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Mirra C, Savani L, Botti C, Botti G. Our 40 Years' Experience on Face and Neck Lift Procedures with High-SMAS Flap Techniques: How to Manage Secondary and Tertiary Surgeries. Aesthetic Plast Surg 2024:10.1007/s00266-024-04400-8. [PMID: 39327278 DOI: 10.1007/s00266-024-04400-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 09/11/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Facial aging drives a growing demand for esthetic procedures, with nonsurgical options often falling short in longevity compared to surgery. Despite primary face and neck lift techniques receiving substantial attention, revision procedures have been relatively overlooked in terms of their unique surgical management, complication incidence, and preventive strategies. METHODS The authors present a 40-year experience with revision face and neck lifts, comprising 283 cases. The primary focus was on the high-SMAS flap technique in revision surgeries, with data collected on complications compared to primary procedures and existing literature. Secondary analysis investigated the time-lapse between primary and revision surgeries in the author's series (secondary and tertiary rhytidectomy) compared to the literature findings. RESULTS Out of 283 cases, 232 were secondary and 51 were tertiary procedures. Overall complication rates in secondary cases mirrored those of primary procedures, with no statistically significant difference observed (p > 0.05). The mean interval between procedures was 9.0 years (range: 3.4-28.8 years), with a significant statistical difference (p < 0.05) observed between the first and second procedures (10.7 years, range: 3.8-18.8 years) and the second and third procedures (7.8 years, range: 3.5-10.8 years). CONCLUSION Results indicate that high-SMAS flaps yield consistent and satisfying outcomes, even in secondary and tertiary cases. Complication rates are comparable to primary surgeries, underscoring the importance of meticulous attention to detail in managing the complexities associated with previous surgeries and the aging process. LEVEL OF EVIDENCE IV 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)
- Carlo Mirra
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
- Villa Bella Clinic, Salò, Italy
| | - Luca Savani
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy.
- Villa Bella Clinic, Salò, Italy.
| | - Chiara Botti
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
- Villa Bella Clinic, Salò, Italy
| | - Giovanni Botti
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
- Villa Bella Clinic, Salò, Italy
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Hu H, Kim SB, Wan J, Chan LKW, Lee AKW, Sydorchuk O, Jalali A, Corrêa MC, Kim JS, Yi KH. Anatomical Guidelines and Technical Tips for Neck Aesthetics with Botulinum Toxin. Arch Plast Surg 2024; 51:447-458. [PMID: 39346003 PMCID: PMC11436334 DOI: 10.1055/s-0044-1788284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/16/2024] [Indexed: 10/01/2024] Open
Abstract
Botulinum toxin can be used for various purposes to enhance neck aesthetics, addressing concerns such as platysmal bands, optimizing the cervicomental angle, preventing worsening of horizontal neckline and decolletage lines during aging, submandibular gland hypertrophy, and hypertrophied superior trapezius muscle. Understanding the anatomy of muscles such as the trapezius, platysma, and submandibular gland is crucial for achieving desirable outcomes with botulinum toxin administration. Techniques for injecting botulinum toxin into these muscles are discussed, emphasizing safety and efficacy. Specific injection points and methods are detailed for treating platysmal bands, optimizing the cervicomental angle, addressing submandibular gland hypertrophy, and managing hypertrophied superior trapezius muscle. Careful consideration of anatomical landmarks and potential complications is essential for successful botulinum toxin injections in these areas.
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Affiliation(s)
- Hyewon Hu
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
| | - Soo-Bin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
| | - Jovian Wan
- Asia Pacific Aesthetic Academy, Hong Kong
| | | | | | | | | | | | | | - Kyu-Ho Yi
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
- Maylin Clinic (Apgujeong), Seoul, Korea
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Cakmak O, Buyuklu F, Kaya KS, Babakurban ST, Bogari A, Tunalı S. Anatomical Insights on the Cervical Nerve for Contemporary Face and Neck Lifting: A Cadaveric Study. Aesthet Surg J 2024; 44:NP532-NP539. [PMID: 38748536 DOI: 10.1093/asj/sjae111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
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.
