Rhytidectomy in male patients

The Avoidance and Management of Complications, and Revision Surgery of the Lower Face and Neck

Complications are an inherent occurrence in surgery. In rhytidectomy, many complications are avoidable with thorough preoperative assessment and optimal intraoperative and postoperative care. Nevertheless, complications do occur. In certain situations, avoidance of risks is the best way to decrease the occurrence. Once complications do occur, there is a large body of literature to aid in the correction.

Male face-lift

Middle-aged men represent an emerging group expressing an interest in facial rejuvenation procedures. One must understand the complex differences in motivation, psychosocial factors, and aspects associated with anatomy and facial aging that are unique to men. To maximize postoperative results and increase patient satisfaction, the facial plastic surgeon must adjust perioperative management and surgical techniques when performing a male face-lift.

[Rejuvenation of the lower third of the face and the neck]

One of the marks of the youth of a face is the absence of ptosis of the cheek and the perfect delimitation of the neck with an angle well defined. The objective of this work is to present our surgical technique for the treatment of the lower third of the face and the neck. After a degreasing of the neck and lower part of the cheek, we carry out an extensive cutaneous separation of these areas. The cervical face lift is performed in different layers. A suspension with posterior direction of the platysma is systematic. It is associated or not, according to the importance with the platysma bands, with an anterior approach or with counter side incisions. A reinforcement of the angles is obtained by a fat grafting. One fills the mandibular ligament and one underlines the relief of the chin.

A comparative study of surgical techniques on the cervicomental angle in human cadavers

BACKGROUND

The cervicomental (CM) angle is formed by the horizontal plane of the submental region and the vertical plane of the neck.

OBJECTIVE

To compare the 2-dimensional effect of 4 surgical techniques on the CM angle in a human cadaver model.

DESIGN

Anatomic presurgical and postsurgical comparative study performed on human cadavers preserved with ethylene glycol.

SETTING

Academic medical research center in St Louis, Mo.

SUBJECTS

Twelve cadaver specimens with obtuse CM angles with heads attached to the sternum and upper thorax.

INTERVENTIONS

Standard superficial musculoaponeurotic system rhytidectomy techniques were performed on all cadaver heads. Four techniques were compared: (1) platysmal plication; (2) platysmal plication and plication of the anterior bellies of the digastrics; (3) platysmal plication, plication of the anterior bellies of the digastrics, and interlocking mastoid-to-mastoid sutures; and (4) platysmal plication and interlocking mastoid-to-mastoid sutures.

MAIN OUTCOME MEASURES

The comparative changes in CM angle, the distance between the mentum and CM angle (mentum-CM distance), and the distance between the sternum and CM angle (sternum-CM distance) obtained with each of the 4 surgical techniques. Anatomic characteristics of the cadavers were also noted.

RESULTS

On average, the CM angle was significantly reduced after all procedures (P<.001). The mean sternum-CM distance increased significantly (P =.01). A trend toward significance was observed in the change in mentum-CM distance (P =.10). The presence of a low hyoid was significantly associated with a smaller CM angle after surgery (P =.009) and demonstrated a trend toward significance with an increase in mentum-CM distance (P =.07), but it was not significantly associated with an increase in sternum-CM distance (P =.58). After controlling for the presence of a low hyoid, the mastoid-to-mastoid suture significantly reduced the CM angle by approximately 11.3 degrees (P =.002) and the sternum-CM distance by 1.15 cm (P<.001).

CONCLUSIONS

The CM angle and the sternum-CM distance were significantly affected by all procedures. The addition of the mastoid-to-mastoid suture had the greatest effect on the CM angle, and the reduction in CM angle was strongly associated with an increase in the sternum-CM distance. Presence of a low hyoid was the only preoperative factor associated with a significant postoperative reduction in CM angle.

Modifications in rejuvenation of the aging neck

Surgical treatment of the aging neck should be approached according to the particular anatomic characteristics of the patient. One size does not fit all when speaking of cervicofacial rejuvenation. This article discusses some of the newer techniques used in rejuvenation of the aging neck.

Neck recontouring with suture suspension and liposuction: an alternative for the early rhytidectomy candidate

The authors present a new technique that uses liposuction of the submental and submandibular areas to remove fat and initiate skin contracture. The technique also includes platysmal resection and the use of interlocking sutures running through a subcutaneous tunnel immediately below the submandibular border. The results of the procedure are a recontoured neck and highlighted mandibular border.

Male face lift in continuity with lower blepharoplasty

Rhytidectomy in the male is always more complicated than in the female. We present important modifications of the usual female-type face lift procedure that solve problems peculiar to the male patient. We describe a combined procedure of male rhytidectomy in continuity with the lower blepharoplasty incision. This technique increases the aesthetic results significantly. It provides an increased mechanical advantage in rotation and elevation of the cheek flap which is necessary to correct adequately the frequent redundancy and marked sagging in the lower face and neck often witnessed in the aging male patient. The preauricular non-hair-bearing portion of skin is left undisturbed with no change in the appearance of the sideburn. There is no elevation of the temporal hairline. The operative technique is fully described with emphasis on the complications we observed and how to avoid them. The results presented justify the slightly visible scarring that may occur in the temporal area which heals extremely well and is very acceptable aesthetically.