What the operation treats
- Ellenbogen and Karlin set visual criteria for the youthful neck in 1980 and advised excising the subplatysmal fat pocket in heavy necks (PMID 7443846).
- Tightening skin and platysma over subplatysmal fat, large submandibular glands and digastric hypertrophy does not correct them (PMID 36563673).
- Structures open to reduction: subplatysmal fat, inter-sternocleidomastoid fat, anterior digastric belly, hyoid position, submandibular gland and parotid tail (PMID 30268239).
- Deep central neck anatomy for this surgery (PMID 30268237).
- Systematic review, 57 studies, 8,648 patients: most altered structures were the submandibular gland (69.9% of studies), digastric (58.6%) and subplatysmal fat (48.6%); nerve palsy 0.2%-12%, hematoma 0.2%-4%; objective outcome measures in 12% of studies (PMID 39652837).
Volumes removed
- 152 deep cervicoplasties, specimens measured by volume displacement: mean 22.3 cm3 removed; 73% subplatysmal (PMID 33543747).
- Deep fat reduced in 96% of patients (mean 7 cm3), submandibular gland in 76% (6.5 cm3), anterior digastric in 70% (1.8 cm3); digastric plication to reposition the hyoid in 34% (PMID 33543747).
- 504 patients, subplatysmal necklift: fat treated in 83.9%, submandibular glands in 60.9%, digastric in 18.1%; no subplatysmal hematoma; lower lip depressor weakness 5.7% (PMID 27356946).
Subplatysmal fat
- 130 patients: preoperative ultrasound subplatysmal fat thickness (mean 5.09 mm) correlated with excised volume (mean 5.95 cc; r=0.595) (PMID 41468305).
Digastric muscle
- Tangential excision of a bulky anterior digastric belly described in 21 patients (PMID 9145126).
- 452 patients, anterior digastric myectomy (310) vs none (142): no difference in dysphagia, dysarthria or throat pain; neck tightness 4.8% vs 13.4%; revision neck lift 3.9% vs 9.2% (PMID 41283798).
Submandibular gland
Landmarks
- Cadaver anatomy for partial resection: marginal mandibular nerve outside the capsule, about 3.7 cm cephalad to the gland's lower edge (PMID 12973234).
- Basket suspension of ptotic glands in fascia, 19 glands in 10 patients (PMID 18766063).
- 112 of 736 facelifts (2002-2013) included gland reduction (13% primary, 25% secondary); reoperation for hematoma 1.8%, one potentially fatal; sialocele 4.5%; neurapraxia 4.5%; no permanent dry mouth (PMID 25989302).
- Partial gland resection technique and indications (PMID 30268240).
- Systematic review to 2019, 6 studies, 602 patients, 1,200 partial resections: gland-related hematoma 0.08%, sialocele 1.3%, transient marginal mandibular weakness 4.7% (PMID 31970454).
Current series
- O'Daniel, ISAPS Olympiad Athens 2023: Gold medal, Oral Communications (Face), "Demystifying Defining Safe Steps for Submandibular Gland Reduction" (https://www.isaps.org/articles/isaps-blog/2023/isaps-olympiad-athens-2023-award-winners/).
- The same congress awarded Silver in that category to Ozan Sozer, "Strategies in Neck Lift" (https://www.isaps.org/articles/isaps-blog/2023/isaps-olympiad-athens-2023-award-winners/).
- O'Daniel and Duff 2026, the Carina technique: 1,100 deep cervicoplasties (2018-2022), 922 with gland reduction (1,844 glands); no sialocele, no uncontrolled bleeding, no postoperative hematoma; transient xerostomia 2 patients (PMID 42759497).
- Carina technique seven steps: incision placement, wide platysmal elevation, visual axis optimization, optical cavity creation, gland mobilization, controlled reduction, capsular reconstruction (PMID 42759497).
- Temporary bilateral lower lip dysfunction occurred in all anterior neck lift patients in the Carina series; asymmetric recovery 7.1% (PMID 42759497).
- LigaSure vessel-sealing device, 83 patients: no intraglandular bleeding, no hematoma, no sialoma; transient lower lip weakness 7 (PMID 38546581).
- LigaSure Exact, 80 of 123 neck lifts: seroma 3.75%, minor hematoma 1.25%, transient lower lip weakness 5% (PMID 42022460).
- East Asian series, 240 partial resections: hematoma 1.3%, sialocele 0.4%, transient lower lip depressor dysfunction 1.7% (PMID 42695798).
