The Lateral Nasal Osteotomy in Rhinoplasty: An Anatomic Endoscopic Comparison of the External versus the Internal Approach

Abstract

The significance of a large, bulky digastric muscle in contributing to an objectionable neck contour should be appreciated in aesthetic surgery. Over the last several years, patients have achieved improved correction of neck contour problems by precise anatomic diagnosis followed by appropriately planned and executed repair. The submental contour correction in the past addressed only problems of the skin, subcutaneous fat, platysma muscle, subplatysmal fat, submaxillary glands, thyroid cartilage, and hyoid bone. Techniques that address each of these components can result in excellent rejuvenation of the neck and mandibular border. However, on occasion, after application of these conventional techniques, a still less than adequate neck contour may result. This results from a fullness in the submental region. Careful preoperative and intraoperative assessment may reveal the etiology to be a large, bulky anterior belly of the digastric muscle. To address this problem, the surgical technique of partial resection (tangential excision) of the anterior belly of the digastric muscle is performed. To date, this technique has been performed on 21 patients who demonstrated an objectionable bulge in the submental region after correction of skin, fat, platysma, and submaxillary gland problems. No untoward result or complication has been associated with this procedure. The benefits have been a pleasing, well-contoured submental area, prevention of residual fullness, ease of procedure, and avoidance of the need for secondary neck contouring procedures.