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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] [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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Yi KH, Lee HJ, Lee JH, An MH, Lee K, Hu H, Kim MS, Choi H, Kim HJ. Sonoanatomy of the platysmal bands: What causes the platysmal band? Surg Radiol Anat 2023; 45:1399-1404. [PMID: 37644238 DOI: 10.1007/s00276-023-03236-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The platysmal band is created by the platysma muscle, a thin superficial muscle that covers the entire neck and the lower part of the face. The platysmal band appears at the anterior and posterior borders of the muscle. To date, no definite pathophysiology has been established. Here, we observed a lack of knowledge of the anatomy of the platysma muscle using ultrasonography in this study. METHODS We conducted a descriptive, prospective study observing the platysmal band in resting and contraction states to reveal muscle changes. Twenty-four participants (aged 23-57 years) with anterior and posterior neck bands underwent ultrasonography in resting and contracted states. Ten cadavers were studied aged 67-85 years to measure the thickness of the platysma muscle at 12 points: horizontally (medial, middle, lateral) and vertically (inferior mandibular margin, hyoid bone, cricoid cartilage, superior margin of clavicle). RESULTS The anterior and posterior borders of the platysma muscle were thicker than the middle of the platysma muscle when in a contracted state, and the muscle also had a convex shape when contracted. The thickness of the platysma muscle was not significantly different over 12 points in the resting state. During contraction, the platysma muscles contracted in the medial and lateral margins of the muscle, which was more significant in the posterior bands. CONCLUSION The anterior and posterior platysmal bands are related to muscle thickness during contraction. These observations support the change in platysmal band treatment only at the anterior and posterior border of the muscle.
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Affiliation(s)
- Kyu-Ho Yi
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul, 03722, Republic of Korea
- Maylin Clinic (Apgujeong), Seoul, Korea
| | - Hyung-Jin Lee
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Ji-Hyun Lee
- Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University, Seongnam, 13120, Korea
| | - Min Ho An
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Kangwoo Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul, 03722, Republic of Korea
| | - Hyewon Hu
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul, 03722, Republic of Korea
| | | | | | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul, 03722, Republic of Korea.
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Lindsey JT, Lee JJ, Phan HTP, Lindsey JT. Defining the Cervical Line in Face-Lift Surgery: A Three-Dimensional Study of the Cervical and Marginal Mandibular Branches of the Facial Nerve. Plast Reconstr Surg 2023; 152:977-985. [PMID: 36881027 DOI: 10.1097/prs.0000000000010369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND Continuous sub-superficial musculoaponeurotic system (SMAS) dissection in the cheek with subplatysmal dissection in the neck is an important feature of many face-lift techniques, yet the neural anatomy in this area remains unclear, and recommendations regarding continuous dissection of these adjacent areas vary widely. The purpose of this study was to define the vulnerability of the facial nerve branches in this transitional area from the face-lift surgeon's perspective and to specifically identify the location of the cervical branch penetration through the deep cervical fascia. METHODS Ten fresh and five preserved cadaveric facial halves were dissected under 4× loupe magnification. The skin was reflected, followed by elevation of a SMAS-platysma flap, with identification of the location of cervical branch penetration through the deep cervical fascia. The cervical and marginal mandibular branches were then dissected retrograde through the deep cervical fascia to the cervicofacial trunk to confirm identifications. RESULTS Cervical and marginal mandibular branch anatomy was found to be similar to that of the other facial nerve branches, all of which initially course deep to the deep fascia in their postparotid course. The emergence of the terminal branch or branches of the cervical branch through the deep cervical fascia was consistently at or distal to a line from a point 5 cm below the mandibular angle on the anterior border of the sternocleidomastoid muscle to the point where the facial vessels course over the mandibular border (cervical line). CONCLUSIONS Continuous dissection of the SMAS in the cheek, with subplatysmal dissection in the neck crossing over the mandibular border, is possible without jeopardizing the marginal mandibular or cervical branches if done proximal to the cervical line. This study serves as the anatomical justification for continuous SMAS-platysma dissection, and has implications for all types of SMAS flap manipulations.
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Affiliation(s)
- John T Lindsey
- From the Department of Surgery, Vassar Brothers Medical Center, Nuvance Health
| | | | | | - John T Lindsey
- Division of Plastic and Reconstructive Surgery, Tulane University
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Faria GEL, Palo JS, Torres AR, Machado ACHR, Boggio RF. RELAX and FIRMNESS: The Combination of Muscle Relaxation with Botulinum Toxin and Collagen Biostimulation with Calcium Hydroxyapatite for the Treatment of the Cervical Region. Clin Cosmet Investig Dermatol 2023; 16:2781-2791. [PMID: 37823019 PMCID: PMC10563772 DOI: 10.2147/ccid.s430762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023]
Abstract
Introduction There are several therapeutic modalities for neck rejuvenation, especially calcium hydroxylapatite. Botulinum toxin, by relaxing the mm. platysma, also provides improvement in facial contour. Combination treatments for this region are usually recommended as they offer better results. Objective This study evaluated the efficacy and safety of the joint dilution of both products (Relax and Firmness - RF), applied in the same device, based on the treatment in the topography of the platysma muscle, ie, starting from the lower third of the face and extending to the neck. Methods Prospective, blinded, controlled study with 10 participants randomly assigned to RF and 5 in the control group (treated with CaHA only). Results were recorded through the Vectra platform and subjectively evaluated through the GAIS scale by participants and blinded evaluators. Objective analysis was performed using corneometry. Times evaluated: pre-treatment, 30 and 90 days. Considered statistically significant when p<0.1. Results 100% of the RF group reported "excellent improvement" at D30 and 30% at D90. In the control group, 100% reported "very improved" at D30 and 20% rated "excellent improvement" at D90. A higher and earlier satisfaction rate was observed in the RF group. No difference in corneometry was found between the groups at D30. At D90, the control group had a mean increase of 0.24 versus 5.17 in the RF group (p-value=0.089*). When we analyzed the percentage variation from baseline, the control group was stable, while the RF showed a mean increase of 8.89% (p-value=0.062*). Discussion We demonstrated the safety and effectiveness of the association of both products, diluted and applied together through microcannulas. Minimization of punctures, patient comfort, and technique based on the anatomy of the platysma muscle underlie the technique. High rates of early satisfaction due to botulinum toxin (Relaxation) and late satisfaction due to CaHA (Firmness).
