Lateral Deep Neck Contouring: An Anatomy-Driven Approach for Cervicomental Definition Without Routine Submental Incision

Abstract Background Achieving a well-defined cervicomental angle remains a central challenge in facial rejuvenation surgery. Traditional deep neck contouring frequently relies on submental access to address midline structures, which may increase morbidity and the risk of visible scarring. A lateral-first approach utilizing deep cervical fascial suspension may offer an effective alternative strategy in appropriately selected patients. Objectives To describe the surgical technique, patient selection criteria, and clinical outcomes of lateral deep neck contouring performed in conjunction with facial rejuvenation surgery. Methods A prospective case series of patients who underwent facial rejuvenation surgery—comprising standard deep-plane face and neck lift or limited-scar retroauricular lower face and neck lift—with adjunctive lateral deep neck contouring between January 2022 and January 2025 was analyzed. The technique emphasized subplatysmal dissection through lateral access, deep cervical fascial suspension using mandibular periosteal anchoring, and selective submandibular gland management when indicated. Results Eighty-three patients (64 females and 19 males) were included; 60 underwent standard deep-plane face and neck lift and 23 underwent limited-scar retroauricular lower face and neck lift. The mean patient age was 44.8 years (range, 26–69 years), with a mean follow-up of 28 months (range, 12–36 months). All patients demonstrated clinically appreciable improvements in cervicomental contour and mandibular definition. Lateral contouring was successfully completed in all cases without conversion to wide submental dissection. Selective submandibular gland reduction was performed in 21 patients (25.3%) without gland-related complications. No major complications, including hematoma requiring surgical evacuation, permanent nerve injury, or revision surgery, were observed. Minor complications were transient and resolved with conservative management. Contour stability was maintained throughout the follow-up period. Conclusions Lateral deep neck contouring represents a safe and effective anatomy-driven approach for cervical rejuvenation in appropriately selected patients. By leveraging deep cervical fascial suspension through lateral access, this technique may reduce the need for routine submental intervention while achieving stable and reproducible cervicomental contour improvements. Further comparative studies with objective outcome measures are warranted.