Neck Contouring and Rejuvenation in Male Patients Through Dual-Plane Reduction Neck Lift

Fat Grafting the Male Face

There are many developmental sexual dimorphisms of the human face, and thereby differences in aging based on sex. Sensitivity regarding the nature of the changes that are unique to the male face as well as understanding men's unique aesthetic goals will allow the skilled practitioner to tailor rejuvenating treatments accordingly. Fat grafting of the male face has not been extensively described but is an excellent tool for facial rejuvenation either as an adjunct or a stand-alone procedure. Each treatment area demands different techniques and special attention to avoid unintentional feminization.

Male Deep-Plane Face and Neck Lifting: Advanced and Customized Techniques

In this article, the authors describe their preferred advanced deep-plane techniques and modifications that have universally improved outcomes and durability in both men and women. Performing a proper extended deep-plane facelift and neck lift avoids the need to camouflage scars and stigmata of lifts seen in superficial musculoaponeurotic system plication and other techniques. In the author's experience, vertical vector deep-plane surgery is more durable, natural, and less reliant on lipofilling and volume addition. The subtleties of examination and analysis, surgical technique, clinical outcomes, and gender-specific considerations in the reconstruction of gonial and cervicomental angles, deep planar volumetric reduction, facial volumetric change, limited skin delamination, and revision techniques are discussed.

Anatomical Insights on the Cervical Nerve for Contemporary Face and Neck Lifting: A Cadaveric Study

BACKGROUND

Despite the significant roles it plays in the functions of the platysma and lower lip, the cervical branch of the facial nerve is often overlooked compared to other branches, but its consideration is critical for ensuring the safety of neck surgeries.

OBJECTIVES

The aim of this study was to clarify the anatomical discrepancies associated with the cervical branch of the facial nerve to enhance surgical safety.

METHODS

The study utilized 20 fresh-frozen hemiheads. A 2-stage surgical procedure was employed, beginning with an initial deep-plane facelift including extensive neck dissection, followed by a superficial parotidectomy on fresh-frozen cadavers. This approach allowed for a thorough exploration and mapping of the cervical nerve in relation to its surrounding anatomical structures.

RESULTS

Upon exiting the parotid gland, the cervical nerve consistently traveled beneath the investing layer of the deep cervical fascia for a brief distance, traversing the deep fascia to travel within the areolar connective tissue before terminating anteriorly in the platysma muscle. A single branch was observed in 2 cases, while 2 branches were noted in 18 cases.

CONCLUSIONS

The cervical nerve's relatively deeper position below the mandible's angle facilitates a safer subplatysmal dissection via a lateral approach for the release of the cervical retaining ligaments. Due to the absence of a protective barrier, the nerve is more susceptible to injuries from direct trauma or thermal damage caused by electrocautery, especially during median approaches.

Isolated Medial Platysmaplasty and Harmonization of the Lower Third of Face with Local Fat Autograft: A Case Report

One of the most common complaints of patients seeking plastic surgery is the presence of age-related changes in the lower third of the face. These often include vertical platysmal bands, a double chin, Venus rings, the absence of the cervico-mental angle, hypertonicity of the muscles in the mental area, and insufficient projection of the chin. The development and implementation of less-traumatic methods of correction of the lower third of the face and harmonization of the projection of the cervico-mental region remain relevant. This article discusses a comprehensive and individualized approach with minimally invasive techniques for correcting age-related changes in the lower third of the face and harmonizing the definition of the jawline. Isolated platysmaplasty with autologous local fat grafting to the chin is effective, safe, minimally invasive, and has a short rehabilitation period, with stable long-term aesthetic outcomes.

