Neck Lift Procedures Research Articles

Neck Lift to Treat Platysma Bands and Defining Cervical Angle: A Systematic Review and Pooled Analysis.

Many surgical techniques have been proposed to address the submental-cervical angle in neck lift. Despite the several advances, obstacles persist when dealing with platysma bands and redefinition of the obtuse cervical angle. The aim of this study was to quantify platysma bands recurrence, any neurovascular damage, and other complications following neck lift procedures involving platysma muscle. After the approval and registration on the International Prospective Register of Systematic Reviews (PROSPERO), the systematic review was performed in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A series of specific keywords and predefined MeSH terms were utilized in different search engines (Medline, PubMed, Google Scholar, and the Cochrane library databases). Primary outcome was the recurrence of platysma bands; secondary outcomes included any postoperative complications, including any nerve damage. Pooled analysis was performed using a random effects model. Twelve articles, encompassing 2,106 patients, were relevant to this issue and included data on neck lift surgery with any platysma transection outcomes. Twenty-six patients had a recurrence of platysma bands during the follow-up, with a pooled rate of 1.4%. The pooled overall nerve damage rate was 0.9%. At the reported follow-up, the pooled hematoma percentage was 1.8%, and the pooled sialoma rate was 0.3%. Even less common complications were long-lasting edema, dehiscence of the submental suspension, and skin necrosis. Cervicomental angle redefinition remains a controversial and complicated procedure, which can be approached with different maneuvers. However, more long-term outcome reports as well as standardized complication outcomes are warranted in order to compare different and new techniques. LEVEL OF EVIDENCE: III.

Our 40 Years' Experience on Face and Neck Lift Procedures with High-SMAS Flap Techniques: How to Manage Secondary and Tertiary Surgeries.

Facial aging drives a growing demand for esthetic procedures, with nonsurgical options often falling short in longevity compared to surgery. Despite primary face and neck lift techniques receiving substantial attention, revision procedures have been relatively overlooked in terms of their unique surgical management, complication incidence, and preventive strategies. The authors present a 40-year experience with revision face and neck lifts, comprising 283 cases. The primary focus was on the high-SMAS flap technique in revision surgeries, with data collected on complications compared to primary procedures and existing literature. Secondary analysis investigated the time-lapse between primary and revision surgeries in the author's series (secondary and tertiary rhytidectomy) compared to the literature findings. Out of 283 cases, 232 were secondary and 51 were tertiary procedures. Overall complication rates in secondary cases mirrored those of primary procedures, with no statistically significant difference observed (p > 0.05). The mean interval between procedures was 9.0years (range: 3.4-28.8years), with a significant statistical difference (p < 0.05) observed between the first and second procedures (10.7years, range: 3.8-18.8years) and the second and third procedures (7.8years, range: 3.5-10.8years). Results indicate that high-SMAS flaps yield consistent and satisfying outcomes, even in secondary and tertiary cases. Complication rates are comparable to primary surgeries, underscoring the importance of meticulous attention to detail in managing the complexities associated with previous surgeries and the aging process. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Full SMAS: Endoscopic-Assisted Full Facial Rejuvenation.

Every region of the face may bear the signs of aging. Treating isolated areas without adequate anatomical knowledge can lead to incomplete or artificial-looking results and decrease patient satisfaction. Here, we describe a technique for complete rejuvenation, coined the "Full SMAS" technique, by addressing the anatomical continuity of the SMAS-Platysma to the deep-plane suspension of the face. This study aims to evaluate the contribution of endoscopic techniques combined with traditional facelift and neck lift procedures. The evaluation is conducted on procedures treating from the frontal and temporal regions of the superior part of the face to its mid and lower parts, including the cervical region. The treatment of the three sub-SMAS layers of the face was performed using endoscopy for repositioning the frontal region and midface. This procedure involves frontal and zygomatic-masseter ligament release, open treatment of the lower subplatysmal section, and the complete release of the retaining ligaments of the face and approach to the jowl. One hundred sixty-one patients underwent the Full SMAS technique, leading to long-lasting results, low complication rates, and high patient satisfaction. The Full SMAS is a systematic technique that provides complete facial rejuvenation by combining an endoscopic approach for the temporal and midface regions with traditional open approaches for the lower face and neck. Treating the temporal and midface regions using minimally invasive techniques (endoscopy) reduces the possibility of permanent nerve injuries, provides smaller scars, and creates more natural, long-lasting results.

