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Timothy J. Marten, Joel J. Feldman, Bruce F. Connell, William J. Little, Treatment of the Full Obtuse Neck, Aesthetic Surgery Journal, Volume 25, Issue 4, July 2005, Pages 387–397, https://doi.org/10.1016/j.asj.2005.04.005
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Dr. Marten: The full, obtuse neck is an interesting and perplexing problem that aesthetic surgeons frequently encounter. The first patient is a 28-year-old woman with longstanding neck fullness and no prior surgeries (Figure 1). Dr. Feldman, what anatomic abnormalities underlie the appearance of this woman's neck, and what treatment options would you offer?
Dr. Feldman: In addition to her obtuse neck angle, this patient appears to have a small chin, poor definition of her jawline, and either an enlarged or malpositioned submandibular salivary gland. I cannot tell much about the subplatysmal tissues just by looking at the photos. Although I feel every neck carefully, I really don't decide what needs to be done underneath the platysma until surgery, when I proceed step-by-step, peeling away one layer after another, systematically examining each layer as I get to it, and only then determining what needs to be done. I suspect that this patient would need to have some subplatysmal fat removed after she has had a subcutaneous lipectomy. Once that was accomplished, I would inspect the suprahyoid or perihyoid fascia to see if it needed to be released.
