PURPOSE: The suture suspension platysmaplasty can be a primary procedure option in the plastic surgeon's armamentarium for treating the aging neck. It is a straightforward procedure with a low rate of complications, but attention to detail is critical. Patients who are to undergo this procedure should meet the following criteria: poorly defined cervical mental angle and submandibular border, absence of laxity in the midface structures, mild to moderate amount of jowling and neck fat, and unwillingness or inability to undergo a full face lift. Over the past fifteen years the senior author has been performing suture suspension platysmaplasties with excellent results. This study reports the longitudinal experience and outcomes of a single surgeon performing suture suspension platysmaplasties from 2000 to 2007 in 500 consecutive patients. We review the complications and give suggestions to minimize potential pitfalls when performing this procedure. METHOD: A retrospective review of 500 consecutive patients who underwent suture suspension platysmaplasty was performed from patient charts. Specific criteria including hematoma, seroma, skin necrosis, unsightly scars, nerve damage, discomfort from the tightness initially, asymmetry, unsatisfactory results, and the incidence of revisional surgery were examined. RESULTS: In 500 procedures the overall complications rate was less than 5% and the need for revision surgery was less than 2%. Long term complications included: postauricular scar irregularity, which can easily be treated with dilute Kenalog injections, overly aggressive liposuction treatment resulting in an unnatural appearance of the neck, too much or too little tension on the suspension suture and insufficient postauricular skin ellipse resection. No patients reported prolonged periods of numbness lasting longer than one year. The senior author has also followed a small portion of patients who underwent suture suspension platysmaplasty for over fifteen years. Most patients still report satisfaction rates over 90% even though other aspects of facial rejuvenation, particularly to the upper face, may have had to be re-operated over the years for optimal aesthetic appearance. CONCLUSION: The suture suspension platysmaplasty is a safe procedure that provides excellent long lasting results in the carefully selected patient. Knowing the potential complications is beneficial to avoiding potential pitfalls which results in high patient satisfaction.