What Lies Beneath: Carotid Artery Depth and the Safe Use of Hemostatic Nets in Facelift Surgery

BACKGROUND: Previous studies have demonstrated the effectiveness of the hemostatic net in reducing post-rhytidectomy hematomas; however, its safety in relation to the proximity to the carotid vessels is unknown. OBJECTIVES: This study aims to provide anatomical data on the depth of the carotid artery and its branches along the neck to inform data-based guidelines for hemostatic net placement to decrease risk of inadvertent vessel injury. METHODS: We retrospectively studied rhytidectomy patients at a single academic aesthetic surgery center who had subsequent neck imaging within 10 years. We studied the common, internal, and external carotid arteries bilaterally at the C2 (angle of mandible), C3 (hyoid), and C4 (thyroid cartilage). For each, distance between the corresponding left and right vessels and vessel depth from the skin were measured. RESULTS: 33 patients (81.9% female; average age at rhytidectomy=64.2 years and at imaging=69.1 years) had images of sufficient quality. At C2-C4, carotid depths ranged from 20.5-32.9 mm. The closest artery to the skin along the neck is internal carotid artery at the level of the thyroid cartilage (C4). CONCLUSIONS: A thorough understanding of the vascular structures in post-rhytidectomy neck underlies safe placement of the hemostatic net. Assuming the use of ⅜ circle suture needle, a 24mm needle (19mm chord length) offers greater inherent margin relative to the mean vessel depth at C4 (20.5mm). However, with a 32mm needle (25mm chord length), safe use depends on controlled bite depth and surgical technique (more oblique needle entry) to maintain a safe margin from carotid vessels.