title: Triple suture for neck contouring: 14 years of experience.
abstract: BACKGROUND
  Preferred techniques for rejuvenation and contouring of the neck region have evolved over the past 40 years. A slender neckline is recognized as an attractive feature of youth, whereas aging of the lower face often includes ptosis of the soft tissues of the chin and banding or cording of the muscles of the anterior and lateral neck. Aesthetic rejuvenation of the face and neck involves repositioning of poorly supported soft tissues.
  
  
  OBJECTIVE
  The authors review their 14-year experience with a technique incorporating standard submental liposuction with a method of triple suturing the medial platysmal bands associated with lateral plication of the superficial muscular aponeurotic system (SMAS)-platysma.
  
  
  METHODS
  Between 1994 and 2008, 507 patients (451 women and 56 men) were treated with this technique which consisted of placing a first line of sutures distributing tension between the medial platysmal bands and the anterior belly of the digastric muscles, a second single suture at the distal medial borders of the platysma, and a third running suture starting at the level of the thyroid cartilage up to the supramental region. In most cases, a lateral plication of the SMAS-platysma and a "stair-like" SMAS plication were performed in order to define the cervicomandibular line and treat midface flaccidity, respectively.
  
  
  RESULTS
  Mean follow-up was eight years. Complications included hematomas (4.6%) and seromas (3.6%). Four percent of patients underwent a second procedure approximately seven years after their primary procedure. Overall the majority of patients exhibited long-lasting results satisfactory to both patients and surgeons.
  
  
  CONCLUSIONS
  The triple-suture technique for neck contouring creates a median vertical vector of traction, whereas lateral plication produces a lateral posterior oblique vector. The combination of these two procedures is an easily reproducible and reliable option for surgeons when patients are seeking a more youthful appearance of the neck.
authors.affiliation: Department of Plastic Surgery, Ivo Pitanguy Institute, Rua Dona Mariana #65, Botafogo, Rio de Janeiro, Brazil.
authors.forename: Enzo Rivera
authors.initials: ER
authors.lastname: Citarella
authors.forename: Alexandra
authors.initials: A
authors.lastname: Condé-Green
authors.forename: Ramil
authors.initials: R
authors.lastname: Sinder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044964:Cervicoplasty / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015187:Lipectomy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D015203:Reproducibility of Results; D049291:Seroma / Q000453:epidemiology / Q000209:etiology; D015595:Skin Aging; D013536:Suture Techniques