The Nuances and Techniques of Deep Plane Face and Neck Lifting to Maximize the Defined Neck and Jawline and Obtain a Sharp and Beautiful Neck Contour

This article seeks to expand on our understanding of lifting by utilizing the benefits of deep plane release and repositioning. The deep plane is a more logical and natural approach to lifting of the face and neck, lifting along the natural anatomic glide planes. Deep plane face and neck lifting have demonstrated superior results in the authors' experience with less dependence on ancillary measures such as fat grafting or implantation for midface volumization. The deep plane technique allows for the face and neck to be treated and lifted as a single composite unit, providing a more natural and long-lasting result and less distortion of underlying structures (i.e., mimetic muscle function). Among facelift surgeons, there is still debate and discussion over treatment of various regions including submandibular gland prominence, jowling and deepened prejowl sulcus, anterior digastric prominence, and a low hyoid. In this article, given the opportunity to share personal experiences, we seek to provide additional insight on the merits of deep plane release in rhytidectomy and our novel approaches to avoiding surgical failures.

Progressive Contouring of the Platysma With Barbed Sutures

BACKGROUND

As the prevalence of neck lift surgeries increases, the field is continually enriched by evolving techniques for enhancing neck aesthetics. While many recent publications focus on deep neck procedures, it is essential not to overlook the significance of platysmal contouring as an integral aspect of neck rejuvenation surgery. Accordingly, we would like to elucidate our unique approach to contouring the platysma.

OBJECTIVES

This study was designed to assess the efficacy of the progressive contouring concept, a technique in which the neck is reshaped with barbed sutures synergistically with other treatment strategies.

METHODS

Our study encompassed 337 patients who received neck rejuvenation treatment with the progressive contouring technique from 2014 to 2021. We conducted a retrospective review to evaluate the change in cervicomental angle (CMA) with Mirror software during the preoperative and postoperative stages.

RESULTS

The study sample predominantly comprised females (304 out of 337), with a median age of 61 years (24-88). Most patients (95%) underwent deep cervicoplasty, with a surgical net applied in all cases for skin adaptation. After a median follow-up of 14 months, significant improvements were observed in CMA values (reduced from 149.8° to 106.7°). This demonstrated statistically significant differences when comparing preoperative and postoperative outcomes.

CONCLUSIONS

Progressive shaping of the neck with barbed sutures is an effective technique in neck rejuvenation. It utilizes multipoint and multivector plication, particularly when integrated with other adjunctive surgical maneuvers.

LEVEL OF EVIDENCE: 3

The Mastoid Crevasse and 3-Dimensional Considerations in Deep Plane Neck Lifting

BACKGROUND

Advances in face and neck lifting involve release of tethering points along the superficial musculoaponeurotic system-platysma complex to freely manipulate the deep natural glide plane in the face and neck.

OBJECTIVES

The aim of this article was to determine a combination of deep plane techniques for addressing the face and neck and to elucidate, for the first time, a measurable endpoint for the gonial angle. Analysis of deep plane tethering and decussation zones was also undertaken.

METHODS

Extended deep plane surgery performed in 79 patients (158 hemifaces; age, 30-75 years; 95% female), over a 3-month period, was reviewed. Patients were followed for 1 year. Measurements were performed systematically during deep plane face and neck lifting.

RESULTS

Before intervention, the mean [standard deviation] gonial depth was 9.4 [3.6] mm on the left and 8.3 [2.7] mm on the right. The mean depth created below the gonial angle when measuring the traditional suspension to the anterior mastoid was 15.8 [3.3] mm on the left and 13.7 [2.5] mm on the right. The distance postoperatively when measuring the gonial depth after performing the crevasse technique was 23.2 [2.2] mm on the left and 22.5 [2.5] mm on the right. This represents a mean increase in the advancement of 7.4 mm on the left and 8.8 mm on the right (average, 8.1 mm) which was demonstrated to be statistically significant bilaterally (P < .0001).

CONCLUSIONS

The deep plane techniques described here aid manipulation of the deep plane and deep neck space, while also providing measurable endpoints and more effective modes of fixation by utilizing the mastoid crevasse. The use of techniques that release tension and allow redrape produce the most natural and well-balanced results.

LEVEL OF EVIDENCE: 4

Surgical Management of Platysma Bands: A Narrative Review of Evolving Concepts and Changing Techniques for Neck Rejuvenation

INTRODUCTION

Platysmal bands are an unappealing feature of the aging face. Incomplete understanding of anatomy and physiology of platysmal bands has led to a long period of flawed or incomplete treatment. This review aims to elucidate the correct study of platysmal bands along with the most recent surgical treatments.