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Grants
- Merz Aesthetics LATAM, through its affiliate in Brazil, Merz Farmaceutica Comercial Ltda, funded translation to English, statistical analysis, and open access fee
- Despite this support, this study was conducted with autonomy and independence by the medical authors, and Merz Farmacêutica Comercial, Ltda
- participation or influence on design, conduct, collect, assess, or evaluate the presented data
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Affiliation(s)
| | - Juliana S Palo
- Cosmiatry Department, Instituto Boggio, São Paulo, SP, Brazil
| | - Andre R Torres
- Cosmiatry Department, Instituto Boggio, São Paulo, SP, Brazil
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Atiyeh B, Emsieh S, Oneisi A, Hakim C, Ghieh F. Surgical Management of Platysma Bands: A Narrative Review of Evolving Concepts and Changing Techniques for Neck Rejuvenation. Aesthetic Plast Surg 2023; 47:1824-1834. [PMID: 37653178 DOI: 10.1007/s00266-023-03604-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023]
Abstract
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 .
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Affiliation(s)
- Bishara Atiyeh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Saif Emsieh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Oneisi
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christopher Hakim
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Ghieh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Kim YG, Jeon A, Hwang K, Chung YH, Han SH. The Distribution of the Nerves and Arteries of the Platysma for Clinical Applications. J Craniofac Surg 2023; 34:2206-2211. [PMID: 37610024 DOI: 10.1097/scs.0000000000009592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/25/2023] [Indexed: 08/24/2023] Open
Abstract
This study aimed to provide anatomical data on the platysma for clinical procedures. The authors obtained 25 specimens from 15 adult Korean cadavers (9 men, 6 women; mean age, 72 years; range, 61-85 years). Lines connecting the gonion with the gnathion (G-GN) and the acromial end (acromial end of the clavicle) with the sternal end (sternal end of the clavicle) were used as references. Modified Sihler staining was used to trace the nerves distributed in the platysma. The superior border values of the platysma were 12.1 ± 2.7 mm, 31.5 ± 5.3 mm, 42.4 ± 5.6 mm, and 61.7 ± 6.4 mm, respectively, for sections 2 through 5 on the G-GN line. The inferior border values of the platysma were 83.6 ± 19.1 mm, 80.1 ± 14.0 mm, 74.8 ± 14.5 mm, 67.2 ± 13.7 mm, and 54.6 ± 7.1 mm, respectively, for the 5 sections on the acromial end of the clavicle-sternal end of the clavicle line. In the hyoid bone, cricoid cartilage, and jugular notch, the mean distance between the bilateral platysma was 14.4 ± 2.2 mm, 22.6 ± 10.6 mm, and 51.1 ± 15.7 mm, respectively. The mean angle at the cervical branch of the facial nerve and the anterior border of the sternocleidomastoid muscle sternal head was 28.7 ± 2.6 degrees and 53.4 ± 7.7 degrees from the G-GN line, respectively. The upper third of the platysma was supplied by branches of the facial artery and submental artery. The middle third was supplied by branches of the occipital artery and received its direct blood supply from branches of the external carotid artery. The lower third was supplied by branches of the transverse cervical artery. The authors hope that the results of this study will be helpful for rejuvenation procedures of the neck.
