Platysmaplasty Facelift

Platysmaplasty Facelift

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Correction of submental ptosis is sometimes necessary to reverse the effects of senescence. Although this is usually undertaken in tandem with facial rhytidectomy, surgeons may find themselves addressing only the cervical region at times.

Skoog first described the modern surgical technique. Millard subsequently advocated a horizontal submental incision for lipectomy, excision of hypertrophic anterior platysmal bands, and wide subcutaneous cervical dissection. [1, 2] Owsley later supported a procedure where the platysma was elevated in conjunction with the superficial muscular aponeurotic system (SMAS). [3]

Weakening of the retaining ligaments of the face contributes to age-related changes. In 1989, Furnas provided a description of these ligaments. [4] These ligaments suspend the more superficial and mobile anatomical structures to the deeper and akinetic facial constituents.

Fasciocutaneous ligaments extend from the dermis to the facial fascia, and osseocutaneous ligaments extend from the dermis to the periosteum.

Other reported causes of skin sagging and drooping over the facial skeleton include loss of bone, loss of skin elasticity, and atrophy of facial fat.

However, a prospective study by Trévidic and Criollo-Lamilla suggested that relaxation of the platysma and skin laxity are not the source of platysmal banding, with the phenomenon instead being related to platysma muscle activity. The study was conducted on 25 patients with unilateral facial palsy, with platysmal bands tending to occur only on the nonparalyzed facial side in these individuals. According to the investigators, the report indicates that denervation of the platysmal muscle, rather than skin tightening, may be the best surgical treatment for aging necks. [5]

Platysmaplasty is used to reverse the effects of aging, sun exposure, and smoking on the cervical region.

Fewer pilosebaceous units populate the integument of this region compared with other facial regions. If laser resurfacing is considered, the presence of fewer pilosebaceous units can increase the risk of pronounced scarring, increase healing time, and increase pigmentary changes. For information on laser resurfacing techniques, see Medscape Reference articles Skin Resurfacing, Laser: Carbon Dioxide and Skin Resurfacing, Laser: Erbium YAG.

Adipose tissue is segregated into subcutaneous and subplatysmal. Increased amounts of subcutaneous fat can be observed with weight gain, aging, and lipodystrophies. Subplatysmal fat is far more vascular and fibrous than subcutaneous fat and is visualized after incising the platysma muscle. This difference results in reduced efficacy of liposuction of subplatysmal fat.

Originating from the pectoralis major muscle fascia, the platysma is a layer of muscle that has multiple insertions. Moving anterior to posterior, the muscle is anchored to the mentum and the inferior mandibular border and meets the orbicularis oris laterally and then the depressor anguli oris. Platysmal meshing with the depressor anguli oris contributes to the superficial muscular aponeurotic system (SMAS), highlighting its importance when attempting to reverse facial aging.

Ventral rami of cervical nerves II-IV provide the tactile sense of the anterior neck. Tracking along the posterior surface of the sternocleidomastoid muscle, these sensory nerves approach the anterior neck.

The lesser occipital nerve moves posteriorly to innervate the posterior upper otic surface and retroauricular scalp; the greater auricular nerve innervates the auricle and mandibular angle. The latter is 6-6.5 mm inferior to the external auditory canal while coursing over the sternocleidomastoid muscle. The anterior triangle of the neck receives the transverse cervical nerve for sensory innervation of the region within the boundaries of the sternum and mandible. This nerve branches out over the anterior surface of the sternocleidomastoid muscle and is found within the deep cervical fascia.

The external and the anterior jugular veins are deep to the platysma. They provide vascular conduits to the facial, retromandibular, and posterior auricular veins.

The submandibular glands are lateral to the anterior belly of the digastric muscles.

This procedure is contraindicated in patients who are not medically stable or those who cannot tolerate anesthetic agents.

Patients who do not have realistic expectations of surgical outcomes should undergo preoperative counseling or should not undergo the operation.

Millard DR, Pigott RW, Hedo A. Submandibular lipectomy. Plast Reconstr Surg. 1968 Jun. 41(6):513-22. [Medline].

Millard DR Jr, Garst WP, Beck RL, Thompson ID. Submennta and submancibular lipectomy in conjunction with a face lift, in the male or female. Plast Reconstr Surg. 1972 Apr. 49(4):385-91. [Medline].

Owsley JQ Jr. SMAS-platysma facelift. A bidirectional cervicofacial rhytidectomy. Clin Plast Surg. 1983 Jul. 10(3):429-40. [Medline].

Furnas DW. The retaining ligaments of the cheek. Plast Reconstr Surg. 1989 Jan. 83(1):11-6. [Medline].

Trevidic P, Criollo-Lamilla G. Platysma Bands: Is a Change Needed in the Surgical Paradigm?. Plast Reconstr Surg. 2017 Jan. 139 (1):41-7. [Medline].

Toft K, Keller GS, Blackwell KE. Submentoplasty. An anatomical approach. Facial Plast Surg Clin N America. May 2000. 8(2):183-92. [Medline].

Brissett AE, Hilger PA. Male face-lift. Facial Plast Surg Clin North Am. 2005 Aug. 13(3):451-8. [Medline].

