Abstract
The neck is an often-neglected part of body lift procedures after massive weight loss. The objective of this study was to classify massive weight loss patients undergoing direct neck lift procedures and provide a standardized treatment algorithm. A retrospective review of all neck lift procedures performed between January of 2012 and December of 2019 was conducted. Patients were classified as follows: Grade I, no skin excess with remaining preplatysmal fat and no platysmal laxity; Grade IIa, moderate submental skin excess with subplatysmal fat deposits and platysmal laxity; Grade IIb, moderate anterior neck skin excess with no fat deposits and platysmal laxity; Grade III, considerable anterior skin excess with no or limited fat deposits and platysmal laxity and bands. Grade I patients had Liposuction, Grade IIa patients Submental Neck Lift with anterior fat excision and central platysmaplasty, Grade IIb Submental Neck Lift with central platysmaplasty, and Grade III patients Median Z-Plasty with fat excision (if needed) and central platysmal resection and tightening. Thirty-one patients were included for analysis. One underwent liposuction, twenty-five a Submental Neck Lift and five a Median Z-Plasty. Concomitant surgery was carried out in all cases. A recurrent skin laxity occurred in 2 (11.8%) patients, so in local anesthesia an operative revision was required. A standardized algorithmic approach for neck lift in massive weight loss patients may optimize the result without increasing the complication rate. Direct neck lift procedures prove to be reliable techniques with rare complication rates that can be performed together with other postbariatric procedures.
Highlights
Redundant midline neck skin is a common cosmetic problem in older patients
Just like other regions of the body the central neck in massive weight loss (MWL) patients often is accompanied by stretch marks, making direct excisions of damaged tissue favorable over lateral neck lift approaches
MWL patients tend to be younger than patients seeking face and neck lifts for rejuvenating reasons or consider a facelift too large of procedure
Summary
Redundant midline neck skin is a common cosmetic problem in older patients. The deformity known as “turkey neck” presents in younger patients after massive weight loss (MWL). Just like other regions of the body the central neck in MWL patients often is accompanied by stretch marks, making direct excisions of damaged tissue favorable over lateral neck lift approaches. The anterior cervicoplasty or zorro-scar-plasty was introduced in the 1970s by Cronin and Biggs and mostly favored in male patients [1, 2]. Due to scarring along the midline the technique has fallen out of favor compared to newer procedures with hidden scars. MWL patients tend to be younger than patients seeking face and neck lifts for rejuvenating reasons or consider a facelift too large of procedure
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