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Affiliation(s)
- Ye-Gyung Kim
- Department of Anatomy, College of Medicine, Chung-Ang University
| | - Anna Jeon
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea
| | - Kun Hwang
- Department of Plastic Surgery, Armed Forces Capital Hospital, Bundang-gu, Seongnam City, Gyeonggi-do, and Ewha Medical Academy, Ewha Womans University Medical Center
| | - Yoon-Hee Chung
- Department of Anatomy, College of Medicine, Chung-Ang University
| | - Seung-Ho Han
- Department of Anatomy, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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Minelli L, Wilson JL, Bravo FG, Hodgkinson DJ, O'Daniel TG, van der Lei B, Mendelson BC. The Functional Anatomy and Innervation of the Platysma is Segmental: Implications for Lower Lip Dysfunction, Recurrent Platysmal Bands, and Surgical Rejuvenation. Aesthet Surg J 2023; 43:1091-1105. [PMID: 37186556 DOI: 10.1093/asj/sjad148] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023] Open
Abstract
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.
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Sun W, Ma H, Song T. The Underappreciated Role of the Platysma Muscle in the Perioral Expressions in Young Adults. Aesthet Surg J 2023; 43:195-201. [PMID: 35947469 DOI: 10.1093/asj/sjac222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The platysma is involved in lower face movement, yet limited information on its functional role when making perioral expressions is available. OBJECTIVES The aim of this study was to use 3-dimensional (3D) photogrammetry to analyze platysma activity when making expressions. METHODS Standardized frontal-view 3D images were obtained from 54 volunteers. Three perioral expressions were analyzed: a full smile, mouth corner depression, and a grimace to show the lower teeth. Positive volume change in the "heat map" of the neck skin surface-determined by the superimposed image subtraction technique-served as a sensitive indicator of platysma contraction. RESULTS When making the 3 expressions, the proportions of platysma contraction were 42.6%, 75.9%, and 92.6%, respectively. The platysma worked as a more critical dynamic force than expected. In most smiles involving the platysma, its upper portion contracted. With the laterally downward traction on the lower lip increasing, the upper and lower portions of the platysma contracted together and formed muscular bands. The platysma contracted extensively in the other 2 expressions. In some cases, platysma bands were observed to form due to vigorous contraction of muscle fibers. In addition, the platysma was found to be highly functionally active in young individuals. CONCLUSIONS This study introduced a simple method that can sensitively identify the functional status of the platysma. The results showed the platysma's highly active function in perioral expressions in young adults. These findings may assist surgeons in personalized decision-making toward platysma muscle-weakening strategies and work as an objective tool for outcome evaluation. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Weiyi Sun
- Plastic Surgery Hospital, Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hengyuan Ma
- Plastic Surgery Hospital, Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Song
- Department One, Plastic Surgery Hospital, Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Yi KH, Lee JH, Lee K, Hu HW, Lee HJ, Kim HJ. Anatomical Proposal for Botulinum Neurotoxin Injection Targeting the Platysma Muscle for Treating Platysmal Band and Jawline Lifting: A Review. Toxins (Basel) 2022; 14:toxins14120868. [PMID: 36548765 PMCID: PMC9783622 DOI: 10.3390/toxins14120868] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/03/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
The platysma muscle is a thin superficial muscle that covers the entire neck and lower part of the face. The platysma muscle is the primary target muscle for botulinum neurotoxin injection therapy aimed at treating platysmal band and lower facial lifting. In the procedure of botulinum neurotoxin injection therapy, a lack of knowledge of the anatomy of the platysma muscle and the properties of botulinum neurotoxin can lead to side effects such as dysphagia, dysphonia, and weakness of the neck muscles. Anatomically safe injection sites have been proposed for the platysma muscle, and the appropriate injection technique has been reviewed. We proposed optimal injection sites based on the external anatomical features of the mandible. The aim of these proposal was to standardize the procedure for the effective use of botulinum neurotoxin injections by minimizing the dose unit and injection points and thereby preventing adverse events.
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Affiliation(s)
- Kyu-Ho Yi
- Wonju Public Health Center, Wonjusi 26417, Republic of Korea
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul 03722, Republic of Korea
| | - Ji-Hyun Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul 03722, Republic of Korea
| | - Kangwoo Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul 03722, Republic of Korea
| | - Hye-Won Hu
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul 03722, Republic of Korea
| | - Hyung-Jin Lee
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul 03722, Republic of Korea
- Correspondence: ; Tel.: +82-2-2228-3047
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Phan K, Younessi S, Dubin D, Lin MJ, Khorasani H. Emerging off-label esthetic uses of botulinum toxin in dermatology. Dermatol Ther 2021; 35:e15205. [PMID: 34792262 DOI: 10.1111/dth.15205] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
Abstract
Botulinum toxin is a neurotoxic protein produced by Clostridium botulinum, the bacterium responsible for botulism. Botulinum toxin was first used for therapeutic indications in the 1970s for the treatment of strabismus. With greater understanding of its underlying physiology and safety profile, the use of botulinum toxin has now expanded to a range of cosmetic and medical indications. We performed a systematic review of current literature on the applications of botulinum toxin on off-label esthetic uses. Electronic databases were searched for original published studies including randomized trials, observational or cohort studies, as well as relevant case reports. To add to the body of evidence, our review summarizes and synthesizes key study characteristics, results, and level of evidence for each use case. Although the body of evidence remains weak, there is increasing support for the use of botulinum toxin in emerging off-label esthetic uses of botulinum toxin in dermatology.
