Redefining the Neck: A Retrospective Review Utilizing Hyoid Suspension

Abstract

Neck contouring is one of the most frequent reasons patients seek cervicofacial rhytidectomy. But what makes for aesthetically pleasing youthful neck? Ellenbogen and Karlin described 5 criteria in their 1980 landmark publication, including having a cervicomental angle between 105° and 120° and a visible subhyoid depression. Recent advances in neck anatomy have revealed the existence of ligamentous like structures attaching the skin and platysma to the hyoid. These have been termed the hyoplatysmal ligament (HPL) and cervicomental suspensory angle ligament by different authors. This study was undertaken to determine whether surgically reestablishing the above structures utilizing a hyoid suspension technique resulted in statistically significant changes in cervicomental contour. A retrospective chart review was performed from January 2014 to present. After December 2016, the second author began utilizing a hyoid suspension technique where the inter-and subplatysmal fat was resected and the HPL was reestablished surgically (hyoid suspension). Cases before this date served as controls if a similar neck manipulation was performed without reestablishing the HPL. In total, 104 charts were queried, of which, 21 charts fit inclusion criteria to serve as controls and 20 as the experimental group. Before and after profile pictures were then compared for differences in cervicomental angle utilizing commercially available imaging software (Canfield Mirror, Parsippany, New Jersey). An unpaired Student t test was then performed to determine whether this 2 groups differed significantly utilizing a P value of .05 to denote statistical significance. The mean difference between pre-and postoperative cervicomental angle for the control group was 17.38° with a standard deviation of 8.05°. The mean difference between pre and postoperative cervicomental angle for the experimental group was 28.75° with a standard deviation of 15.52°. The resulting 11.37° difference in cervicomental angle between the 2 groups was found to be statistically significant with a P value of .0051. Our cosmetic surgical and anatomical knowledge continues to progress. Brant first described a ligamentous structure that attaches the platysma to the hyoid. Through biomechanical testing, he noted this ligament to be one of the weakest in the face and neck. Thereafter, in 2016 Yousif et al and Le Lourn separately described similar procedures to attach the platysma to the hyoid, in effect reestablishing this ligament. Utilizing one simple surgical maneuver, the hyoid suspension reestablishes the HPL. This surgically creates an acute cervicomental angle, resulting in less platysmal displacement postoperatively, with virtually no addition to surgical time or morbidity.