What Is The Best Method For Webbed Neck Surgery – Lateral Z-Plasties or Posterior Diamond Excision?
Q: Dr. Eppley, I am contacting you in regards to a webbed neck as you can see from the photographs. I have met with a surgeon local to our area and discussed options with him. His recommendations left us a little concerned. He kept mentioning doing a Z-Plasty, and we had already researched and found many examples on your website where you avoid Z-Plasty and scarring on the side of the neck by keeping all scarring on the posterior of the neck. He said he would do his best to hide the Z-Plasty behind the neck and claimed that the approaches you typically use may not work for me although he also noted that the webbing was not very tight.I would really like a second opinion from you.
A :In answer to your webbed neck questions:
1) I do not know what is meant by the Z-plasty location in terms of hiding it. Typically that means the Z-plasties are put along or at the lateral web lines in which there is no hiding it. But it may the Z-plasty is put on the back of the neck. If you really want to know what it means exactly have the surgeon draw it on your pictures of howe plans to do it…because he is going to have to draw it on for surgery. Just as good would be to see some actual intraoperative pictures of he does it. Then you will known for sure.
2) It is not clear to me how he would know that a posterior approach to the webbing would not work or why it would be a poor choice for your neck webs ….unless he has done the actual procedure. Is this a theory or is that opinion based on actual clinical experience.
3) The basic concept about neck web surgery is that, while improvement is possible, you have to be careful about trading off one aesthetic problem for another. If you make the assumption that the direct lateral Z-plasty approach produces better reduction of the neck webs than the posterior approach (I am not saying it does but for the sake of this discussion let’s assume that it does) the question then is it is better to have less neck webs but visible scarring OR less neck web improvement with no visible scarring. As that is fundamentally what the decision is between the two approaches.
Dr. Barry Eppley
World-Renowned Plastic Surgeon