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Affiliation(s)
- Kevin Phan
- Department of Dermatology, St George Dermatology and Skin Cancer Centre, Sydney, Australia
| | - Shannon Younessi
- Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Danielle Dubin
- Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matthew J Lin
- Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hooman Khorasani
- Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Discussion: Anatomy behind the Paramedian Platysmal Band: A Combined Cadaveric and Computed Tomographic Study. Plast Reconstr Surg 2021; 148:989-991. [PMID: 34705772 DOI: 10.1097/prs.0000000000008415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Anatomy behind the Paramedian Platysmal Band: A Combined Cadaveric and Computed Tomographic Study. Plast Reconstr Surg 2021; 148:979-988. [PMID: 34529598 DOI: 10.1097/prs.0000000000008414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The muscular hypothesis explanation of the pathophysiology behind paramedian platysmal bands does not seem to provide a sufficient explanation for the clinical presentation of these platysmal bands in aged individuals with cervical soft-tissue laxity. The purpose of this study was to investigate the fascial relationships of the anterior neck to enhance appropriate surgical treatment. METHODS Retrospective analysis of computed tomographic scans of 50 Caucasian individuals (mean age, 55.84 ± 17.5 years) and anatomical dissections of 20 Caucasian and 10 Asian body donors (mean age, 75.88 ± 10.6 years) were conducted. Fascial adhesions were classified according to platysma fusion types, and platysma mobility was tested during dissection procedures. RESULTS Fusion between the left and right platysma muscles occurred in 64 percent in the suprahyoid region and in 20 percent at the thyroid cartilage, and in 16 percent, the platysma attached to the mandible without fusion. In the absence of muscular fibers, a fascial adhesion zone with limited mobility was observed where the superficial cervical fascia fused with the investing layer of the deep cervical fascia. CONCLUSIONS Muscular contraction of the platysma results in elevation of the most medial platysma muscle fibers, which are not attached in the fascial adhesion zone. The presence of a fatty layer deep to the platysma enables platysmal movement and anterior and inferior gliding of the skin and platysma when cervical soft-tissue laxity exists. Surgical treatments should include transection of the fascial adhesion; this could potentially prevent the recurrence of paramedian platysmal bands.
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16
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Hashem AM, Couto RA, Surek C, Swanson M, Zins JE. Facelift Part II: Surgical Techniques and Complications. Aesthet Surg J 2021; 41:NP1276-NP1294. [PMID: 33558887 DOI: 10.1093/asj/sjab081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although previous publications have reviewed face and necklift anatomy and technique from different perspectives, seldom were the most relevant anatomical details and widely practiced techniques comprehensively summarized in a single work. As a result, the beginner is left with a plethora of varied publications that require sorting, rearrangement, and critical reading. A recent survey of US plastic surgery residents and program directors disclosed less facility with facelift surgery compared with aesthetic surgery of the breast and trunk. To this end, 4 of the widely practiced facelift techniques (ie, minimal access cranial suspension-lift, lateral-SMASectomy, extended-SMAS, and composite rhytidectomy) are described in an easy review format. The highlights of each are formatted followed by a summary of complications. Finally, the merits and limitations of these individual techniques are thoroughly compared and discussed. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Ahmed M Hashem
- Department of Plastic Surgery at Cairo University, Cairo, Egypt
| | | | | | - Marco Swanson
- Department of Plastic Surgery at Case Western University, Cleveland, OH, USA
| | - James E Zins
- Department of Plastic Surgery at Cleveland Clinic Foundation, Cleveland, OH, USA
- Facial Surgery co-section editor for Aesthetic Surgery Journal
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Abstract
Facial rejuvenation procedures have become more commonly performed due to an increasing elderly population and greater general public acceptance. As a result, patients are now increasingly undergoing secondary and tertiary rhytidectomies to treat natural aging and/or to correct complications from prior procedures. Revision face and neck lifts are more complex by nature of the procedure and require a comprehensive preoperative assessment for enhanced outcomes. In this review, we discuss the preoperative evaluation, surgical challenges encountered, primary face and neck lift deformities, and their surgical management for patients undergoing secondary face and neck lifts.