Open Neck Lift: Surgical Technique and A Clinical Classification for Cervical Rejuvenation.

Careful evaluation of the neck and its relationship to the lower third of the face is fundamental to provide appropriate recommendations for procedures. The authors propose a modified Baker "clinical" classification as a more reliable and reproducible evaluative basis for the treatment of the aging neck. A total of 450 patients underwent procedures for cervical rejuvenation between December 2012 and December 2022 by the senior author. These included 9 cases of neck liposuction, 6 isolated neck lifts, 15 minimal access cranial suspension face lifts, 94 face lifts with open neck lifts, and 326 extended R-face and neck lifts. The male-to-female ratio was 1:20. The mean patient age was 59.1 years and the mean follow-up was 14 months (range 11.5-20 months). From the data, a modified Baker clinical classification for the aging neck was formulated along with recommendations for possible solutions. Ninety-four percent of the patients expressed high satisfaction on the Owsley Facelift Satisfaction Survey at 1-year follow-up. The complication rate was 1.78% (8 patients), including 1 hematoma, 1 skin edge necrosis (1 cm), 1 slow healing site (postauricular), 3 limited postauricular/earlobe scar revisions, and 2 mild contour irregularities. Cervical rejuvenation can be achieved by a spectrum of interventions and approaches. A comprehensive preoperative assessment and a clinical neck lift classification are the keys to selecting the correct surgical technique for achieving reliable and consistent results. The authors propose a pragmatic approach for both isolated and integrated neck lift procedures with excellent aesthetic outcomes and minimal complications.

Why Deep Plane Face and Neck Lifting Results in the Maximum Short- and Long-term Results? My Primary Choice for Rhytidectomy in My Practice.

I converted to the extended deep plane facelift and neck lift with a shorter skin flap elevation in the face to achieve a more complete release of the facial ligaments to obtain more mobilization of the skin/superficial musculoaponeurotic system composite flap, and a more medial suspension resulting in improved correction of the midface, nasolabial fold, marionette fold and jowl. Treatment of the deep neck structures allowed for more refinement of the submentum in the deep neck lift procedures as well. In this article, we shall review the surgical technique of the deep plane facelift and neck lift as well as postoperative management pearls, the management of complications from the procedure, and the incorporation of ancillary procedures.

Facelift: Assessment of Total Platysma Muscle Transection to Prevent the Recurrence of Platysmal Bands

IntroductionDetermining which facelift technique yields the most effective long-term rejuvenation results and ensures optimal stability over time remains a significant question in cosmetic surgery: Does the most invasive surgery lead to the best long-term outcomes? This study aims to evaluate the authors’ approach using total platysma muscle transection to prevent platysma band recurrence, and to provide anatomical observations supporting and justifying their procedure.Material and MethodsA preliminary study in anatomical basic sciences was conducted to establish the rationale for our method. A prospective single-blind study was conducted, involving eighty patients seeking facial rejuvenation with platysmal band correction. They underwent face and neck-lift procedures with total platysma transection by the same surgeon between May 2013 and May 2016. Cosmetic outcomes were assessed using the Face and Neck-Lift Objective Photo-Numerical Assessment Scale. Scores by three blind evaluators before surgery, at 1 and 5 years postoperatively, were compared using a matched T Test (p < 0.05).ResultsThe preliminary anatomical study revealed a consistent anastomotic system between the cervical branch of the facial nerve and the branches of the cervical plexus. Incomplete platysma section during a facelift might contribute to platysma band recurrence. The clinical study demonstrated satisfactory outcomes, with significant overall appearance improvement (p < 0.00001) and no platysma band recurrence. Complication rate was low.ConclusionThe authors’ technique achieved satisfactory long-term results with minimal complications. However, due to the lengthy operating time and steep learning curve, it should be reserved for highly motivated patients.Level of Evidence IIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

