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Meningaud JP, Pensato R, Pineau V, D'Andrea L, Pizza C, Coiante E, Hersant B, La Padula S. Facelift: Assessment of Total Platysma Muscle Transection to Prevent the Recurrence of Platysmal Bands. Aesthetic Plast Surg 2024; 48:122-133. [PMID: 37737877 PMCID: PMC10912268 DOI: 10.1007/s00266-023-03664-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Determining which facelift technique yields the most effective long-term rejuvenation results and ensures optimal stability over time remains a significant question in cosmetic surgery: Does the most invasive surgery lead to the best long-term outcomes? This study aims to evaluate the authors' approach using total platysma muscle transection to prevent platysma band recurrence, and to provide anatomical observations supporting and justifying their procedure. MATERIAL AND METHODS A preliminary study in anatomical basic sciences was conducted to establish the rationale for our method. A prospective single-blind study was conducted, involving eighty patients seeking facial rejuvenation with platysmal band correction. They underwent face and neck-lift procedures with total platysma transection by the same surgeon between May 2013 and May 2016. Cosmetic outcomes were assessed using the Face and Neck-Lift Objective Photo-Numerical Assessment Scale. Scores by three blind evaluators before surgery, at 1 and 5 years postoperatively, were compared using a matched T Test (p < 0.05). RESULTS The preliminary anatomical study revealed a consistent anastomotic system between the cervical branch of the facial nerve and the branches of the cervical plexus. Incomplete platysma section during a facelift might contribute to platysma band recurrence. The clinical study demonstrated satisfactory outcomes, with significant overall appearance improvement (p < 0.00001) and no platysma band recurrence. Complication rate was low. CONCLUSION The authors' technique achieved satisfactory long-term results with minimal complications. However, due to the lengthy operating time and steep learning curve, it should be reserved for highly motivated patients. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Jean-Paul Meningaud
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII, 1 rue Gustave Eiffel, 94000, Créteil, France
| | - Rosita Pensato
- Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Virginie Pineau
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII, 1 rue Gustave Eiffel, 94000, Créteil, France
| | - Luca D'Andrea
- Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Chiara Pizza
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII, 1 rue Gustave Eiffel, 94000, Créteil, France
| | - Edoardo Coiante
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII, 1 rue Gustave Eiffel, 94000, Créteil, France
| | - Barbara Hersant
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII, 1 rue Gustave Eiffel, 94000, Créteil, France
| | - Simone La Padula
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII, 1 rue Gustave Eiffel, 94000, Créteil, France.
- Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131, Naples, Italy.
- , Paris, France.
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Abstract
Following incomplete facial nerve injury, patients may develop aberrant facial nerve reinnervation, which can result in facial synkinesis. The treatment goals for patients with postfacial paralysis synkinesis are to improve resting oral commissure position, oral competence, facial and cervical tightness, and smile symmetry and spontaneity. Modified selective neurectomy of the facial nerve as described by Azizzadeh and colleagues is a targeted surgical method that allows the surgeon to eliminate the antagonist movements of the face and allow the favorable movements of the face to predominate, resulting in a more natural smile.
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Affiliation(s)
- Anna Frants
- Department of Facial Plastic & Reconstructive Surgery, Center for Advanced Facial Plastic Surgery, 9401 Wilshire Boulevard, Beverly Hills, Suite 650, CA 90212, USA
| | - Babak Azizzadeh
- Department of Facial Plastic & Reconstructive Surgery, Center for Advanced Facial Plastic Surgery, 9401 Wilshire Boulevard, Beverly Hills, Suite 650, CA 90212, USA; Division of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, 200 UCLA Medical Plaza, Suite 550, Los Angeles, CA 90095, USA.
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