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Affiliation(s)
- Rami P Dibbs
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Edward Chamata
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Andrew M Ferry
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jeffrey D Friedman
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
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Qiu H, Zhao R, Cao L, Liu S, Yu D, Wang H. The Aesthetic Concerns of Botulinum Toxin Type A in the Treatment of Neck Wrinkles: A Systematic Review. Aesthet Surg J 2021; 41:NP592-NP601. [PMID: 33220046 DOI: 10.1093/asj/sjaa312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aged and unattractive appearance of the neck has a profound impact on the overall youthfulness and attractiveness of the face. Neck wrinkles are one of the manifestations of neck skin aging. Botulinum toxin type A (BTX-A) represents an effective means for aesthetic neck rejuvenation as novel facial rejuvenation technologies are progressively developed. OBJECTIVES The objective of this article was to review the pertinent clinical literature for descriptions of BTX-A treatments and evaluations of their efficacy and safety for neck wrinkles. METHODS The Web of Science, PubMed, EMBASE, Cochrane Library, and SCOPUS databases were searched from inception to April 30, 2020, for the existing literature, which is presented along with the authors' experience with neck wrinkles. RESULTS Overall, 112 women between 24 and 65 years of age were included in 3 studies of monotherapy and 2 studies of multimodal combination therapy. BTX-A has been reported in combination with other approaches, including intensity focused ultrasound, cohesive polydensified matrix hyaluronic acid, and microfocused ultrasound. Only 1 of the 3 reports on monotherapy had a less than 50% satisfaction and improvement rate. Overall, BTX-A attained high patient satisfaction without serious and persistent side effects, notwithstanding the relatively limited sample size. CONCLUSIONS The existing research cannot strongly prove the aesthetic effect of BTX-A in neck wrinkles. However, BTX-A is probably an effective technology in response to the growing demand for neck wrinkle treatment, whether in a single treatment or combined treatment. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- He Qiu
- Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Rui Zhao
- Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Lideng Cao
- Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Shuo Liu
- Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Donglei Yu
- Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Hang Wang
- Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, China
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Friedman O, Shamban A, Fabi S, Duncan DI, Artzi O. The Aging neck-A Case base treatment algorithm. J Cosmet Dermatol 2020; 20:569-576. [PMID: 33340202 DOI: 10.1111/jocd.13877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Effective nonsurgical treatments for the aging face are widely accepted and utilized. Although changes in the aging neck, often patients to seek esthetic rejuvenation protocols are neither well defined nor well designed. Increasingly, patients desire less invasive cosmetic treatments with less morbidity and downtime. A significant challenge exists in managing expectations and educating patients about the pros and cons of a surgical approach compared to the plethora of nonsurgical options. When equipped with state of the art information and technique, using a multi-modality nonsurgical approach, surprisingly outstanding results may be obtained. AIMS In this paper, we aim to revisit the neck's anatomy and then demonstrate current nonsurgical techniques in managing actual cases. METHODS To achieve that, we have utilized an intuitive four-point grading scale to guide both physician and patient regarding appropriate treatment combinations. RESULTS The proposed four-point scale was applied to six patients and their treatment plan was described in detail. CONCLUSIONS Skin laxity is not the only factor that comes into play when assessing the neck. careful analysis of the neck and face hold the key for treatment choice and execution.
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Affiliation(s)
- Or Friedman
- Maccabi Healthcare Services, Tel Aviv, Israel
| | - Ava Shamban
- Univ Calif Los Angeles, Los Angeles, CA, USA
| | - Sabrina Fabi
- University of California Los Angeles, Los Angeles, CA, USA
| | - Diane I Duncan
- Plastic Surgical Associates of Fort Collins, P.C., Fort Collins, CO, USA
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Abstract
AbstractOver the history of facial rejuvenation surgery there has been a progressive assimilation of knowledge about the anatomy of neck structures that are central to the manifestations of the aging neck. These advances in knowledge have been accompanied by the innovation and introduction of several surgical techniques to restore the neck to a more youthful appearance. The rejuvenation of the aging neck frequently incorporates a consideration and execution of accepted methods to restore the platysma muscles to a more aesthetic form. Lasting and dependable surgical techniques remain somewhat elusive and late failures in the neck continue to be a frustration for both patients and surgeons.In this manuscript, the author reviews some of the more enduring and innovative methods to manage the platysma in facelifting and cites the rationale and limitations of the various techniques. The concept of the restoration of an effective platysma “sling” in the upper neck to eliminate platysma bands and recreate a defined jawline is highlighted. A framework of patient evaluation and decision making is presented, and a suggested individualized application of accepted surgical maneuvers is suggested.