80. The Over-tightened Neck: Causes, Complications, and Management

PURPOSE: The over-tightened neck following necklift procedures is a clinical problem that has received little attention in plastic surgical literature. Possibly, plastic surgeons are either reluctant to discuss it or see few cases. Also, an overtightened neck reflects both the subjective and objective opinions of the patient along with objective clinical findings. METHODS: A retrospective review of 250 consecutive necklift procedures from 2013 to 2020 was performed, of whom 211 (84%) had a submental crease incision with anterior neck tightening of platysmal bands combined with a lateral neck plication. Follow-up continued was at least one year. RESULTS: A total of five patients (2%) presented with complaints of an over-tightened neck that caused pain (5) and difficulty swallowing, interference with speech (1), dyspnea (1), and fat necrosis (1). Three patients had anatomical evidence of a long neck that measured 11cm. Three patients complained throughout and at the end of the first year. Two other patients who had a necklift elsewhere which included anterior platysmaplasty were referred for evaluation. Their procedures has been performed one and one and a half years previously. All five patients were evaluated by neck CT (3) and neck MRI (2). Two patients had videofluroscopy and barium swallow studies that were negative. CONCLUSION: The overtightened neck is an uncommon postoperative sequel to a necklift procedure that may be difficult to assess because of its subjective nature. It can, however, be associated with severe symptoms requiring recognition and appropriate diagnostic work-up.

The Functional Anatomy and Innervation of the Platysma is Segmental: Implications for Lower Lip Dysfunction, Recurrent Platysmal Bands, and Surgical Rejuvenation.

Despite the central role of the platysma in face and neck rejuvenation, much confusion exists regarding its surgical anatomy. This study was undertaken to clarify the regional anatomy of the platysma and its innervation pattern and to explain clinical phenomena, such as the origin of platysmal bands and their recurrence, and the etiology of lower lip dysfunction after neck lift procedures. Fifty-five cadaver heads were studied (16 embalmed, 39 fresh, mean age 75 years). Following preliminary dissections and macro-sectioning, a series of standardized layered dissections were performed, complemented by histology and sheet plastination. In addition to its origin and insertion, the platysma is attached to the skin and deep fascia across its entire superficial and deep surfaces. This composite system explains the age-related formation of static platysmal bands, recurrent platysmal bands after complete platysma transection, and recurrent anterior neck laxity after no-release lifting. The facial part of the platysma is primarily innervated by the marginal mandibular branch of the facial nerve, whereas the submandibular platysma is innervated by the "first" cervical branches, which terminate at the mandibular origin of the depressor labii inferioris. This pattern has implications for postoperative dysfunction of the lower lip, including pseudoparalysis, and potential targeted surgical denervation. This anatomical study, comprised of layered dissections, large histology, and sheet plastination, fully describes the anatomy of the platysma including its bony, fascial, and dermal attachments, as well as its segmental innervation including its nerve danger zones. It provides a sound anatomical basis for the further development of surgical techniques to rejuvenate the neck with prevention of recurrent platysmal banding.

D43. The Over-tightened Neck: Causes, Complications, and Management

PURPOSE: The over-tightened neck following necklift procedures is a clinical problem that has received little attention in plastic surgical literature. Possibly, plastic surgeons are either reluctant to discuss it or see few cases. Also, an overtightened neck reflects both the subjective and objective opinions of the patient along with objective clinical findings. METHODS: A retrospective review of 250 consecutive necklift procedures from 2013 to 2020 was performed, of whom 211 (84%) had a submental crease incision with anterior neck tightening of platysmal bands combined with a lateral neck plication. Follow-up continued was at least one year. RESULTS: A total of five patients (2%) presented with complaints of an over-tightened neck that caused pain (5) and difficulty swallowing, interference with speech (1), dyspnea (1), and fat necrosis (1). Three patients had anatomical evidence of a long neck that measured 11cm. Three patients complained throughout and at the end of the first year. Two other patients who had a necklift elsewhere which included anterior platysmaplasty were referred for evaluation. Their procedures has been performed one and one and a half years previously. All five patients were evaluated by neck CT (3) and neck MRI (2). Two patients had videofluroscopy and barium swallow studies that were negative. CONCLUSION: The overtightened neck is an uncommon postoperative sequel to a necklift procedure that may be difficult to assess because of its subjective nature. It can, however, be associated with severe symptoms requiring recognition and appropriate diagnostic work-up.

