Facial Rejuvenation: More than a Pretty Face Panel to Address Neck Challenges at ASAPS Annual Meeting

NEW YORK, NY (May 16, 2003) — What signs of aging do people find most disturbing? It may be surprising, but most people don't notice their aging faces as much as their aging necks - the crepey skin, the jaw line that has lost its smooth definition, and the prominent vertical cords. The latest methods for treating the neck to create a harmonious facial appearance will be discussed by leading experts at the Annual Meeting of the American Society for Aesthetic Plastic Surgery (ASAPS). The ASAPS meeting, considered the major international forum for education and research in cosmetic surgery, runs May 16-21 at the Hynes Convention Center in Boston.

In the early days of face lifting, procedures to improve the neck were often done as separate operations. Today, the face and neck are usually treated simultaneously, often in conjunction with lipoplasty (liposuction) to sculpt the area beneath the chin and jaw line. The exception: younger patients who have fatty necks but no significant facial aging may be treated with neck contouring alone.

Things get more difficult as the age of the patient increases, according to panelist Fritz Barton, Jr., MD, past president of ASAPS. "You often can't do just the neck on an older person," he says. The Texas plastic surgeon notes that "it's like shortening one leg on a chair," resulting in an overall facial appearance that's out of balance. He says he tells patients he'd rather they do nothing at all than upset the harmony between face and neck. Dr. Barton notes that men sometimes are satisfied with a modified approach because they may be less concerned with their upper or mid-face than with their "turkey gobbler necks."

The neck is comprised of three layers: skin, fat, and muscle. The platysma muscle, at the deepest layer, is held together with fascia that works something like shrink-wrap. With time, however, the fascia stretches, resulting in separation of the muscle and visible cords running vertically down the neck. The platysma often must be "repaired" or tightened in the center. In addition, something must be done with excess skin.

"Plastic surgeons often see patients who say they are not ready for a facelift, but who want something done to get rid of the 'wattle' under their chin," says panelist and ASAPS president-elect Robert Bernard, MD, of White Plains, NY. "Tightening the muscles of the neck isn't enough; if there is excess skin, it has to be removed. And the only way to do that is with a combination face and neck lift."

ASAPS past president and New York surgeon Sherrell Aston, MD, who will moderate the ASAPS neck panel, notes that the neck is perceived as a difficult area to achieve aesthetically satisfying results. He emphasizes that no two patients are alike, and that each operation must be custom-designed.

Dr. Bernard agrees, but feels that, in reality, "there is no such thing as a 'difficult neck.' There is simply misunderstanding about the right way to achieve the best results." Whatever surgical technique is used, good communication with the patient is essential. "It is important to talk with the patient about the structure of the neck, what can and cannot be improved," he says. "When patients understand the limitations of surgery, as well as the marvelous potential, they are likely to be satisfied with the results."

What about new, short scar techniques for face and neck surgery? "These techniques can be effective for certain patients. But shorter incisions and reduced recovery time may mean less dramatic improvement, especially in the neck area," says Dr. Bernard.

"Plastic surgery needs to be predictable, and new techniques never are," says Dr. Barton. He tells his patients that their face is among their most valuable possessions, and the best approach in facial surgery, as in art, is a classical one. "For art to become classic, it has to stand the test of time," says Dr. Barton. "It's the same with surgical techniques."

According to ASAPS statistics, nearly 125,000 facelifts were performed in 2002.


The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.


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