Watson D. Submentoplasty. Facial Plast Surg Clin N Am. 2005. 13:459-467.

Bitner JB, Friedman O, Farrior RT, Cook TA. Direct submentoplasty for neck rejuvenation. Arch Facial Plast Surg. 2007 May-Jun. 9(3):194-200. [Medline].

Labbe D, Franco RG, Nicolas J. Platysma suspension and platysmaplasty during neck lift: anatomical study and analysis of 30 cases. Plast Reconstr Surg. 2006 May. 117(6):2001-7; discussion 2008-10. [Medline].

Caplin DA, Perlyn CA. Rejuvenation of the aging neck: current principles, techniques, and newer modifications. Facial Plast Surg Clin North Am. 2009 Nov. 17(4):589-601, vi-vii. [Medline].

Ramirez P, Leibowitz A, Traylor-Knowles M, et al. Short-flap facelift with 924 nm/975 nm laser lipolysis: a retrospective study of 78 patients. J Cosmet Dermatol. 2014 Mar. 13(1):22-9. [Medline].

Fuente del Campo A. Midline platysma muscular overlap for neck restoration. Plast Reconstr Surg. 1998 Oct. 102(5):1710-4; discussion 1715. [Medline].

Gentile RD. Purse-string platysmaplasty: the third dimension for neck contouring. Facial Plast Surg. 2005 Nov. 21(4):296-303. [Medline].

Henderson J, O’Neill T, Logan A. Direct anterior neck skin excision for cervicomental laxity. Aesthetic Plast Surg. 2010 Jun. 34(3):299-305. [Medline].

Gryskiewicz JM. Submental suction-assisted lipectomy without platysmaplasty: pushing the (skin) envelope to avoid a face lift for unsuitable candidates. Plast Reconstr Surg. 2003 Oct. 112(5):1393-405; discussion 1406-7. [Medline].

Cohen AJ, Mercandetti M, Chang EW. Rhytidectomy, Subperiosteal Facelift. Medscape Reference. Updated October 13, 2008. [Full Text].

Giampapa V, Bitzos I, Ramirez O, Granick M. Suture suspension platysmaplasty for neck rejuvenation revisited: technical fine points for improving outcomes. Aesthetic Plast Surg. 2005 Sep-Oct. 29(5):341-50; discussion 351-2. [Medline].

Knize DM. Limited incision submental lipectomy and platysmaplasty. Plast Reconstr Surg. 2004 Apr 1. 113(4):1275-8. [Medline].

Mercandetti M, Cohen AJ. Facelift, SMAS Plication. Medscape Reference. Updated April 30, 2008. [Full Text].

Mercandetti M, Mirante JP. Aesthetic facial surgery. Krause JH, Mirante JP, Christmas DA, Donley S, eds. Office-Based Surgery in Otolaryngology. Philadelphia, Pa: WB Saunders; 1999. 143-55.

Noone RB. Suture suspension malarplasty with SMAS plication and modified SMASectomy: a simplified approach to midface lifting. Plast Reconstr Surg. 2006 Mar. 117(3):792-803. [Medline].

Owsley JQ Jr. Platysma-facial rhytidectomy: a preliminary report. Plast Reconstr Surg. 1977 Dec. 60(6):843-50. [Medline].

Ruiz-Esparza J. Near [corrected] painless, nonablative, immediate skin contraction induced by low-fluence irradiation with new infrared device: a report of 25 patients. Dermatol Surg. 2006 May. 32(5):601-10. [Medline].

Tonnard PL, Verpaele A, Gaia S. Optimising results from minimal access cranial suspension lifting (MACS-lift). Aesthetic Plast Surg. 2005 Jul-Aug. 29(4):213-20; discussion 221. [Medline].

Adam J Cohen, MD Physician/CEO, Eyelid and Facial Plastic Surgery and MediSpa

Adam J Cohen, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Mimedx.

Michael Mercandetti, MD, MBA, FACS Private Practice

Michael Mercandetti, MD, MBA, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, Sarasota County Medical Society, American Academy of Ophthalmology, American College of Surgeons, American Society for Laser Medicine and Surgery, American Society of Ophthalmic Plastic and Reconstructive Surgery, Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jorge I de la Torre, MD, FACS Professor of Surgery and Physical Medicine and Rehabilitation, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; Director, Center for Advanced Surgical Aesthetics

Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, Association for Academic Surgery, Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Deepak Narayan, MD, FRCS Associate Professor of Surgery (Plastic), Yale University School of Medicine; Chief of Plastic Surgery, West Haven Veterans Affairs Medical Center

Deepak Narayan, MD, FRCS is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Plastic Surgery Research Council, Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Indian Medical Association

Disclosure: Nothing to disclose.

David W Furnas, MD, FACS Emeritus Professor and Chief, Division of Plastic Surgery, University of California, Irvine, School of Medicine

David W Furnas, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Cleft Palate-Craniofacial Association, American College of Surgeons, American Head and Neck Society, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society for Surgery of the Hand, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society of Transplantation, California Medical Association, Phi Beta Kappa, Plastic Surgery Research Council, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of University Surgeons

Disclosure: Nothing to disclose.

Platysmaplasty Facelift

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