Platysmal Bands Research Articles

The Purse-String Reinforced SMASectomy Short Scar Facelift

Over the last two decades, short scar facelifts, often referred to as "mini" facelifts, have gained popularity. We use a purse-string reinforced (PRS) superficial musculoaponeurotic system rhytidectomy (SMASectomy) shortscar facelift that combines a SMASectomy in the vertical direction and suspension sutures in order to improve structural facial support. In the case of visible platysma bands and/or local fat deposition, liposuction (frequently followed by an anterior plastysmaplasty procedure) was added to correct features that are not consistently correctable using only a short scar facelift. This study retrospectively analyzes our experience with a new type of short scar facelift technique that combines both a superficial musculoaponeurotic system rhytidectomy (SMAS-ectomy) and suspension sutures with a thorough approach to the anterior surface of the neck. Over a period of three years, the PRS short scar facelift was performed in 137 patients with a mean age of 55 years (range 23-79 years). In almost half of the patients, the PRS short scar facelift was preceded by a separate treatment of the anterior neck contour by liposuction (67/137 patients; 49%). In two-thirds of these patients (42/67 patients), this liposuction was followed by an anterior plastymaplasty. Most patients (129/137; 94%) were satisfied or very satisfied with their results at the end of the follow-up period. Eight patients were not satisfied: five because of higher expectations, two because of insufficient improvement of the plastysma bands (which had not been treated by a plastysmaplasty procedure), and one because of the improper recognition of midface sagging (which had not been treated and was not properly discussed preoperatively). In the case of plastysma bands, platysmaplasty (n = 42) did improve the presence of these bands. There were no major complications in this series: 1 case had temporary neuropraxia of a buccal branch, which resolved after two months; two cases had hematoma, requiring evacuation on the outpatient clinic after one week; two cases with traction dimpling in the neck over the sternocleidomastoid region required late surgical revision; and one case had hypertrophic scarring in the preauricular area. The PRS technique is a short scar facelift technique that is both simple and safe. Complications are uncommon and usually minor. However, in the presence of platysma bands and/or local fat deposition, an anterior neck procedure-liposuction and/or anterior platysmaplasty-should be incorporated in order to optimize the results.

Les techniques d’injection de la toxine botulique dans le tiers inférieur et moyen du visage, le cou et le décolleté. Le « Néfertiti lift »

Although correction of the dynamic wrinkles of the upper part of the face is the major indication for botulinum toxin, there are also many possibilities for the middle and lower thirds of the face and neck. However, these injections are more delicate and require an experienced operator who has excellent knowledge of the muscles of these regions, their functions, the antagonist actions exercised on other muscles, particularly in terms of the complex equilibrium of the mouth. An excessive dose, an inappropriate injection point, or a centering mistake can all easily be responsible for undesirable side effects. However, the results obtained, often with lower doses than in the superior part of the face, can be highly satisfactory, notably in erasing bunny lines, improvement of marionette lines, peau d'orange chin, attenuation of peribuccal lines, melomental folds, correction of a gummy smile, and facial asymmetries. In the neck it is possible to reduce platysmal bands, horizontal lines, and diagonal lines of the neck and décolleté. The face contours can also be improved by the Nefertiti lift. In the mid and lower regions of the face, botulinum toxin is often a complement to other esthetic techniques, particularly filling procedures.

