Redefining Neck Rejuvenation: The Novel Hyoid-to-Mastoid Crevasse Neo-Ligament and OnderKaak Angle in Deep Plane Neck Lift.

[BACKGROUND] Neck rejuvenation has evolved from superficial skin tightening to deeper structural modifications targeting the platysma, submental and subplatysmal fat, and the submandibular gland (SMG). Significant controversy surrounds the surgical maneuvers necessary to achieve the ideal neck.

[OBJECTIVES] The objective is to introduce the Hyoid-to-Mastoid Crevasse (HMC) neo-ligament for neck rejuvenation that elevates the SMG via a suture secured from the hyoid periosteum to the mastoid crevasse. Moreover, we introduce the OnderKaak (OK) angle, representing the region overlying the submandibular gland, best appreciated from the posterior oblique view, also known as the reverse ogee view.

[METHODS] Patients who underwent deep plane facelift and neck lift with HMC neo-ligament performed between January 2024 and October 2024 were included. Cervicomental (CMA), gonial (GA), and OK angle measurements were recorded pre and postoperatively. Patients were divided into two cohorts: without SMG resection ("no-SMG resection") and with SMG resection ("SMG resection").

[RESULTS] A total of 25 patients were included. Fifteen patients (60%) underwent partial SMG resection, and 10 (40%) did not. Both groups demonstrated significant improvement in cervicomental, gonial, and OK angles (all < .05). There was no difference in the mean change of CMA, GA, and OK angles between both groups (all > .05).

[CONCLUSIONS] The HMC neo-ligament can be used to achieve improved neck aesthetics, thus offering a new technique for neck lift surgery. This technique may be used with and without submandibular gland resection. We also introduce the novel OnderKaak angle to better characterize the improved contours delivered by the HMC neo-ligament.