- East Asian series, 341 patients with gland reduction and/or parotid-tail shaving: hematoma 1.17%, marginal mandibular weakness 0.59%, no permanent nerve injury (PMID 42137253).
- Systematic review 2026, 51 studies, 2,971 patients, 6 approaches: overall complications 15.1%; marginal mandibular nerve injury 9.8% (PMID 41092483).
Platysma
Anatomy
- 50 cadavers: medial fibers decussate 1-2 cm below the chin in 75%, join at the thyroid cartilage in 15%, stay separate in 10% (PMID 7433553).
- 55 cadaver heads: platysma is attached to skin and deep fascia across both surfaces; facial part innervated mainly by the marginal mandibular branch, submandibular part by the first cervical branches, which end at the mandibular origin of depressor labii inferioris (PMID 37186556).
- That segmental pattern explains recurrent bands after complete transection and lower lip "pseudoparalysis" after neck lift (PMID 37186556).
- 45 synkinesis patients with nerve mapping: 95.5% of branches to depressor labii inferioris were cervical; isolated marginal mandibular neurectomy did not worsen lower lip position (PMID 41568933).
- 20 hemiheads: cervical branch runs under the investing deep cervical fascia after leaving the parotid, then in areolar tissue to the platysma; 2 branches in 18 of 20 (PMID 38748536).
Platysmaplasty techniques
- Corset platysmaplasty: continuous midline suture down and up the neck, 75 patients (PMID 2304983).
- Platysma suspension to Loré's fascia near the earlobe, 30 patients (PMID 16651976).
- Complete transection with midline approximation, 150 patients: at 1 year 55% had no band recurrence and 52% no anterior skin excess (PMID 27307341).
- Total platysma transection, 80 patients, 5-year follow-up, no band recurrence (PMID 37737877).
- Denervation neck lift (transection with intentional denervation), 80 patients: band recurrence 10% at 1 year, all over 63 years (PMID 40456286).
- Complete platysma suspension in deep-plane facelift with vertical midline platysmaplasty and low cervical release (PMID 39212629).
- Mastoid crevasse fixation in 79 deep-plane patients increased gonial depth by a mean 8.1 mm over standard mastoid suspension (PMID 37767973).
- Pooled analysis, 12 studies, 2,106 patients with platysma transection: band recurrence 1.4%, nerve damage 0.9%, hematoma 1.8%, sialoma 0.3% (PMID 39406360).
Submental-only approach
- Anterior-only neck lift (platysmaplasty plus submental lipectomy), 33 patients: 61% improved one grade, 36% two grades (PMID 15861088).
- Anterior approach long-term, 27 patients: mean 3.6-year reduction in apparent age at 24.7 months (PMID 32436583).
Revision neck lift
- Systematic review, 5 series, 188 revisions: recurrent bands, persistent submental fullness and gland ptosis were the main indications; outcomes mostly surgeon-reported (PMID 41673281).
Glossary
- Platysma: thin neck muscle under the skin that forms the neck bands (PMID 7433553).
- Subplatysmal fat: fat deep to the platysma in the central neck (PMID 33543747).
- Deep cervicoplasty / deep neck lift: neck lift that reduces subplatysmal structures (PMID 39652837).
- Submandibular gland (SMG): salivary gland under the jaw; partial reduction removes the part below the mandibular border (PMID 12973234).
- Sialocele / sialoma: saliva collection after gland surgery (PMID 25989302).
- Anterior digastric: paired muscle bellies under the chin; excised or plicated in neck lifts (PMID 9145126).
- Corset platysmaplasty: midline platysma suturing along the full neck (PMID 2304983).
- Marginal mandibular / cervical branch: facial nerve branches that move the lower lip; injury causes lower lip weakness (PMID 37186556).
- LigaSure: bipolar vessel-sealing device (PMID 38546581).
- Carina technique: O'Daniel's seven-step gland reduction (PMID 42759497).
