Understanding the Mastoid Crevasse: A Breakthrough in Neck Lift SurgeryDr. Gould Plastic Surgery

For decades, surgeons have worked to create a sharper, more refined, and natural jawline. Yet certain anatomical factors—like submandibular gland fullness or a low hyoid bone—often limited even the best techniques. Traditional approaches sometimes produced a blunted or underwhelming jawline, leaving a gap between “good” and “truly exceptional”. The Mastoid Crevasse technique represents a major shift in solving these deep-anatomy challenges and achieving elegant, consistently defined neck contours.

Sections:

1. Introduction
2. Old Approach vs. New Concept
3. The Three Anatomical Anchors
4. Surgical Technique (Step-by-Step)
5. The Measured Difference (Data)
6. Key Patient Benefits
7. Conclusion: A New Standard

I. Introduction

Traditional neck lift approaches often struggle to overcome deep anatomical limitations. While tightening the skin and muscle can offer improvement, it often results in a pull vector that fails to address the vertical drop of the neck tissues. The Mastoid Crevasse technique was developed to solve the problem of the "blunted" gonial angle.

II. Old Approach vs. New Concept

To understand the innovation, one must compare the mechanical vectors of the traditional method versus the Mastoid Crevasse.

Traditional Method: Platysma Onlay

• Platysma is elevated and laid over the mastoid fascia
• Pull vector = mostly superolateral
• Result = sometimes flatter or “blunted” gonial angle
• Limited vertical correction for deep neck issues

Mastoid Crevasse Method: Platysma Inset

• A vertical “crevasse” is created at the anterior mastoid
• Platysma is inset into this deep pocket
• Creates a 3D rotational vector (superior + posterior)
• Dramatically enhances jawline depth and vertical neck correction

Key Insight:

This is not a new stitch. It is a new mechanical system that uses the patient’s own anatomy to generate more powerful, natural, and durable results.

III. The Three Anatomical Anchors

• Platysma — The foundational muscle of the neck lift and part of the SMAS-platysma complex
• Gonial Angle — The aesthetic dividing line between face and neck; sharper angle = more sculpted jawline
• Mastoid Process — A strong, reliable bony anchor behind the ear; the crevasse is created here

The technique’s power comes from how these three structures interact once the platysma is inset beneath the mastoid.

IV. Surgical Technique (Step-by-Step)

Step 1 — Release the Muscle

The platysma is fully released from the cervical retaining ligaments, allowing the entire SMAS-platysma unit to mobilize. This is the hallmark of deep plane surgery.

Step 2 — Create the “Crevasse”

A vertical fascial incision at the anterior mastoid creates a deep pocket. This also decompresses the tail of the parotid, slimming the jawline.

Step 3 — Inset the Platysma

The released muscle is rotated upward and backward, then anchored securely inside the crevasse rather than over the bone.

Step 4 — Establish the “Pulley System”

By anchoring deep to the gonial fulcrum, the force vector becomes a superior-posterior rotation — creating:

• a stronger vertical neck lift
• a more sculpted submandibular region
• a “negative submentum” profile
• improved hyoid position

This system solves problems that surface-level techniques physically cannot.

V. The Measured Difference: Quantifiable Improvement

The Mastoid Crevasse technique has documented, measurable improvements in the gonial angle:

Jawline Depth Measurements

This measurable endpoint differentiates the technique from subjective “looks better” claims.

VI. Key Patient Benefits

• Sharper, More Sculpted Jawline
• The deep inset physically increases the gonial angle depth, creating a chiseled profile.
• More Powerful Vertical Neck Lift
• Ideal for patients with a low hyoid or stubborn neck fullness.
• More Secure, More Natural Fixation
• Anchoring in bone periosteum = longer-lasting, tension-free results.
• Works on “Difficult Anatomy
• Broad mastoids, full parotid tail, deep neck fullness — all addressed more effectively.

VII. Conclusion: A New Standard

This innovation moves neck lift surgery beyond surface tension and toward true 3D anatomical repositioning. By adding quantifiable measurements and a structurally superior anchor point, it elevates outcomes and consistency for patients seeking refined, natural neck rejuvenation.

The neck lift is widely regarded as one of the most anatomically unforgiving procedures in facial plastic surgery. Unlike the face, where volume loss is often the primary concern, the neck is defined by structural boundaries that tend to blur with age. For years, the standard neck lift procedure relied on addressing the superficial layers, specifically removing loose skin and tightening the muscle edges laterally. While this approach can improve basic skin laxity, it often fails to correct the bulky structures in the deeper layers—such as excess fat, submandibular glands, and muscle attachments—that ultimately determine the shape of the neck.

The deep neck lift represents an advanced evolution in neck surgery, moving beyond simple skin excision to address the root causes of an undefined profile. This approach is indicated not only for the aging neck characterized by vertical bands and muscle laxity but also for younger patients who possess good skin elasticity yet suffer from a genetic double chin or obtuse neck angle. These patients often find that neck liposuction alone is insufficient because the fullness lies deep to the muscle, where standard suction cannulas cannot safely reach. By treating the neck area as a three-dimensional structural project rather than a surface tightening exercise, Dr. Gould can engineer a result that looks stable and natural looking, avoiding the pulled appearance common in traditional techniques.

For more information about a specific procedure, please visit the following links.

