Yes to a tight neck, no to a rhytidectomy

Abstract

Many patients emphatically refuse a face lift to improve the shape of the cervico-mandibular angle, but are nevertheless not prepared to put up with ugly skin folds and the platysma bands. As an alternative we can offer a platysmaplasty in combination with a submental skin excision, often used with liposuction in the chin and cheek area. From December 1995 to April 1999, 20 patients between the ages of 33 and 82 (mean age 57), 12 female and eight male were operated on using a submental incision. A cervical skin flap with a thin layer of fat was raised. It was taken down to the larynx and its length was 4–5 cm. Most of the fat was taken off the platysma muscle up to the external jugular vein, where this crosses the sternocleidomastoid muscle. The platysma edges were raised and joined in the midline, using a running suture. Any excess skin was excised in a spindle-shaped fashion. In 14 cases additional liposuction above the mandible was necessary. In three cases no platysma tightening was indicated, and on 3 occasions a midline skin excess was excised incorporating a Z-plasty. In summary, the operations are performed under local anesthesia and therefore do not cause the patient too much stress. If necessary, subplatysmal fat can also be removed in the same operation. The median platysma muscle edges are approximated in the midline starting at the mandibular symphysis, and this is continued at least down to the middle of the neck above the larynx. In female patients the approximation is done above that level to avoid the prominence of the larynx. A small horizontal incision below the suture line will eliminate the bowstring effect. A platysma duplication above the submandibular gland can make it less obvious.