Papers
| PMID | First author | Year | Journal | Title | Finding |
|---|---|---|---|---|---|
| 42759497 | O'Daniel TG | 2026 | Aesthet Surg J | Safe Submandibular Gland Reduction in 7 Steps: The Carina Technique. | Carina technique: 922 gland reductions, no sialocele, no hematoma |
| 33543747 | O'Daniel TG | 2021 | Aesthet Surg J | Optimizing Outcomes in Neck Lift Surgery. | 152 necks: 22.3 cm3 removed, 73% subplatysmal |
| 30268237 | O'Daniel TG | 2018 | Clin Plast Surg | Understanding Deep Neck Anatomy and Its Clinical Relevance. | Deep central neck anatomy for neck lift |
| 37186556 | Minelli L | 2023 | Aesthet Surg J | The Functional Anatomy and Innervation of the Platysma is Segmental: Implications for Lower Lip Dysfunction, Recurrent Platysmal Bands, and Surgical Rejuvenation. | Platysma is segmental; cervical branches supply submandibular platysma |
| 40712094 | O'Daniel TG | 2026 | Aesthet Surg J | Neck Lift After Nonsurgical Treatments: Fibrosis, Fat Loss, and Surgical Complexity. | Prior nonsurgical neck treatment: fibrosis in secondary neck lift |
| 7443846 | Ellenbogen R | 1980 | Plast Reconstr Surg | Visual criteria for success in restoring the youthful neck. | Visual criteria for the youthful neck (landmark) |
| 36563673 | Marten T | 2022 | Facial Plast Surg | Deep Neck Lift: Defining Anatomical Problems and Choosing Appropriate Treatment Strategies. | Deep neck problems not corrected by skin/platysma tightening |
| 30268239 | Bravo FG | 2018 | Clin Plast Surg | Reduction Neck Lift: The Importance of the Deep Structures of the Neck to the Successful Neck Lift. | Reduction neck lift: deep structures and parotid classification |
| 39652837 | Chinta SR | 2025 | Ann Plast Surg | Current Trends in Deep Plane Neck Lifting: A Systematic Review. | Systematic review 8,648 patients: gland, digastric, fat most altered |
| 27356946 | Auersvald A | 2017 | Aesthet Surg J | Subplatysmal Necklift: A Retrospective Analysis of 504 Patients. | 504 subplatysmal necklifts: no subplatysmal hematoma |
| 41468305 | Kim S | 2026 | J Craniofac Surg | Preoperative Ultrasound Measurement of Subplatysmal Fat Thickness as a Predictor of Excision Volume in Neck Contouring Surgery: A Quantitative Analysis. | Ultrasound subplatysmal fat thickness predicts excision |
| 9145126 | Connell BF | 1997 | Plast Reconstr Surg | The significance of digastric muscle contouring for rejuvenation of the submental area of the face. | Digastric tangential excision, 21 patients (landmark) |
| 41283798 | Gray AJ | 2026 | Facial Plast Surg Aesthet Med | Patient-Reported Outcomes of Anterior Digastric Myectomy in Deep Plane Facelift and Neck Lift Surgery. | Digastric myectomy: less tightness, fewer revisions |
| 12973234 | Singer DP | 2003 | Plast Reconstr Surg | Submandibular gland I: an anatomic evaluation and surgical approach to submandibular gland resection for facial rejuvenation. | Cadaver anatomy for partial gland resection (landmark) |
| 18766063 | Guyuron B | 2008 | Plast Reconstr Surg | Basket submandibular gland suspension. | Basket gland suspension, 10 patients (landmark) |
| 25989302 | Mendelson BC | 2015 | Plast Reconstr Surg | Submandibular Gland Reduction in Aesthetic Surgery of the Neck: Review of 112 Consecutive Cases. | 112 gland reductions: 1.8% reoperation for hematoma (landmark) |
| 30268240 | Auersvald A | 2018 | Clin Plast Surg | Management of the Submandibular Gland in Neck Lifts: Indications, Techniques, Pearls, and Pitfalls. | Partial gland resection technique |
| 31970454 | Benslimane F | 2020 | Aesthetic Plast Surg | Partial Removal of the Submaxillary Gland for Aesthetic Indications: A Systematic Review and Critical Analysis of the Evidence. | Systematic review 1,200 partial resections |
| 38546581 | Basaran K | 2025 | Plast Reconstr Surg | LigaSure-Assisted Submandibular Gland Excision in Deep-Plane Neck Lift: Review of 83 Patients. | LigaSure gland excision, 83 patients, no hematoma |
| 42022460 | Afrooz PN | 2026 | Aesthet Surg J Open Forum | Partial Submandibular Gland Resection in Deep Neck Surgery: An Assessment of Safety Using the LigaSure Exact Dissector. | LigaSure Exact, 80 patients, minor hematoma 1.25% |
