Why I Open the Neck: Counterpoint.

Durable neck rejuvenation often requires direct management of subplatysmal anatomy rather than reliance on platysmal tightening. Effective deep neck surgery requires commitment to address all relevant structures with a comprehensive understanding of the anatomy. When appropriately performed, complication rates are much lower than perceived. Through clinical experience, anatomic studies, and revision outcomes, excess deep cervical volume, particularly from the submandibular glands, is the primary driver of recurrent neck deformity. An algorithmic, sequential approach to deep neck management is presented, highlighting submandibular gland reduction as foundational to achieving stable, long-term cervicomental contour.