Our present technique for rhytidectomy

Submental muscular medialization and suspension

BACKGROUND

Many techniques have been presented over recent decades to address the neck contour in facial rejuvenation surgery. Despite advances, limitations remain when dealing with the obtuse cervical angle.

OBJECTIVE

The authors describe a technique for improving the obtuse cervicomental angle.

METHODS

The authors reviewed the charts of 295 patients who underwent the authors' submental muscular medialization and suspension (SMMS) technique to improve their neck contour, either alone or in combination with a facelift, between January 1, 2001, and December 30, 2003. The technique medializes and suspends the medial free edges of the platysma muscle and, when anatomy dictates, the anterior bellies of the digastric muscle to the deeper mylohyoid muscle.

RESULTS

Eighty-seven (30.5%) of the 285 facelift patients examined underwent SMMS, and 10 additional patients underwent isolated SMMS. No patient required reoperation for hemostasis or evacuation. Three (1.05%) of the facelift with SMMS patients required reoperation for dehiscence of the submental suspension. None of the isolated SMMS patients had muscular suspension dehiscence or required reoperation. Seven (2.4%) patients (5 with SMMS and 2 without SMMS) with excessive facial and cervical tissue preoperatively developed a small amount of postoperative submental skin redundancy and subsequently underwent submental skin excision at 1 year postoperatively.

CONCLUSIONS

Submental muscular medialization and suspension is a simple yet highly effective surgical technique that can result in dramatic and enduring improvement in the cervicomental angle.

Limited incision submental lipectomy and platysmaplasty

Thirty years ago, submental fat deposition and platysma band formation were inadequately addressed by surgeons attempting facial rejuvenation procedures. Simple skin envelope tightening as practiced commonly at that time resulted in reappearance of submental bands within months, disappointing both patient and surgeon. During each subsequent decade, existing techniques for aesthetic surgical treatment of the submental and neck areas were refined, and new techniques were introduced. The earliest in this evolution of surgical approaches to rejuvenate the aging submental region was direct excision of redundant anterior cervical skin and platysma muscle bands. Later, periauricular incision approaches without anterior skin excision were used to address platysma muscle bands and remove excess submental fat. Today, the standard approach for submental and anterior neck rejuvenation is some variation of "corset" platysmaplasty and suction-assisted lipectomy both superficial and deep to the platysma muscles. The introduction of endoscopy to plastic surgery has stimulated interest in performing many surgical procedures through limited-incision approaches. While endoscopic techniques may not have a clear application for the submental area, redundant submental soft tissues producing obliquity of the cervicomandibular angle may be treated through a single submental incision approach under direct vision. A technique practiced by the author since 1981 for performing submental lipectomy and platysmaplasty through a single limited anterior submental incision without skin excision is described and discussed. Postoperative compression of the submental area with an elastic garment facilitates smooth skin contraction and redraping for all patients except those with poor or no residual skin elasticity.