return to: Cosmetic Facial Surgery

Note: last updated before 2013

GENERAL CONSIDERATIONS

1. Dedo diagnosis and classification of the aging neck (Dedo 1980)

   1. Class I - neck is an essentially normal younger patient with a well defined mental angle, little fat, and good skin and platysma tone.

   2. Class II - patients show laxity of the cervical skin without significant fat deposition or muscle pathology. The skin must be redraped so wide undermining is required but a submental incision is usually not needed. A standard rhytidectomy with plication of the SMAS-platysma complex is usually all that is required.

   3. Class III - patients have a pathologic layer of subcutaneous fat, which is either genetic or acquired and liposuction is usually required to improve the cervical contour.

   4. Class IV - patients have varying degrees of platysma pathology, which must be diagnosed by voluntary facial grimacing preoperatively. This is usually evident as anterior cervical cording, but it may be difficult to asses the platysma due to fat accumulation. These patients require some form of surgical manipulation of the platysma.

   5. Class V - patients have retrognathia that contributes to their neck pathology and may require chin augmentation or mandibular osteotomies.

   6. Class VI - patients have an abnormal hyoid position. The hyoid is either too low or the mandible-to-hyoid distance is too low, limiting the effect of submental surgery. Patients with abnormally low hyoids (normal is at C4) need to be counseled preoperatively because there are currently no effective procedures to elevate the hyoid and their surgical results will likely be less than optimal.

REFERENCES

Dedo DD. "How I do it"--plastic surgery. Practical suggestions on facial plastic surgery. A preoperative classification of the neck for cervicofacial rhytidectomy. Laryngoscope. 1980;90(11 Pt 1):1894-1896. doi:10.1288/00005537-198011000-00020