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Affiliation(s)
- Fred G. Fedok
- Fedok Plastic Surgery, Foley, Alabama
- Department of Surgery, University of South Alabama, Mobile, Alabama
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21
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Skin Excursion with Cannula Lipodissection and the Anatomical Implications of Superficial Musculoaponeurotic System Movement in the Tumescent Face Lift. Plast Reconstr Surg 2020; 146:269-276. [PMID: 32740573 DOI: 10.1097/prs.0000000000006977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The tumescent face lift uses the concept of subcutaneous cannula lipodissection of the neck, as opposed to wide skin undermining. Lipodissection mobilizes soft tissue while preserving perforating neurovascular branches. The purpose of this study is two-fold: (1) to compare the skin recruitment with subcutaneous lipodissection of the neck alone versus wide undermining and (2) to examine the effect of superiorly oriented superficial musculoaponeurotic system (SMAS) movement on jowl excursion in the tumescent face lift. METHODS A cadaveric study was performed on five fresh tissue cadavers. Postauricular skin excursion was measured following subcutaneous lipodissection and then measured again after traditional, wide undermining of the neck skin. Jowl excursion (in reference to the mandibular border) was measured following superiorly oriented SMAS excursion. An electronic force gauge was used to measure force application during measurements. RESULTS Cannula lipodissection resulted in a mean skin excursion of 41.9 mm. There was no significant difference in skin excursion compared to wide undermining (41.9 mm versus 42.1 mm; p = 0.785). Jowl position, in reference to the mandibular border, moved superiorly by a mean distance of 18.3 mm with vertical SMAS excursion. CONCLUSIONS Subcutaneous cannula lipodissection results in equivalent skin recruitment in comparison to wide undermining of the neck. A superior vector of pull on the SMAS results in vertical excursion of the jowl in reference to the mandibular border.
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Platysma and the cervical superficial musculoaponeurotic system — Comparative analysis of facial crease and platysmal band development. Ann Anat 2020; 227:151414. [DOI: 10.1016/j.aanat.2019.151414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/20/2019] [Accepted: 08/05/2019] [Indexed: 11/19/2022]
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Abstract
An aesthetically pleasing neck contour remains the cornerstone for facial rejuvenation. In this article a detailed description of the anatomy pertaining to the necklift surgery is provided, with supplemental cadaver video dissections going over the most common and novel necklift techniques.
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Affiliation(s)
- Ali H Charafeddine
- Center for Plastic & Reconstructive Surgery, 5333 McAuley Drive, Suite 5001, Ypsilanti, MI 48197, USA
| | - Rafael A Couto
- Cleveland Clinic Foundation, 9500 Euclid Avenue, A60, Cleveland, OH 44195, USA
| | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, A60, Cleveland, OH 44195, USA.
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Sugrue CM, Kelly JL, McInerney N. Botulinum Toxin Treatment for Mild to Moderate Platysma Bands: A Systematic Review of Efficacy, Safety, and Injection Technique. Aesthet Surg J 2019; 39:201-206. [PMID: 30052764 DOI: 10.1093/asj/sjy179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Platysma bands are characteristic of an aging neck. Resection and plication of the platysma muscle is the basis of treatment. However, unfavorable surgical outcomes and improved understanding of platysma band etiology have shifted treatment towards nonsurgical rejuvenation. Objectives The aim of this paper was to assess the efficacy, injection techniques, and complications associated with botulinum toxin injection for the treatment of platysma bands. Methods A systematic literature search was performed to identify articles reporting botulinum toxin injections for platysma bands in neck rejuvenation. The search included published articles in three electronic databases-Ovid MEDLINE, EMBASE, and the Cochrane Library-between January 1985 and December 2017. Results Three studies met the inclusion criteria, with a total of 78 patients undergoing botulinum toxin injection for platysma bands. Incobotulinumtoxin A was used in 62.3% (n = 45/78) of patients, with 38.4% (n = 30/78) receiving abobotulinumtoxin A. Efficacy was assessed using the Merz platysma score scale. A mean score improvement of 2.0 points, with a response rate of 93.7%, was observed after 14 ± 2 days. At 3 months, the mean score improvement was 1.2 points with a response rate of 86%. Patient-reported metrics demonstrated an improvement in 91% (n = 71/78) of subjects. The three studies used a standard injection technique, with a maximum 20 IU of incobotulinumtoxin A and 5 U abobotulinumtoxin A administered per band. Complications were reported in 15.4% (n = 12/78) of patients, with none requiring further intervention. Conclusions Botulinum toxin is a highly effective treatment for isolated platysma bands. A safe injection technique is described and recommended for clinical practice. Level of Evidence 4
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Affiliation(s)
- Conor M Sugrue
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - Jack L Kelly
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - Niall McInerney
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
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Sinno S, Thorne CH. Cervical Branch of Facial Nerve: An Explanation for Recurrent Platysma Bands Following Necklift and Platysmaplasty. Aesthet Surg J 2019; 39:1-7. [PMID: 30052756 DOI: 10.1093/asj/sjy150] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Recurrent platysma bands remain a common problem in neck rejuvenation. Objectives The goals of this cadaver study were to document the course of the cervical branches of the facial nerve and investigate the pattern of platysma muscle innervation before and after various platysmaplasty maneuvers. Methods A total of 8 fresh cadaver specimens were dissected for a total of 16 hemifaces/necks. After subcutaneous undermining and identification of the main trunk of the facial nerve, the cervical branch was dissected as distally/anteriorly as possible under loupe magnification. The following 4 platysmaplasty maneuvers were each performed on 4 hemifaces/necks: platysma window, extended SMAS with platysma flap, full width platysma transection, and lateral skin-platysma displacement (LSD). Upon completion of the techniques, the integrity of the cervical branches was evaluated. Results Contrary to some reports, all specimens in this study had only 1 main cervical branch. There were no branches detectable under 3.2× magnification until branches were given off to the platysma muscle at approximately the location of the facial vessels. The main cervical branch continued distally/anteriorly to the medial edge of the muscle below the thyroid cartilage. After performing the various platysma techniques, all cervical branches were in continuity in all specimens. Specifically, the main cervical branch was in continuity to the medial border of the muscle caudal to all platysmaplasty maneuvers. Conclusions Undermining the platysma muscle results in no injury to platysmal innervation unless continued beyond the facial vessels. Recurrent bands are likely related to persistent innervation of the medial platysma, which remains intact cranial and caudal to any described platysmal transection maneuvers.
