Scientific Forum
The Male Neck and T-Z-plasty: 28
Years Later
Thomas M. Biggs, MD; and R. Lee Steely, MD
Background: Many men seek treatment for excess submental tissue—the so-called
“turkey gobbler” deformity. However, these patients are frequently unwilling to undergo the definitive treatment, a rhytidectomy and platysmaplasty with submental
lipectomy.
Objective: The purpose of this article is to present an update on an alternative treatment,
originally reported in 1971, called the T-Z-plasty.
Methods: The procedure, which is performed with the patient under local anesthesia,
entails excision of excess fat and skin, tightening of the platysma, a Z-plasty to prevent
contracture, and wound closure with excision of redundant skin.
Results: In a series of more than 100 patients, the results have been consistently superior
with extremely low morbidity. There was 1 postoperative hematoma requiring exploration and, in the same patient, a subsequent seroma requiring multiple aspirations. In
addition, 2 patients required scar revision.
Conclusions: The T-Z-plasty is a simple outpatient procedure with consistently low
morbidity and high rates of patient satisfaction. Although the procedure does not offer
the same result as the definitive treatment, rhytidectomy and platysmaplasty, it is a reasonable compromise that directly and effectively addresses the primary complaint.
M
any men consult with plastic surgeons complaining about excess submental tissue—the so-called “turkey gobbler” deformity. However, many of these
patients are unwilling to undergo the definitive treatment for this condition, a
rhytidectomy and platysmaplasty with submental lipectomy. In 1971, we reported on an
alternative treatment for these patients,1 and like most procedures, it has undergone
modifications to improve the final result. This article will present the modifications from
the original T-Z-plasty, an operation that is a compromise, but one that has yielded
excellent results with a high rate of patient satisfaction. It is a short, simple operation,
easily performed with the patient under local anesthesia, that entails an elliptic excision
of excess skin and fat, closure of the platysma with a Z-plasty or other form of transverse tightening, Z-plasty to the skin prevent contracture and to further accentuate the
angle of the neck, and an occasional transverse incision of a modest amount of redundant skin just above the thyroid cartilage.
The “turkey gobbler” is a problem involving not only skin but also fat and muscle. Excess
submental fat with lax or diverging platysmal bands must be corrected and excess skin
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Drs. Biggs and Steely are in private
practice in Houston, TX.
Accepted for publication October
13, 1999.
Reprint requests: Thomas M.
Biggs, MD, 1315 St. Joseph
Parkway, Houston, TX 77002.
Copyright © 2000 by The American
Society for Aesthetic Plastic
Surgery, Inc.
1084-0761/2000/$12.00 + 0
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Figure 1. Diagram shows how to determine the amount of tissue laxity
for excision.
Figure 2. Diagram shows preoperative markings above the level of the
thyroid cartilage.
A
B
C
Figure 3. Diagram demonstrates elevation of the platysmal leaves.
Figure 4. Diagrams demonstrate methods of tightening the platysmal
leaves. A, Simple imbrication. B, “Vest-over-pants” technique. C, Zplasty of the muscle.
Figure 5. Diagram shows primary closure with dog-ear deformities at
the poles of the wound.
Figure 6. Diagram demonstrates Z-plasty closure of the wound with
excision of dog-ear deformities.
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A
B
C
E
F
G
D
Figure 7. A, C, and E, Preoperative views of a 56-year-old man. B, D, F, and G, Postoperative views shown 1 year after T-Z plasty.
removed to produce optimal results. Skin redundancy is
primarily a problem in the transverse vector, and vertical
laxity is of secondary importance. Correction of only 1 of
the 3 factors will not yield a satisfactory result; all 3 must
be remedied in order to effect the best outcome.
Surgical Technique
The patient is marked while fully awake in an upright
position (Figure 1). A point is established just cephalad to
the thyroid cartilage with another just below the submental fold. The lateral boundaries of the excision are delineated by pinching the excess tissue; the boundaries should be
relatively conservative to allow for the subsequent Z-plasty. It is vitally important to keep the excision above the
level of the thyroid cartilage to avoid migration of the neck
skin with assumption of the upright position; such migration would yield an unsightly scar. This placement of the
incision creates a wound that is hidden by the chin during
everyday activities. The vertical ellipse is created within the
transverse confines of the redundant tissue, the vertical
The Male Neck and T-Z-plasty: 28 Years Later
AESTHETIC
component staying above the thyroid cartilage (Figure 2).
Generally, the ellipse is wider inferiorly because there is a
larger amount of redundant skin at that point.
Local anesthesia (lidocaine 0.5% with 1:200,000 epinephrine) is infiltrated, and the ellipse of skin and subcutaneous tissue is excised above the level of the platysma.
Excess submental fat is excised, and the leaves of the
platysma are elevated slightly (Figure 3). These leaves may
be joined by one of a variety of methods depending on the
amount of laxity present. We have used simple imbrication, a “vest-over-pants” technique, and a Z-plasty of the
muscle and obtained good results in all cases (Figure 4). In
recent years, we have used the Z-plasty with increasing
frequency but have made the arms of the Z considerably
larger to minimize platysmal banding. After the leaves of
the platysma are joined, the skin is brought together vertically. This may result in a dog-ear deformity at the level
of the hyoid bone and sometimes at both poles of the incision. These are corrected with a small transverse skin
ellipse (Figure 5). Finally, a Z-plasty is designed in the
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midportion of the wound, taking great care not to create
the Z too low over the thyroid cartilage. The flaps are
transposed, and the wound is closed with interrupted
Vicryl sutures (ETHICON, Inc., Somerville, NJ) and
nylon sutures (Figure 6).
Results
A
In our series of more than 100 patients, the results have
been superior (Figures 7 and 8), with patient satisfaction
near 100% and almost no morbidity. There was 1 postoperative hematoma that required exploration, and the
same patient subsequently developed a seroma that
required multiple aspirations. In addition, 2 patients
required scar revisions.
B
We do not recommend performing this procedure on
women because the scar from the thyroid cartilage to the
submental position is more prominent in women than it
is in men.
Summary
C
To date, this office has performed the T-Z-plasty on
more than 100 patients, resulting in an overwhelmingly
high patient satisfaction rate. The youngest patient on
whom the procedure was performed was 40 years old.
To our knowledge, none of these patients has subsequently gone on to have a formal rhytidectomy. The T-Zplasty of the male neck is a procedure that should be
considered a compromise in comparison with the
rhytidectomy with platysmaplasty, but it is a reasonable
compromise. The procedure directly addresses the primary complaint, carries almost no morbidity, produces very
high patient satisfaction, and yields a scar that is virtually
imperceptible to others in everyday situations.
D
Reference
1. Cronin TD, Biggs TM. The T-Z-plasty for the male “turkey gobbler” neck.
Plast Reconstr Surg 1971;47:534-538.
E
Figure 8. A and C, Preoperative views of a 53-year-old man. B, D, and
E, Postoperative views shown 2 years after T-Z plasty.
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