Deep Plane Face & Neck Lift with Deep Neck Reduction

Deep Plane Face & Neck Lift with Deep Neck Reduction — Surgical Case Study

Overview

This case describes a 51-year-old male patient with a longstanding constitutional pattern of submental and submandibular fullness and an obtuse cervicomental angle — the same combination of features present in his father and other first-degree male relatives, and present since early adulthood rather than acquired with age. Layered over that pattern were changes consistent with his age, including prominent nasolabial folds and moderate jowling overlying the mandibular border. Bilateral upper eyelid dermatochalasis had also developed over recent years, encroaching on his superior visual field and most noticeable in low light and while driving at night.

The operative objectives were correction of the submental and submandibular fullness at its anatomical source, repositioning of the descended facial soft tissues, placement of structural volume along the mandibular border and midface, and excision of the redundant upper eyelid skin encroaching on the visual field.

Preoperative assessment & clinical findings

Clinical evaluation identified the following features, reflecting both a longstanding constitutional pattern of neck and jawline morphology and changes consistent with his age:

Periorbital region

• Bilateral upper eyelid dermatochalasis (excess upper eyelid skin) with hooding
• Hooding encroaching on the superior visual field, most noticeable in low light and while driving at night
• Eyebrow position within normal limits, with the excess confined to the upper eyelid itself

Lower face & jawline

• Mandibular border contour present since early adulthood, not attributable to skin laxity
• Prominent nasolabial folds
• Moderate jowling overlying the mandibular border, consistent with age-related change
• Relative soft tissue volume deficiency over the mandibular border and malar region

Neck & cervical region

• Marked submental and submandibular fullness, present since young adulthood
• Prominent, ptotic submandibular glands projecting into the submandibular contour
• Hypertrophic anterior bellies of digastric within the submental triangle
• Substantial subplatysmal fat, not accessible to subcutaneous liposuction
• Obtuse cervicomental angle with reasonable cervical skin quality
• Hereditary pattern, with the same combination of features present in his father and other first-degree relatives

Operative plan & surgical decision-making

The operative plan combined a deep plane face and neck lift, a formal deep neck reduction, and structural autologous fat grafting to the mandibular border and face. Each component acts on a different anatomical layer. The lift addresses soft tissue descent and skin excess, repositioning the face and neck as a connected unit. Deep neck reduction addresses the structures beneath the platysma — the submandibular glands, the anterior bellies of digastric, and the subplatysmal fat — which a lift does not reach. Fat grafting places volume in the regions identified as volume-deficient at assessment.

The distinction between constitutional morphology and age-related change governed the plan. Because the submental and submandibular fullness had been present since early adulthood and lay deep to the platysma, a face and neck lift addressing skin and platysma alone would act on the surface layers while leaving the ptotic submandibular gland, the hypertrophic digastric and the subplatysmal fat pad in place. Deep neck reduction was therefore a necessary component of the operation.

The upper eyelid dermatochalasis was addressed at the same time as a bilateral upper blepharoplasty, on functional grounds — the hooding had begun to encroach on the superior visual field.

Procedure performed

Face & neck lift — deep plane technique

A deep plane face and neck lift was performed bilaterally. The composite flap of skin and SMAS was elevated together and the facial retaining ligaments released, allowing the flap to be repositioned as a single unit along a defined vector rather than by skin tension. The jowling, the nasolabial folds and the mandibular border were addressed together as one repositioned unit.

Deep neck reduction — submandibular gland resection

A partial resection of the submandibular glands was performed bilaterally. Both glands were low-lying and full, projecting directly into the submandibular contour. Reduction of gland volume is not addressed by a standard neck lift and formed part of the deep neck work.

Deep neck reduction — digastric muscle resection

The hypertrophic anterior bellies of the digastric muscles were resected. A prominent digastric belly projects into the submental triangle and acts on the cervicomental angle independently of the skin, platysma and glands.

Deep neck reduction — subplatysmal fat resection

The deep fat pad sitting beneath the platysma was resected under direct vision. This layer sits beyond the reach of subcutaneous liposuction. Together with the gland and digastric work, this completed the deep neck reduction, addressing the glandular, muscular and fat components of the obtuse cervicomental angle.

