Hemostatic Net Sutures and Microneedling Aid in Optimal Results in Percutaneous Neck Lift
First described by Popescu in 1985 as intratumoral ligation used treat hemangiomas, the hemostatic net has evolved throughout the years into a technique utilized to prevent hematoma formation and improve neck contours. Postoperative hematomas are one of the most frequent complications following a neck lift and are caused by blood pooling beneath the skin flaps. Whether onset be slow and gradual or rapid, patients experience increased pain and face possible major sequalae. Thus, surgeons have taken preoperative, intraoperative, and postoperative precautions to minimize the risk of postoperative hematoma development. One such technique utilized is the hemostatic net, a running transfixing suture encompassing the skin and the superficial musculoaponeurotic system (SMAS)-platysma. Publications have shown, placement of the hemostatic net immediately post procedure prevents hematoma formation for the first 72 hours. This is believed to occur secondary to several factors including, but not limited to, complete obliteration of dead space, pressure of the skin on the SMAS-platysma, and stability of the flap. As the hemostatic net continues to prove its effectiveness in preventing postoperative hematomas, the percutaneous patients may have puckered and redundant skin after removal. While the benefits achieved from the hemostatic net greatly outweigh this minor complication, patients do seek to improve this appearance. By creating micro injuries to the reticular dermis, microneedling stimulates cellular pathways involved in scarless healing. Thus, it can be insinuated that treatment with microneedling has the potential to soften the puckered skin and create a smoother, more youthful appearance.
Methods/Technique
:Postoperative outcomes of patients who underwent percutaneous neck lift performed by the senior author were reviewed. All procedures had neck liposuction, PrecisionTx SmartLipo, and the MyEllevate technique with a 4-0 ethibond suture placed around the mastoid sling. The hemostatic net consisted of a 4-0 monocryl net placed along the neck. No tissue glue, fibrin sealant, or drains were used. Patient satisfaction and aesthetic outcomes were monitored for 6 months postoperatively. Patients that noted submental puckering after hemostatic net removal were treated with aggressive microneedling to soften the appearance.
Results/Complications
:Twenty-four patients over the course of 1 year were reviewed. There was 1 hematoma and no other complications. Hemostatic net was removed on average at postoperative day 2.56 (range 2-5). Patients with visible submental puckering after removal were treated with 3 rounds of aggressive microneedling with complete resolution. All patients reported improved aesthetic outcomes and were beyond satisfied with their results.
Conclusion
:Postoperative hematomas are the most common complication secondary percutaneous neck lift procedures. The hemostatic net has successfully been proven to prevent the formation of hematoma in the first 72 hours post procedure. However, in patients where postoperative puckering is noted, our study showed that postoperative microneedling leads to a more supple appearance, improving aesthetic outcomes and patient satisfaction.