| 42695798 | Lee I | 2026 | Plast Reconstr Surg | Submandibular Gland Resection in East Asian Patients: An Anatomical and Clinical Series of 240 Cases. | 240 East Asian partial resections, hematoma 1.3% |
| 42137253 | Lee I | 2026 | Aesthet Surg J Open Forum | Safety Profile of Submandibular Gland Reduction and Parotid-Tail Minimal Shaving in Deep Neck Lifting: A 341-Patient East Asian Series. | 341 East Asian deep necks, no permanent nerve injury |
| 41092483 | Shauly O | 2026 | Aesthet Surg J | Submandibular Gland Reduction in the Modern Necklift Surgery: A Systematic Literature Review. | Systematic review 2,971 gland reductions, 15.1% complications |
| 7433553 | de Castro CC | 1980 | Plast Reconstr Surg | The anatomy of the platysma muscle. | Platysma decussation patterns in 50 cadavers (landmark) |
| 41568933 | Har-Shai L | 2026 | Plast Reconstr Surg | Muscles of the Lower Lip: Functional Anatomy, Innervation Patterns, and Nerve Injury Prevention. | Depressor labii inferioris mostly cervical-branch innervated |
| 38748536 | Cakmak O | 2024 | Aesthet Surg J | Anatomical Insights on the Cervical Nerve for Contemporary Face and Neck Lifting: A Cadaveric Study. | Cervical branch course relative to deep cervical fascia |
| 2304983 | Feldman JJ | 1990 | Plast Reconstr Surg | Corset platysmaplasty. | Corset platysmaplasty, 75 patients (landmark) |
| 16651976 | Labbé D | 2006 | Plast Reconstr Surg | Platysma suspension and platysmaplasty during neck lift: anatomical study and analysis of 30 cases. | Platysma suspension to Loré's fascia, 30 patients (landmark) |
| 27307341 | Pelle-Ceravolo M | 2016 | Plast Reconstr Surg | Complete Platysma Transection in Neck Rejuvenation: A Critical Appraisal. | Complete transection: 55% band-free at 1 year |
| 37737877 | Meningaud JP | 2024 | Aesthetic Plast Surg | Facelift: Assessment of Total Platysma Muscle Transection to Prevent the Recurrence of Platysmal Bands. | Total transection, 80 patients, no recurrence at 5 years |
| 40456286 | Criollo-Lamilla G | 2026 | Facial Plast Surg | Denervation Neck Lift: An Updated Rhytidectomy Technique and Prospective Follow-Up of 80 Patients. | Denervation neck lift: 10% band recurrence |
| 39212629 | Timberlake AT | 2025 | Plast Reconstr Surg | Complete Platysma Muscle Suspension in Deep-Plane Face-Lift Surgery. | Complete platysma suspension in deep-plane facelift |
| 37767973 | Talei B | 2024 | Aesthet Surg J | The Mastoid Crevasse and 3-Dimensional Considerations in Deep Plane Neck Lifting. | Mastoid crevasse: +8.1 mm gonial depth |
| 39406360 | Cambiaso-Daniel J | 2025 | Facial Plast Surg | Neck Lift to Treat Platysma Bands and Defining Cervical Angle: A Systematic Review and Pooled Analysis. | Pooled 2,106 transections: band recurrence 1.4% |
| 15861088 | Zins JE | 2005 | Plast Reconstr Surg | The "anterior-only" approach to neck rejuvenation: an alternative to face lift surgery. | Anterior-only neck lift, 33 patients (landmark) |
| 32436583 | Kochuba AL | 2021 | Aesthet Surg J | Anterior Approach to the Neck: Long-Term Follow-Up. | Anterior approach long-term: 3.6 years younger |
| 41673281 | Şibar S | 2026 | Aesthetic Plast Surg | Revision Neck Lift Surgery: A Systematic Review of Indications, Techniques, and Outcomes. | Revision neck lift systematic review, 188 cases |
Open questions / controversies
- Gland reduction nerve risk: 9.8% marginal mandibular injury pooled across 6 approaches (PMID 41092483) against lower rates in single-surgeon series (PMID 42759497, PMID 42137253).
- Transection against suspension for bands: recurrence ranges from 0% (PMID 37737877) to 45% at 1 year (PMID 27307341).
- Segmental innervation and targeted denervation as a band strategy (PMID 37186556, PMID 40456286).
- Outcome reporting: objective outcome measures in 12% of deep neck studies (PMID 39652837).
- Deep neck surgery in patients with prior nonsurgical neck treatment: fibrosis and contour irregularity (PMID 40712094).