Deep neck lift Reset lift

II. Old Approach vs. New Concept: A Paradigm Shift

To appreciate why the Mastoid Crevasse is a breakthrough, one must understand the mechanical limitations of traditional methods. Standard neck lift surgery typically uses a "platysma onlay" technique. In this surgical procedure, the platysma muscle is dissected and then pulled upward, where it is draped over the mastoid fascia behind the ear. The primary vector of tension in this method is superolateral, meaning the tissue is pulled up and out. While effective for smoothing loose neck skin, this vector pulls the tissues flat against the side of the neck, which can result in a blunted or "swept" look rather than creating the crisp right angle that defines a youthful appearance.

Unlike traditional neck lifts, the Mastoid Crevasse method introduces a fundamentally new mechanical system. Instead of simply draping the muscle over the bone, Dr. Gould creates a vertical space—a "crevasse"—deep within the fibrous tissue at the anterior mastoid. The platysma muscle is then inset into this pocket rather than lying on top of it. This change in fixation creates a powerful 3D rotational vector that pulls the underlying muscles and tissue both superiorly and posteriorly. This unique mechanical advantage allows for dramatic vertical correction of the neck skin and muscle, effectively clearing the submandibular space and sharpening the neck contour in a way that surface tension simply cannot achieve.

III. Key Deep Neck Anatomy

The success of a deep plane technique relies on the precise manipulation of specific anatomical anchors rather than skin tension. Unlike superficial lifts that treat facial skin and excess skin as the primary targets, this method focuses on the interplay of three deep structures. The first is the platysma muscle, the broad sheet of muscle that acts as a sling for the neck contents and must be fully mobilized to support the deep structures.

The second critical landmark is the gonial angle, the bony corner of the jaw that visually defines the transition between the face and neck. A sharp, distinct gonial angle is essential for a defined jawline, and this technique uses that angle as a fulcrum to pivot the soft tissues, creating a chiseled shadow. Finally, the mastoid process—the sturdy bone behind the ear—serves as the absolute anchor point. By creating the crevasse here, Dr. Gould utilizes the body's own skeletal framework to secure the lift, ensuring that the youthful looking neck remains stable over time.

IV. Surgical Technique (Step-by-Step)

The Mastoid Crevasse procedure is a highly choreographed operation that requires a deep understanding of facial features and nerve anatomy, performed under general anesthesia to ensure patient safety. The procedure begins with the complete release of the platysma from the cervical retaining ligaments. This mobilization allows the entire muscle unit to move freely, a critical step in any deep plane facelift or neck lift that prevents the "pulled" look associated with stretching tissue under tension.

Once the muscle is mobilized, Dr. Gould creates a precise vertical incision in the fascia at the anterior mastoid. This creates the deep pocket or "crevasse" that will serve as the new anchor point, a step that also allows for the decompression of the parotid gland tail to further slim the jawline. The released platysma muscle is then rotated upward and backward and tucked securely inside the crevasse. This inset maneuver distinguishes the technique from standard suspension, providing a mechanical advantage that locks the muscle into a new position. Finally, once anchored, the muscle acts as a "pulley system," lifting the deep neck contents vertically to create a "negative submentum"—the concave curve under the chin that eliminates turkey neck and heaviness.

V. The Measured Difference: Quantifiable Improvement

In an industry often driven by subjective claims, Dr. Gould’s engineering background prioritizes measurable data. The efficacy of the Mastoid Crevasse technique has been documented through precise measurements of the "gonial angle depth," which essentially measures the depth of the jawline shadow.

This data confirms that the deep inset method provides significantly greater structural definition than traditional suspension, offering a tangible difference for most patients seeking a sharper profile.

VI. Key Patient Benefits

The Mastoid Crevasse technique offers distinct advantages for patients in Beverly Hills and beyond who are seeking elite-level facial rejuvenation.

• Sharper, More Sculpted Jawline: By increasing the physical depth of the jawline, the procedure creates a chiseled look that is often impossible with neck liposuction or chin implant procedures alone.
• Powerful Vertical Correction: This approach is ideal for correcting the vertical drop of tissues seen in the aging neck, effectively reversing the gravitational changes that lead to jowls and banding.
• Natural Looking Results: Because the lift is anchored in the bone’s periosteum (connective tissue) rather than soft tissue, the results are exceptionally secure and durable. This avoids the "windblown" look and ensures the neck ages naturally with the patient.
• Solutions for "Difficult Anatomy": Patients with broad necks, excess fatty deposits, or prominent glands often struggle to find solutions. This technique directly modifies the deep anatomy to sculpt a neck that the patient may never have had naturally.

VII. Conclusion

The Mastoid Crevasse technique moves neck lift surgery from the era of skin tightening into the era of true structural engineering. By utilizing a 3D anatomical reset and precise measurements, Dr. Gould offers a solution that addresses the root causes of neck fullness and aging. Whether performed as a standalone procedure or combined with a deep plane facelift, eyelid surgery, or a lower facelift, this technique represents a new standard for achieving a defined, elegant, and youthful-looking neck.

For patients considering this transformative surgery, it is important to have realistic expectations and understand the whole process. Recovery typically involves keeping the head elevated to minimize swelling and wearing a compression garment to reduce swelling for several weeks. While swelling and bruising are part of the healing process, most patients find the recovery manageable and the results well worth the investment.