Face and Neck Lift

As surgical treatment of aging is increasingly sought after by both male and female patients, there is great interest in optimizing treatment and management strategies related to surgical rejuvenation of the face. To this end, safe and effective performance of face and neck lifts requires an understanding of head &amp; neck anatomy, and of the different surgical options that can be used to address the patient’s concerns. This chapter reviews the history, anatomy, surgical techniques, complications, and advances associated with face and neck lift procedures. This review contains figures, tables, and references Keywords: face lift, neck lift, rhytidectomy, aging face, surgical rejuvenation

Direct Neck Lift in Massive Weight Loss Patients – Classification and Treatment Algorithm

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.

Submandibular Gland Aesthetic Elimination With Neurotoxin

PURPOSE: Submandibular glands can be noticeable in some facelift and necklift patients. The current standard is to surgically remove them. The senior author has treated them with neuromodulators during necklift operative procedures and occasionally post-operatively with follow-up injections. We present a novel way to eliminate submandibular glands without the need for excision, achieving a smooth jawline contour post necklift surgery. METHODS AND MATERIALS: Before any lower facelift and necklift, assessment is done by visual inspection and palpation of the submandibular glands to determine if they require neuromodulator injection. During necklift, if the gland is prominent, then 50 units of Dysport (Galderma) is injected into each gland. Two injections are placed into each gland. Care is taken to inject with a 25-gauge needle under direct visualization. Six weeks after necklift, a postoperative visit with visual inspection and palpation of the submandibular gland is performed. If necessary, a repeat injection of 50 units of Dysport (Galderma) per gland is given. EXPERIENCE/DATA: A total of 12 patients underwent initial necklift with Dysport injection from 2016 to 2020. Out of these patients, a total of 1 patient/8% of patients required a second injection 6 weeks post surgery. No patient required a third injection. A postsurgical survey was performed with interpretation by 3 independent plastic surgeons as well as a patient satisfaction survey. Independent plastic surgeons who did not perform the actual necklift procedure were asked to grade the submandibular gland appearance from before and after photographs. Out of 12 patients, a total of 11 patients/92% were deemed “Total Correction,” 1 patient/8% was deemed “Incomplete Correction,” and a total of 0 patient/0% were deemed “No Correction.” All 12 patients were asked similar questions. A total of 11 patients/92% self reported “Total Correction,” 1 patient/8% self reported “Incomplete Correction,” and a total of 0 patient/0% self reported “No Correction.” One patient required a second injection due to continued palpability of the gland after surgery. She developed the sensation of “dry mouth,” which resolved 2 months after the second injection. No other sequelae were noted by the patient or Plastic Surgeon. No other sequelae were noted in any other patient, including excessive bleeding, pain at the submandibular gland size, irregular contour deformity, skin necrosis, or seroma formation. SUMMARY: Dysport (Galderm) injection directly into the submandibular gland, whether through an open technique or by palpation, resulted in substantially less prominent gland and a more aesthetically pleasing jawline. CONCLUSIONS: Direct submandibular gland excision has a risk of difficult to control bleeding due to the unique and random arterial supply of the gland. Having smaller exposure due to a necklift incision lateral to the gland does not aid in visualization of the gland and the blood supply. Direct neuromodulator injection into the gland is a safe and effective way to decrease the visibility and palpability of the gland on a long-term basis. We feel it is a useful alternative to surgical excision of the submandibular gland.

