetic result is usually equivalent to complete excision with better long-term function.
If you've already had complete excision and notice symptoms (dysphagia, banding, asymmetry), the issues sometimes settle over 6 to 18 months as the body adapts. Persistent symptoms warrant evaluation by your surgeon and possibly speech/swallow therapy.
For patients considering this procedure: ask your surgeon specifically about their approach to digastric anatomy and whether they preserve or fully excise. The answer reveals a lot about their philosophy.

Complete excision of anterior digastric - can this cause long term issues?

Answers (1)

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