Dr. Edward Buckingham and colleagues recently published a case report in The Laryngoscope (September 2025) addressing a unique challenge in facial plastic surgery: performing a cervical rhytidectomy (neck lift) in patients who already have a hypoglossal nerve stimulation (HNS) device for obstructive sleep apnea.
This paper, co-authored by Dr. Buckingham, Dr. Hudson Frey, and colleagues, represents an essential contribution at the intersection of sleep medicine and aesthetic surgery.
What Is Hypoglossal Nerve Stimulation (HNS)?
Hypoglossal nerve stimulation is an advanced therapy designed for patients with moderate to severe obstructive sleep apnea (OSA) who cannot tolerate or do not respond well to CPAP (continuous positive airway pressure) machines (Johns Hopkins Medicine).
Instead of relying on an external mask, the HNS system uses a small implanted device. It delivers mild, timed electrical impulses to the hypoglossal nerve, the nerve that controls tongue movement, gently repositioning the tongue and nearby muscles to keep the airway open during sleep (Cleveland Clinic).
Here’s what you need to know about HNS:
- Implantable design: The system has three parts placed beneath the skin of the chest and neck — a pulse generator, a breathing sensor, and a stimulation lead (FDA Inspire UAS Data).
- Nightly activation: Using a handheld remote, patients switch the device on before bed and off when awake.
- Improved quality of life: Many patients report reduced snoring, better oxygen levels, and improved daytime energy compared to CPAP (ENT Today).
- Growing popularity: Since FDA approval, eligibility has expanded to include patients with higher apnea–hypopnea index scores and body mass index, making this therapy more widely available (University of Miami Health System).
As more patients choose this therapy, the number seeking facial rejuvenation procedures, such as a neck lift, will continue to rise.
Why Neck Lift Surgery Becomes Complex With an HNS Device
Neck lift surgery, or cervical rhytidectomy, addresses loose skin, muscle banding, and excess fat in the neck.
However, the presence of an implanted HNS device requires:
- Careful preoperative planning to map device placement and leads
- Modified surgical techniques to avoid disrupting the stimulator or its wiring
- Close coordination with sleep specialists to ensure the device remains fully functional
The Buckingham Center team successfully performed a neck lift with platysmaplasty in a patient with an HNS device, showing that natural, safe results are possible with experienced surgical care (The Laryngoscope case report).
Case Report Highlights
- The popularity of HNS devices is rising, meaning more patients may need aesthetic surgery after implantation
- A thorough understanding of device anatomy and placement is critical before surgery
- With thoughtful adjustments, long-lasting rejuvenation results can be achieved without compromising device safety
- Collaborative care between surgeons and sleep specialists supports both aesthetic and medical goals
Why This Matters for Patients
If you have a hypoglossal nerve stimulation device and are considering facial plastic surgery, this research underscores that:
- You are not excluded from rejuvenation procedures, such as a neck lift
- Surgeon expertise is essential. Few surgeons have hands-on experience performing facelifts or neck lifts around an implanted device
- Safe, natural outcomes are achievable with fellowship-trained, double board-certified facial plastic surgeons who understand these complexities
Considering Facial Rejuvenation With an HNS Device?
At the Buckingham Center for Facial Plastic Surgery, our team offers:
- Over 20 years of focused experience in facial surgery
- Double board-certified surgeons (Dr. Buckingham, Dr. Smith, and Dr. Frey) who specialize exclusively in the face and neck
- Leadership in research and education, with publications in peer-reviewed journals such as The Laryngoscope
- A philosophy of natural, discreet, long-lasting results tailored to each patient
This case report demonstrates our commitment to advancing surgical knowledge and providing the highest standard of care, even for patients who face unique challenges, such as those who have implanted devices.
Please schedule a confidential consultation with our team to discuss safe, personalized options for restoring your confidence while prioritizing your health.
