Treatment of the full obtuse neck

Timothy J. Marten, MDJoel J. Feldman, MDBruce F. Connell, MDWilliam J. Little, MDDr. Marten: The full, obtuse neck is an interesting and perplexing problem that aesthetic surgeons frequently encounter. The first patient is a 28-year-old woman with longstanding neck fullness and no prior surgeries (Figure 1). Dr. Feldman, what anatomic abnormalities underlie the appearance of this woman's neck, and what treatment options would you offer?Figure 1 This 28-year-old woman has longstanding neck fullness and no prior history of surgery.Dr. Feldman: In addition to her obtuse neck angle, this patient appears to have a small chin, poor definition of her jawline, and either an enlarged or malpositioned submandibular salivary gland. I cannot tell much about the subplatysmal tissues just by looking at the photos. Although I feel every neck carefully, I really don't decide what needs to be done underneath the platysma until surgery, when I proceed step-by-step, peeling away one layer after another, systematically examining each layer as I get to it, and only then determining what needs to be done. I suspect that this patient would need to have some subplatysmal fat removed after she has had a subcutaneous lipectomy. Once that was accomplished, I would inspect the suprahyoid or perihyoid fascia to see if it needed to be released.In the process of performing a subplatysmal lipectomy underneath the medial platysma, I would open into the capsule of the submandibular salivary gland, and if the gland appeared to be large or fixed by intracapsular adhesions low in the neck, I would either resect a portion of the gland or perform a fairly thorough intracapsular release and repositioning of the gland. Then I would assess the anterior digastric muscles to see if they needed a low release just above the hyoid, or, if they were …