MATERIALS AND METHODS

To identify all articles related to the topic of surgical management of platysmal bands, an extensive search was performed on PubMed and Medline databases for all articles related to platysmal bands from 1990 to 2023. The articles were then reviewed by 2 independent reviewers, and all relevant articles were selected. The search was narrowed down to clinical trials and cohort studies.

RESULTS

6130 articles were identified, of which 21 articles matched the inclusion criteria and were selected for the study totaling 2331 patients. Different surgical procedures were mentioned. Assessment of results was mostly subjective and done by the surgeon.

CONCLUSION

Composite platysma-skin flap repositioning as opposed to wide skin undermining with or without submental incisions is being gradually accepted as a valid approach, with closed platysma myotomy and platysma denervation emerging as effective less invasive surgical modalities. Nevertheless, merits of more extensive procedures involving wide skin undermining and anterior platysma plication must not be lightly forgotten.

LEVEL OF EVIDENCE III

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 .

The Functional Anatomy and Innervation of the Platysma is Segmental: Implications for Lower Lip Dysfunction, Recurrent Platysmal Bands, and Surgical Rejuvenation

BACKGROUND

Despite the central role of the platysma in face and neck rejuvenation, much confusion exists regarding its surgical anatomy.

OBJECTIVES

This study was undertaken to clarify the regional anatomy of the platysma and its innervation pattern and to explain clinical phenomena, such as the origin of platysmal bands and their recurrence, and the etiology of lower lip dysfunction after neck lift procedures.

METHODS

Fifty-five cadaver heads were studied (16 embalmed, 39 fresh, mean age 75 years). Following preliminary dissections and macro-sectioning, a series of standardized layered dissections were performed, complemented by histology and sheet plastination.

RESULTS

In addition to its origin and insertion, the platysma is attached to the skin and deep fascia across its entire superficial and deep surfaces. This composite system explains the age-related formation of static platysmal bands, recurrent platysmal bands after complete platysma transection, and recurrent anterior neck laxity after no-release lifting. The facial part of the platysma is primarily innervated by the marginal mandibular branch of the facial nerve, whereas the submandibular platysma is innervated by the "first" cervical branches, which terminate at the mandibular origin of the depressor labii inferioris. This pattern has implications for postoperative dysfunction of the lower lip, including pseudoparalysis, and potential targeted surgical denervation.

CONCLUSIONS

This anatomical study, comprised of layered dissections, large histology, and sheet plastination, fully describes the anatomy of the platysma including its bony, fascial, and dermal attachments, as well as its segmental innervation including its nerve danger zones. It provides a sound anatomical basis for the further development of surgical techniques to rejuvenate the neck with prevention of recurrent platysmal banding.

[Necklift: the optimal local technique for each neck]

Eine Vielzahl Patienten stört nur der Hals, sei es ein leichtes Doppelkinn, ein Fetthals, die auffälligen medialen Platysma-Stränge oder ein richtiger „turkey gobbler“. Für jede dieser Indikationen gibt es eine geeignete Operationsmethode, die Alter und Vorstellung der Patienten, aber auch die Beschaffenheit der Haut, deren Fettgehalt, und die Ausprägung der Falten im ganzen Gesicht und am Hals in Betracht zieht. Hier werden 8 verschiedene moderne Techniken vorgestellt, die einzeln, aber auch in Kombination durchgeführt, für jeden Patienten individuell ausgewählt werden können. 1. Ein „angedeutetes Doppelkinn“ wird abgesaugt 2. Ein „ausgeprägtes Doppelkinn“ wird horizontal exzidiert 3. Ein „reiner Fetthals“ wird abgesaugt und die Haut exzidiert 4. „Lockere Halshaut“ wird vertikal exzidiert oder als Facelift gestrafft 5. Ein ausgeprägter “Truthahnhals“ wird vertikal exzidiert oder als vertikales Facelift gestrafft