Autologous fat grafting — mandibular border & face

Fat was harvested, processed and grafted along the mandibular border and face bilaterally, placing structural volume in the regions identified as volume-deficient at preoperative assessment.

Bilateral upper blepharoplasty

Excess upper eyelid skin was excised bilaterally, addressing the hooding that had progressively encroached on the superior visual field.

Results — 6 weeks postoperative

The photographs below were taken at six weeks postoperatively. At this timepoint the change in the submental and submandibular contour reflects the deep neck component of the operation, which acts on structures that skin and platysma surgery do not reach. What any individual patient can expect depends on their own anatomy, the underlying cause of their neck contour and their healing, and can only be assessed in consultation.

Some swelling remains through the face and neck at six weeks. Swelling after deep neck work takes longer to settle than after skin and SMAS surgery alone, and continues to resolve over the following weeks to months. The contour shown is not the settled result.

Recorded at the six-week review:

• Reduction in submental and submandibular fullness following the gland, digastric and subplatysmal fat resection
• A less obtuse cervicomental angle
• Repositioning of the jowl and nasolabial region as part of the deep plane flap
• Volume placed along the mandibular border and malar region by structural fat grafting
• Upper eyelid skin excess excised, with the superior visual field no longer obstructed by the eyelid fold

Recovery

Recovery from combined face and neck lift surgery, deep neck reduction and blepharoplasty follows a general pattern, though it varies between individuals:

• Swelling and bruising are expected through the first one to two weeks and settle gradually over the weeks that follow; at the six-week timepoint shown below, some swelling is still present
• Most people take around two to three weeks away from work and social commitments
• Strenuous activity and exercise are avoided for at least six weeks
• Sutures are removed in stages across the early follow-up appointments, including those from the upper eyelid incisions
• The final result continues to mature over several months

Risks

This is major surgery, performed under general anaesthesia, and it requires a recovery period. All surgery carries risk. The following list is not exhaustive, and the risks relevant to any individual are discussed at consultation:

• Bleeding, haematoma (which may require a return to theatre), infection and delayed wound healing
• Scarring, which is permanent, and which may become thickened, widened or pigmented
• Temporary or permanent injury to branches of the facial nerve, including the marginal mandibular branch, affecting movement of the lower lip
• Altered or reduced sensation over the face, neck and ear, which may be prolonged
• Salivary leak, sialocele or fluid collection following submandibular gland resection
• Injury to the lingual or hypoglossal nerve during deep neck dissection, affecting tongue sensation or movement
• Contour irregularity, asymmetry, or over-correction or under-correction of the neck contour
• With fat grafting: variable graft survival, palpable lumpiness, fat necrosis, cyst formation, and the possibility of further grafting
• With upper blepharoplasty: dry eye, irritation, difficulty closing the eyes fully (lagophthalmos), asymmetry and visible eyelid scarring; rarely, bleeding behind the eye with visual loss
• Anaesthetic risks, venous thromboembolism and general medical complications
• Dissatisfaction with the outcome, and the possibility of revision surgery at additional cost

A GP referral is required before a cosmetic surgery consultation, and a seven-day cooling-off period applies before proceeding with cosmetic surgery. A second opinion is encouraged.

Photographic comparison

Clinical photography: preoperative and 6 weeks postoperative.

Preoperative (left) & 6 weeks postoperative (right), shown in frontal, oblique and lateral views. The photographic backgrounds have been standardised; no alteration has been made to the patient or to the clinical result.

Surgical technique summary

AHPRA compliance notice: This case study is intended for general information purposes only. Individual outcomes vary, as the result experienced by one person does not necessarily reflect the result another person may experience. All surgical procedures carry risks and require a recovery period — further information is available at Risks of Surgery. Results shown are specific to this patient and cannot be guaranteed for others. Surgery should only be considered after thorough consultation with an appropriately qualified Specialist Plastic Surgeon, and a second opinion is encouraged. This content does not constitute medical advice.

Dr David Sparks — Specialist Plastic Surgeon | FRACS (Plast.) | MED0001863770 | The Coastal Clinic, Southport QLD | Fraser-Kirk Plastic Surgery, Sunshine Coast QLD