Revisional neck surgery

Abstract

Dr. Pitman: The first patient is a 61-year-old woman who is seeking rejuvenation of her face and neck (Figure 1). Fourteen years ago she underwent a superficial musculoaponeurotic system (SMAS)–platysma face and neck lift and lipoplasty of the neck. Dr. Aston, how would you treat this patient? Figure 1 This 61-year-old woman is seeking rejuvenation of the face and neck. Fourteen years ago she underwent neck lipoplasty and SMAS-platysma face and neck lift. Gerald Pitman, MD Dr. Aston: I see laxity in the lower portion of her face. In the front view, I see prominent labiomandibular folds and platysma laxity under the chin that does not appear to extend down to the first cervical crease. In the three-quarter and profile views, I see some laxity along the jawline and in the jowl area, so she would benefit from a secondary face lift. Sherell J. Aston, MD In the grimace view, there is some weakness of lower lip depressor function on the left evidenced by diminished pull down of the left lower lip and less dental show on the patient's left side. We do not know what work was initially done to her face. However, work on the anterior neck surface with platysma plication, or dissection in that area, could obviously damage the marginal mandibular branch. The damage could have occurred with a lateral platysma SMAS dissection. Dr. Pitman: She had lipoplasty of the anterior neck and lateral SMAS elevation. Dr. Aston: Then I suspect the damage was connected with undermining of the SMAS platysma flap. Dr. Pitman: Would the past injury influence your present approach? Dr. Aston: Not really. I would counsel her, pointing out that she has lower lip weakness along with platysma laxity, making absolutely sure she understood. I would be aware of the weakness when dissecting, but it would …