The "Segmental SMAS Model": A Didactic Concept of Face and Neck Lift Anatomy.

Profound understanding of the surgical anatomy of the face and neck is the key to successful face lift surgery. The "Segmental SMAS Model" presented herein is the result of a decade-long effort in teaching fellows a logical and coherent anatomic model of face lift anatomy. The superficial musculo-aponeurotic system (SMAS) consists of segments with distinct surgical characteristics. These are determined by the presence of a deep gliding plane and/or adhesion through fibrous insertions. In this article, we define SMAS segments that are profoundly heterogeneous in their behavior and have surgical implications on the maneuvers required for a deep plane face lift. The present model introduces several novel interpretations of the surgical anatomy of the face and neck lift procedure and hopes to convey a better understanding of face lift anatomy to training surgeons.

Ten Tips Based on Anatomy and Design to Refine Face and Neck Lift Surgery.

Background:Any face/neck lift operation has a natural flow of slower and speedier portions; slower when dissecting under the superficial musculoaponeurotic system and around nerves while faster during opening, undermining, defatting, and closing. Surgeons can maximize efficiency with these simple maneuvers.Methods:We introduce and demonstrate ten reproducible surgical techniques based on anatomy, which span aspects of the entire face and neck lift procedure including markings, skin flap elevation, sub-superficial musculoaponeurotic system manipulation, preplatysmal fat management, skin re-draping, and post-operative dressings.Results:As examples, altered scissors facilitate “push” undermining, scoops reduce time for fat removal in the neck, a non-inset method for lobule creation, and digital measurements for certain technical maneuvers are discussed. Moreover, a block and tackle method of facial nerve blocks is reviewed which permits local-only face and neck lifting as well as hematoma drainage without patient intolerance.Conclusions:Implementation of these surgical techniques in face and neck lift procedures allows the surgeon to potentially decrease operative time and work towards minimizing post-operative edema while attaining aesthetic and natural results.

Relationship of the lobular branch of the great auricular nerve to the tympanoparotid fascia: Spatial anatomy for salvage during face and neck lift.

To enable selection of a safer suspension site to use in face and neck lifting procedures, the spatial relationship between the tympanoparotid fascia and the great auricular nerve should be clarified. In this study, we aimed to elucidate the position of the tympanoparotid fascia and the pathway of the lobular branch of the great auricular nerve traversing the tympanoparotid fascia. Twenty hemifaces from non-preserved bequeathed Korean cadavers (5 males, 7 females; mean age, 77.0 years) were dissected to determine the great auricular nerve distribution close to the tympanoparotid fascia of clinical significance for face and neck lift procedures. We observed the tympanoparotid fascia in all specimens (20 hemifaces). The tympanoparotid fascia was located anteriorly between the tragus and intertragic notch. Regarding the spatial relationship between the tympanoparotid fascia and the great auricular nerve, we found the sensory nerve entering the tympanoparotid fascia in all specimens (100%), and the depth from the skin was approximately 4.5 mm; in 65% of the specimens, the lobular branch was found to run close to the tympanoparotid fascia before going into the earlobe. Provided with relatively safer surface mapping to access the tympanoparotid fascia free of the lobular branch of the great auricular nerve, surgeons may better protect the lobular branch by anchoring the SMAS-platysma flap and thread to the deeper superior and anterior portions of the expected tympanoparotid fascia.

The extended modified male Z-plasty necklift for correction of severe aging changes of the neck with secondary improvement of the lower third of the face

The male Z-plasty necklift (MZPN) is a well described procedure [1-4], specifically used for men with severe aging neck changes who cannot be achieve a satisfactory aesthetic outcome with other necklift procedures that are performed through a submental incision.

Recent Advances in Face Lift to Achieve Facial Balance.

Facial balance is achieved by correction of facial proportions and the facial contour. Ageing affects this balance in addition to other factors. We have strived to inform all the recent advances in providing this balance. The anatomy of ageing including various changed in clinical features are described. The procedures are explained on the basis of the upper, middle and lower face. Different face lift, neck lift procedures with innovative techniques are demonstrated. The aim is to provide an unoperated balanced facial proportion with zero complication.

