D43. The Over-tightened Neck: Causes, Complications, and Management

PURPOSE: The over-tightened neck following necklift procedures is a clinical problem that has received little attention in plastic surgical literature. Possibly, plastic surgeons are either reluctant to discuss it or see few cases. Also, an overtightened neck reflects both the subjective and objective opinions of the patient along with objective clinical findings. METHODS: A retrospective review of 250 consecutive necklift procedures from 2013 to 2020 was performed, of whom 211 (84%) had a submental crease incision with anterior neck tightening of platysmal bands combined with a lateral neck plication. Follow-up continued was at least one year. RESULTS: A total of five patients (2%) presented with complaints of an over-tightened neck that caused pain (5) and difficulty swallowing, interference with speech (1), dyspnea (1), and fat necrosis (1). Three patients had anatomical evidence of a long neck that measured 11cm. Three patients complained throughout and at the end of the first year. Two other patients who had a necklift elsewhere which included anterior platysmaplasty were referred for evaluation. Their procedures has been performed one and one and a half years previously. All five patients were evaluated by neck CT (3) and neck MRI (2). Two patients had videofluroscopy and barium swallow studies that were negative. CONCLUSION: The overtightened neck is an uncommon postoperative sequel to a necklift procedure that may be difficult to assess because of its subjective nature. It can, however, be associated with severe symptoms requiring recognition and appropriate diagnostic work-up.