We would like to thank the Drs. Citarella, Condé-Green, and Hasbun from the Ivo Pitanguay Institute for their reply to our article “Secondary Neck Lift and the Importance of Midline Platysmaplasty: A Review of 101 Cases.” Our secondary neck lift article espouses a five-step approach that includes skin undermining, submental access with direct fat excision and midline platysmal plication, lateral platysmal window, contour assessment with possible release of the mandibular septum, and superficial musculoaponeurotic system and skin redraping.1,2 The authors Condé-Green et al. describe their technique in detail, along with before-and-after photographs. In their technique, the authors lipocontour the neck to the appropriate degree, followed by supraplatysmal and subplatysmal undermining of the skin, and possible resection of the midline platysma. Afterward, a unique aspect of their procedure is to perform three types of suturing in the midline: a line of triple point sutures is first placed, followed by a single nylon suture at the thyroid region, and finally a line of sutures from the thyroid region back up to the supramental region. The platysma and digastric muscles are often addressed. This helps to create a youthful cervicomental angle. The lateral technique involves superficial musculoaponeurotic system–platysmal plication to the mastoid, thus defining the cervicomental region.3
We commend the authors on their nuanced technique. The before-and-after photographs clearly show dramatic improvement of all elements of the cervicomental region, jawline, and cheek. Although the lateral plication technique is similar, our technique differs in the fact that we prefer open excision of fat as opposed to liposuction. This includes supraplatysmal and possibly subplatysmal fat excision. In addition, we do release some platysma muscle sharply from the lower midline to allow for lateral advancement. Finally, we use multiple midline contouring sutures for the platysma. A triple point suture may also close empty space and adherence of skin to improve results.
A key element in both techniques is the underlying need for reliability in primary and secondary neck lift. We live in a society that wants quicker procedures with less downtime. However, in patients with skin excess and fullness, a limited procedure can be a disadvantage. Lateral plication alone may give only transient improvement in the midline. Opening the neck by a variety of techniques can improve overall contour and longevity. We encourage further long-term studies regarding which techniques can produce more reliable results.
Dr. Rohrich is a volunteer member of the Allergan Alliance for the Future of Aesthetics and receives instrument royalties from Eriem Surgical, Inc., and book royalties from Taylor and Francis Publishing. Dr. Narasimhan has no financial information to disclose. No funding was received for this communication.
Kailash Narasimhan, M.D.
Sherman Surgery Center
Rod J. Rohrich, M.D.
Department of Plastic Surgery
University of Texas Southwestern Medical Center
1. Narasimhan K, Ramanadham S, O’Reilly E, Rohrich RJ. Secondary neck lift and the importance of midline platysmaplasty: Review of 101 cases. Plast Reconstr Surg. 2016;137:667e675e.
2. Narasimhan K, Stuzin JM, Rohrich RJ. Five-step neck lift: Integrating anatomy with clinical practice to optimize results. Plast Reconstr Surg. 2013;132:339350.
3. Citarella ER, Condé-Green A, Sinder R. Triple suture for neck contouring: 14 years of experience. Aesthet Surg J. 2010;30:311319.