Modified Tuckster Suture Technique: Safe, Reliable, Reproducible and Teachable

Goals/Purpose: Neck lifting is one of the most common aesthetic procedures in the United States. Patients seek to improve visible signs of aging such as wrinkles, excessive skin, jowls and fat deposition for a smoother, firmer and more youthful appearance. Neck lift techniques have evolved since first performed in the early 20^th century. We present our Modified Tuckster musculofascial suture technique and provide a critical evaluation of postoperative results and complications.

Methods/Technique: The senior authors performed 300 consecutive neck lift procedures from January 2013 to September 2022 using the Modified Tuckster suture technique.

In our practice, we perform a facelift with a neck lift. We start the procedure with a midline submental incision to directly excise pre-platysmal and subplatysmal fat, eliminate platysma bands and perform a platsymaplasty. Once the full extent of undermining and platysmaplsaty has been performed, we proceed with lateral dissection. We make a retrotragal incision that extends superiorly into the scalp or around the sideburn and post auricular. Next we elevate the skin flaps connecting with the midline dissection.

The Modified Tuckster technique is an update of Dr. Feldberg’s Tuckster suture. It is a purse strung suture that extends from the mastoid fascia postauricular on a diagonal vector approximately 1cm inferior and parallel to the inferior border of the mandible and ends at the angle of the mandible that effectively “tucks in” deeper structures and laxity in the platysma and inferior SMAS to crease a defined mandibular border. Additional SMAS plication sutures are placed to improve jowls and contour the lower and midface.

Results/Complications: Majority of patients were white non-Hispanic women with a mean age of 64 years old. A total of 14 patients (6.3%) had a least one complication. Hematoma was present in three patients (1.3%) seroma in 8 (3.5%), surgical site infection in two (0.9%) tightness in four patients (1.8%) fat necrosis in one (0.4%) and a nerve paresis in one (0.4%) with complete recovery. Reoperation performed in seven patients- two to retighten the neck, one due to excessive tightness and one for scar revision.

Conclusion: The Modified Tuckster is safe, reliable, reproducible and teachable. The suture technique improves neck contour and creates a sharper and more defined profile which has a significant impact on a person’s overall appearance. Complication rate is low, and can be performed in concomitant with additional facial rejuvenation procedures including face lift and chin augmentation.