Deep Neck Contouring through the Ages.

Deep neck contouring can achieve dramatic results in young and old patients. Both genetic predisposition and aging contribute to the malposition of deep neck structures and a poorly contoured neckline. Depending on the patient's anatomy, deep neck contouring should involve a combination of submental liposuction, platysmaplasty, subplatysmal fat lipectomy, resection of the anterior belly of the digastric muscle, and either cautery or resection of the submandibular glands. Resorption of the facial bony skeleton that occurs with aging affects the ultimate postoperative mandibular contour, and postoperative results thus differ in the young versus old patient. In patients in which there is concern for excess skin laxity, a concurrent facelift is necessary to excise excess neck skin. This article includes a discussion on how a combination of aging and genetics influence a patient's neck anatomy, critical preoperative considerations prior to performing deep neck contouring, intraoperative technique, and adjunct procedures that can further improve a patient's neckline.

Needs Assessment of Gender-Affirming Face, Neck, and Voice Procedures and the Role of Gender Dysphoria.

OBJECTIVE: To assess the needs of transgender and nonbinary (TNB) adults for gender-affirming face, neck, and voice procedures. STUDY DESIGN: Cross-sectional survey. SETTING: Online, February to May 2022. METHODS: Primary outcomes included utilization of otolaryngologists and speech-language pathologists; gender dysphoria felt from the face, neck, and voice self-reported on a 0 to 10 numeric rating scale (0 = no dysphoria, 10 = unbearable); and desire for various gender-affirming face, neck, and voice procedures. We used ordinal logistic and linear regression to assess relationships between site-specific dysphoria and the desire for relevant procedures. RESULTS: TNB participants (N = 234) infrequently sought gender-affirming care with speech-language pathologists (23%), facial plastic surgeons (8%), or laryngologists (3%). Participants experienced the strongest dysphoria from the voice (median 7/10), jawline/chin (4/10), and neck (3.5/10). Transmasculine and nonbinary participants typically seeking masculinization (n = 83) frequently desired voice therapy (want = 35%, had = 8%). Transfeminine and nonbinary participants typically seeking feminization (n = 145) frequently desired voice therapy (want = 52%, had = 23%), chondrolaryngoplasty (want = 45%, had = 5%), and hair removal/electrolysis (want = 43%, had = 44%). Many desired at least 1 facial feminization surgery procedure (65%), especially mandible reduction (want = 42%, had = 3%), rhinoplasty (want = 41%, had = 1%), and forehead reduction (want = 37%, had = 4%). Dysphoria ratings were associated with desiring relevant procedures (p < .05 for all), notably voice therapy (odds ratio [OR] = 1.50), chondrolaryngoplasty (OR = 1.46), mandible reduction (OR = 1.38), rhinoplasty (OR = 1.59), and forehead reduction (OR = 1.82). CONCLUSION: Gender dysphoria from the face, neck, and voice can be severe for TNB people and is associated with the desire for gender-affirming procedures. The high demand yet low reported access to these procedures highlights the need for providers of gender-affirming face, neck, and voice care.