Deep Cervical Fascia Plication in the Difficult Neck Rhytidectomy

Abstract

Introduction: The purpose of the present article is to compare the long- and short-term results of two rhytidectomy techniques: the superficial musculoaponeurotic system (SMAS) plication and the plication of the deep cervical fascia (DCF). Materials and Methods: The areas of incision are injected with lidocaine 1% and epinephrine 1:200000. Klein's tumescent solution is then injected in the areas of skin dissection and liposuction. Submental and face liposuction are performed. Skin dissection is carried wide laterally to the anterior border of the SCM muscle, and, inferiorly, it extends near the sternal border if necessary. A 2–3-cm incision is made in the submental crease. Plication extends to the superior border of the thyroid cartilage. The malar fat pad is dissected and imbricated as described by Owsley. The SMAS is then dissected and imbricated extensively. Results: Plication of the DCF produces better long-term results than does SMAS plication and will benefit patients with severe sagging necks and sagging or bifid platysmata. Conclusions: Deep and wide plication of the platysma includes the DCF. The tenacious layer of fascia provides an anchorage which will maintain a tight neck over 8 years according to the author's experience.