Five-Step Neck Lift

A harmonious and youthful appearing neckline is arguably the most vital aspect of a successful facial rejuveation. Without sound principles, the neck appears skeletonized, tethered, and hollow. The anatomical studies that the authors have performed regarding the neck, jowl, and subplatysmal elements have influenced the techniques that they now use. The authors' approach modifies the classic techniques of the past, and seeks a nuanced approach to each patient by resuspension and reshaping of deeper neck elements. In this article, the authors apply their anatomical research and cadaveric studies to demonstrate and support their neck-lift techniques. The authors integrate their knowledge to describe how the technique of one of the senior authors (R.J.R.) has evolved over time. The main tenets of the authors' approach have evolved into a sequence that involves skin undermining over the neck and cheek, submental access to the neck, with possible excision of fat and midline plication of the platysma with release of the muscle inferiorly, platysmal window suspension laterally, precise release of the mandibular septum and ligament if needed, and finally redraping of the superficial musculoaponeurotic system (SMAS) by plication or SMASecomy. These five steps ensure correction of jowling, a smooth jawline, and a well-shaped neck. The five-step neck lift helps to optimize results in creating the ideal neck contour. The authors provide four points that should be considered in any neck-lift procedure. The end result is a well-defined, well-contoured neck, with an approach grounded in sound anatomical principles.

Isolated Management of the Aging Neck

The contour of the neck is a very important determinant of facial aesthetics. Precise knowledge of neck anatomy is essential for adequate planning and execution of this procedure. There are three anatomic and surgical planes involved in the management of the aging neck; the superficial plane (subcutaneous fat), the intermediate plane (platysma muscles and the fat between the two muscles), and the deep plane (subplatysmal fat, the anterior belly of the digastric muscles, and the submandibular glands). These planes need to be thoroughly evaluated in the preoperative assessment and dealt with according to each patient's needs. Even though this article focuses on isolated management of the aging neck, careful evaluation of the neck and its relationship to the lower third of the face is fundamental. If there is significant jowling and descent of the neck-face interface, an isolated neck-lift procedure will not address that problem and will lead to a suboptimal result. In these patients, a face and neck lift is a more appropriate operation.

“The Stork Lift”: A Circumoccipital Extended Neck-Lift

The goal of the lower face- and neck-lift is restoration of a sharp cervicomental angle. However, standard cervical rhytidectomy for the patient with extensive excess skin of the neck often leaves the patient with objectionable vertical or diagonal skin folds of the lateral neck, a large hair-step deformity, or both. To remove extensive excess skin of the neck and to avoid vertical/diagonal folds and a stepped hairline, the authors "walk" the excess skin posteriorly along the hairline, often from ear to ear along the inferior posterior hairline. Patients with extensive excess skin of the neck underwent neck-lift procedures using the circumocciput incision technique during a 1-year period. With the patient in a sitting position, a postauricular face-lift incision is extended along the inferior hairline from ear to ear. The flap is "walked" posteriorly to and along the occiput on either side of the midline. It is closed using a divide and close technique. Flaps are created, and the wound is closed in a multilayered fashion with a posterior midline A-to-T flap. During a 1-year period, 25 patients (22 women and 3 men) underwent a cheek/neck-lift, and 2 patients (1 man and 1 woman) underwent isolated neck-lift procedures using the circumocciput incision technique. The average patient age was 64.8 years (range, 49-79 years). There were no instances of obvious lateral neck folds. Complications included hematoma (1 patient), Candida wound infection (1 patient), and a widened scar revised secondarily (1 patient). All the patients were satisfied with their cosmetic result 6 months after the operation. None of the patients stated that their final scar was noticeable or objectionable. The patients in this study who presented with excessive redundant skin of the neck were treated with the "stork lift," which provided excellent lifting of the anterior, lateral, and posterior neck as well as excellent cervicomental angles without postoperative sequelae of lateral neck folds or stepped hairlines.