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Affiliation(s)
| | - Charles H Thorne
- Department of Plastic Surgery, Lenox Hill Hospital and Manhattan Eye, Ear and Throat Hospital, New York, NY
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Hodgkinson DJ. The Fate of Fogli's Lore's Fascial Platysma Fixation Optimalising the Results of Fogli's Neck Lift Procedure. Aesthetic Plast Surg 2018; 42:1002-1012. [PMID: 29770861 DOI: 10.1007/s00266-018-1147-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/28/2018] [Indexed: 10/16/2022]
Abstract
The author has modified previously described techniques of the superior suspension of the platysma muscle to Lore's fascia by developing an auriculoplastysmal fascial flap, which detaches the posterior platysma from its retaining ligaments to the sternomastoid muscle. Anterior to this flap, the platysma muscle is undermined and suture captured with three throws of a permanent 2.0 Tevdek suture. This suture and its three throws are fixed anterior to the tragus, which includes Lore's fascia and on tightening elevates the whole of the anterior neck as well as defines the cervicomental angle. A separate submental dissection may be required to assess and deal with pathology and resect excessive laxity of the platysma which has not been adequately addressed by the lateral superior traction suturing technique. Follow-up of fifteen cases of secondary facelift surgery with recurrent neck laxity demonstrated the fate of the suturing to Lore's fascia. The permanent knot at the pre-tragal fixation point descended approximately 3 cm from the original position at the pre-tragal region. Secondary surgery is facilitated by capture of the knot and re-suturing it to its original primary position, restoring the neck to the approximate pre-operative condition and avoiding excessive dissection including return to the submental incision.Level of Evidence IV 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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Commentary on A Novel Modality for Neck Rejuvenation. Dermatol Surg 2017; 44:218-219. [PMID: 28945620 DOI: 10.1097/dss.0000000000001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Botulinum Toxin for Neck Rejuvenation: Assessing Efficacy and Redefining Patient Selection. Plast Reconstr Surg 2017; 140:9e-17e. [PMID: 28654586 DOI: 10.1097/prs.0000000000003429] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The "Nefertiti lift" consists of injecting the platysmal bands and the inferior border of the mandible with botulinum toxin. No clinical trial has evaluated its effect on the different lower face and neck aging components, and little is known about the clinical characteristics that predict treatment success. METHODS Patients were injected with abobotulinumtoxinA along the inferior border of the mandible and into the platysmal bands. Using standardized preinjection and postinjection photographs, the jowls, marionette lines, oral commissures, neck volume, and platysmal bands at maximal contraction and at rest were assessed with validated photonumeric scales. In addition, the overall appearance of the lower face and neck was evaluated by the Investigators and Subjects Global Aesthetic Improvement Score. Pain and patient satisfaction rates were also evaluated. RESULTS Thirty patients were injected with a mean dose of 124.9 U of abobotulinumtoxinA per patient. Platysmal bands at rest and with maximal tension reached a statistically significant improvement. The other components showed a tendency for improvement but did not reach statistical significance; 93.3 percent of investigators and patients rated the overall results as improved, and 96.6 percent of patients were satisfied with their results. When comparing the patients who improved the most to all the other patients, they had lower preinjection region-specific scores. CONCLUSIONS The Nefertiti lift can be used on its own or in conjunction with other rejuvenating procedures. It is particularly helpful in younger patients with platysma muscle hyperactivity and retained skin elasticity. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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