Improving surgery on the aging neck with an adjustable expanded polytetrafluoroethylene cervical sling.

OBJECTIVES To evaluate the ability of the expanded polytetrafluoroethylene (ePTFE) cervical sling to improve results of surgery on the aging neck in the short term as well as its ability to achieve long-term cosmesis through its secondary adjustability. DESIGN A retrospective analysis. SETTING A private facial plastic surgery practice. Patients The first 100 consecutive patients who underwent placement of the ePTFE cervical sling with a minimum follow-up of 36 months. Intervention Placement of a preplatysmal, mastoid-to-mastoid, ePTFE cervical sling sutured to the fascia overlying the insertion of the sternocleidomastoid bilaterally in conjunction with a graded surgical approach appropriate for each patient. This included lipoplasty, midline platysmal plication, and rhytidectomy. OUTCOME MEASURES Aesthetic appearance of the neck was evaluated by comparison of preoperative and postoperative photographs at 1 year. Appraisal of secondary adjustability was similarly assessed 1 month after sling tightening. Patient satisfaction was recorded via self-assessment of both procedures for cosmesis and comfort. Complications specific to sling placement and tightening were reviewed. RESULTS One year after initial surgery, 85 patients had significant or marked improvement. More than 90% of patients felt that the procedure met or exceeded their cosmetic expectations, while 99 patients felt no residual discomfort. Secondary to rebound tissue relaxation, 9 of 100 patients required sling tightening a mean interval of 14 months after primary surgery. All 9 of these had either a significant or marked improvement, with similarly high patient satisfaction in cosmesis (n = 9; 100%) and comfort (n = 8; 89%). Two patients had postauricular infections necessitating sling removal. There were no complications with sling tightening. CONCLUSIONS Placement of the ePTFE cervical sling is a safe and effective procedure to aesthetically improve short-term surgical results on the aging neck. By virtue of its secondary adjustability, it offers a safe, long-term solution to rebound tissue relaxation and associated submental laxity.