Sir: A recurrent request in plastic surgery is, “Doctor, please operate on my neck, but I do not want a face lift.” We are communicating a new, endoscopic, water-assisted, “pure” neck lift that can be used when necks need restoration of an acute cervicomental angle, or correction of a soft-tissue bulge such as fat, ptotic platysma bands (lateral and medial), or glands, without face-lift scars. Through a prospective cohort study, we reviewed the charts of nine patients operated on with this procedure from March of 2007 to April of 2008. Tumescent infiltration of the anterior neck consisted of a 1:100,000 solution of epinephrine delivered through three incisions: one submental and two below both ear lobules. An arthroscopic 30-degree short endoscope was introduced through the submental incision to develop an optical cavity with a constant infusion of saline through a bidirectional arthroscopic pump (ConMed Linvatec). The input of the system is developed through a 30-degree, 3-mm, double-lumen endoscope that carries a camera (3CCD Digital Camera; ConMed Linvatec) and a xenon light source (LIS 8430; ConMed Linvatec). The right earlobe incision was used to introduce a 3-mm ultrasonically activated scalpel (Harmonic Scalpel, hook type; Johnson & Johnson, Cincinnati, Ohio) to dissect adhesions and trabecula, and for hemostasis (works under water). A “pistol” forceps was introduced to manipulate a 3-mm curved needle carrying a 5-0 Prolene suture. The right earlobe incision was used to assist the suturing process with a 3-mm endoscopic forceps (Johnson & Johnson) (Fig. 1).Fig. 1.: (Left) The ConMed Linvatec 3CCD digital camera is shown above, left; the xenon light source (ConMed Linvatec LIS 8430) is shown above, right; below, left is the video recorder; and below, right is the arthroscopic pump. (Right) A 30-degree short endoscope introduced through a submental incision. The optical cavity (working space) is developed with a constant infusion of saline with an arthroscopic pump. “Pistol” forceps are introduced through the right earlobe incision to manipulate a 3-mm curved needle carrying a 5-0 Prolene suture, and the right earlobe incision is used to assist the suturing process with a 3-mm endoscopic forceps.We identified both platysma muscles just over the cricoid cartilage. A fisherman's knot was performed at that point (no ties), and the muscles were sutured in the midline (Feldman's corset fashion).1 The posterolateral superficial musculoaponeurotic system/platysma flap fixation was performed using the same principle to refine the jaw line and contour the anterolateral neck. Another Prolene suture was used to fixate the lateral platysma rotation flap to the mastoid area. We never used drains and the dressing was performed with Reston foam (3M, St. Paul, Minn.) along with a pressure garment used for 3 weeks. Functional and aesthetic results were evaluated by two surgeons unfamiliar with the patients, using preoperative and postoperative photographs and by direct examination of the cases. Results were graded on a four-point scale—“Visual Criteria for Success in Restoring the Youthful Neck”—described by Ellenbogen.2 All of the patients demonstrated a smooth and perpendicular neck contour with well-concealed scars in the submental and both posterior ear lobule areas, eliminating the stigma of face-lift surgery (Fig. 2).Fig. 2.: A 48-year-old woman, with an Ellenbogen result graded as good.The endoscope in aesthetic surgery of the face and neck has not gained wide acceptance because of the expertise required, longer operation time, and the extra cost of specialized instruments.3 We describe a gasless, water-assisted, single-surgeon videoendoscopic neck-lift operation, using reduced incisions to reposition the ptotic elements of the aging neck. Enlarged or ptotic submandibular glands should be addressed preoperatively. It is our opinion that leaving fat over the platysma to camouflage the glands is not a good solution. We still prefer an extensive liposuction4 and additional endoscopic suturing to create a strong and flat muscle to correct the submandibular gland bulging. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. PATIENT CONSENT The patient provided written consent for the use of her images. Arturo S. Prado, M.D. Patricio Andrades, M.D. Patricio Fuentes, M.D. Francisco Parada, M.D. Plastic Surgery Division Department of Surgery Jose Joaquin Aguirre Clinical Hospital University School of Medicine and Clinica Santa Maria Santiago, Chile