Second Thoughts
Advantages of W-plasty in the Anterior Neck
“Second Thoughts” focuses on ways in which aesthetic
surgeons have modified or even dramatically changed
their techniques over time to achieve optimal results.
Contributors are Aesthetic Society members and other
recognized experts.
I
solated correction of the hanging neck has remained
a vexing problem in my practice despite substantial
personal experience in facial aesthetic surgery.
Requests for neck correction alone, with no associated
treatment of the face, are usually made by patients who
profoundly fear a traditional face and neck rhytidectomy,
strongly wish to avoid any change in the appearance of
their face, or simply cannot afford a more extensive pro-
A
B
D
cedure. Despite my best
efforts to explain that the
soft tissues of the face and
neck are linked anatomically
and are therefore difficult to
lift separately, these patients
adamantly request correction of the neck alone.
Boyd R. Burkhardt, MD,
For a fatty neck with preTucson, AZ, is a board-certified
dictably good skin elasticiplastic surgeon and an ASAPS
member.
ty, liposuction alone
produces good results.
Patients whose necks have more skin and less fat may
benefit from open lipectomy under direct vision, with
approximation of the anterior platysma margins and supportive neck dressings to
encourage adhesion of the
redundant skin envelope.
For the thin neck with
severely redundant skin,
however, both procedures
have their problems. Even
carefully performed liposuction can leave unsightly
contour irregularities. A
hematoma or seroma following direct excision, even
when promptly drained,
C
can turn into an unsightly,
thickened, and lumpy
fibrous mass that defies surgical correction and must
be left to resolve slowly on
its own.
F
E
Figure 1. A-C, Preoperative views of a 68-year-old man. D-F, Postoperative views 24 months after isolated
neck correction with the W-plasty procedure. The incisional scar is shown at 2 weeks after the procedure.
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For patients who are willing to accept the incisional
scar, many surgeons perform direct anterior sagittal
excision with closure using
1 or more Z-plasties. This
approach is moderately
complex, requires substantial undermining of the
Second Thoughts
flaps, and produces dog-ears at the point of the requisite
90° rotation. I have used this procedure in the past, but I
now believe the W-plasty is a superior technique.
B
A
A W-plasty in the anterior neck has several major advantages over the more traditional Z-plasty. Undermining is
minimal with the W-plasty approach, reducing the probability of tip necrosis as well as potential dead space for a
hematoma. Contour irregularities are reduced because
the flaps do not need to be transposed. The anterior margins of the platysma are well exposed and easily approximated. Surgery is short in duration and can be easily
performed with local anesthesia.
Planning is important, as is the case with any procedure
requiring interposition of wound margins. The best
approach is to first estimate and outline the amount of
skin to be removed, using finger and thumb approximation. Only after the limits of the proposed vertical ellipse
are drawn should the W-plasty be designed around it
(Figure 1, C).
Although clearly a surgical compromise, W-plasty excision of the anterior neck yields satisfactory results for
patients willing to accept the anterior neck incisional scar
in lieu of having a more extensive procedure performed.
D
C
Weeding out unsatisfactory candidates for a W-plasty is
best performed by showing them photographs of other
patients’ scars. Although women are less likely than men
to accept the scars from a W-plasty procedure, patients of
both genders who decide to proceed have been consistently pleased with the results (Figure 2) ■
Reprint orders: Mosby, Inc, 11830 Westline Industrial Drive, St Louis, MO
63146-3318; phone (314) 453-4350; reprint no. 70/1/105384
doi:10.1067/maj.2000.105384
E
Figure 2. A-B, Preoperative view
of a 76-year-old woman. C-E,
Postoperative views 5 months
after a W-plasty procedure; the
incisional scar is shown.
Advantages of W-plasty in the Anterior Neck
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