Complications of fractional CO2 laser resurfacing: Four cases

Fractional ablative laser therapy is a new modality which will likely be widely used due to its efficacy and limited side-effect profile. It is critical to recognize, characterize, and report complications in order to acknowledge the limits of therapeutic efficacy and to improve the safety of these devices. The photographs, treatment parameters, and clinical files of four female patients aged 54-67 who had scarring or ectropion after fractional CO(2) laser resurfacing on the face or neck were carefully reviewed to search for any possible linking factors. Patient 1 developed erosions and swelling of the right lower eyelid 2 days postoperatively, which developed into scarring and an ectropion. Patient 2 developed linear erosions and beefy red swelling on the right side of the neck which developed into a tender, band-like scar over 1-month. Patient 3 developed stinging and yellow exudate in multiple areas of the neck 3 days postoperatively. Cultures grew methicillin-resistant Staphylococcus aureus. Despite appropriate treatment, she developed multiple areas of irregular texture and linear streaking which developed into scars. Patient 4 developed an asymptomatic patchy, soft eschar with yellowish change on the left side of the neck. Azithromycin was started, however at 2-week follow-up she had fibrotic streaking which developed into horizontal scars and a vertical platysmal band. The treatment and final outcome of each patient are described. Scarring after fractional CO(2) laser therapy may be due to overly aggressive treatments in sensitive areas (including excessive energy, density, or both), lack of technical finesse, associated infection, or idiopathic. Care should be taken when treating sensitive areas such as the eyelids, upper neck, and especially the lower neck and chest by using lower energy and density. Postoperative infections may lead to scarring and may be prevented by careful taking of history, vigilant postoperative monitoring and/or prophylactic antibiotics.

Long-Term Efficacy of Anchored Barbed Sutures in the Face and Neck

The thread lift is a minimally invasive procedure that uses barbed sutures, inserted subcutaneously, to produce lifting of ptotic tissue of the face and neck. There are currently very limited data on longevity and patient satisfaction following barbed suture lifting procedures. The purpose of this study was to assess long-term efficacy following the use of barbed sutures. A satisfaction survey was mailed to 20 patients who were a minimum of 6 months (range, 6 to 16 months) postprocedure. Physician assessment of pre- and postprocedure photographs was also performed. At an average of 11.5 months postprocedure, patients felt that the barbed suture lift met their expectations, rating their satisfaction a 6.9 on a scale of 1 to 10. Independent physicians rated the overall improvement an average of 4.6 of 10. Higher scores were noted in Zone 1 (tear trough/malar fat pad and nasolabial folds) compared to Zone 2 (marionette lines, jowls, and jawline definition) and Zone 3 (platysmal bands and neck contour). The barbed suture lift procedure provides moderate long-term and sustained improvement for facial laxity, with most improvement seen in the tear trough/malar fat pads and nasolabial folds. In this study, clinical efficacy was seen up to 16 months postprocedure.

Managing platysma bands in the aging neck

The author demonstrates his method of achieving optimal contour in the aging neck. Primary features of the technique are horizontal cuts in the vertical bands of the platysma muscle combined with a corset Z-plasty medial suture and bilateral rein plication suture. This combined procedure, which effectively lifts the sagging neck, is useful in treating vertical platysma bands in primary cases, as well as recurrent platysma bands.

Skin and Platysma Muscle Anchoring

Anatomically, the platysma muscle is composed of two parts: a facial part and a cervical part. This observation allows a better understanding of the modifications due to aging. The correction of platysma bands needs nearly vertical directional vectors at the facial level. The periosteum of the malar bone and the anterior border of the parotid fascia are two solid structures that are not modified during aging. They allow the anchoring of the ptotic tissues including premalar fat pads, jowls, and platysma bands. The connections between the skin and the platysma muscle are not affected, although most of the described techniques need a detachment of the platysma muscle from the skin and a suture of the anterior border via a submental approach. Furthermore, the posterior border of the platysma muscle is not modified by aging. This explains why it is useless to detach this structure. The principles of the proposed technique are fundamentally different. Lore's fascia is used as a guide for approaching the trunk of the facial nerve. Labbé and colleagues have done an anatomic study of this procedure. It allows a solid anchoring of the platysma muscle, which is not detached from the skin. This is the key to the operation because the skin and the muscle are elevated en bloc. The author demonstrates that the absence of separation between skin and muscle, particularly at the cervical level, is a very efficient means for correcting platysma bands and for obtaining good definition of the cervicomental angle.

Optimising Results from Minimal Access Cranial Suspension Lifting (MACS-Lift)

Between November 1999 and February 2005, 450 minimal access cranial suspension (MACS) lifts were performed. Starting with the idea of suspension for sagging soft tissues using permanent purse-string sutures, a new comprehensive approach to facial rejuvenation was developed in which the vertical vector appeared to be essential. The neck is corrected by extended submental liposuction and strong vertical traction on the lateral part of the platysma by means of a first vertical purse-string suture. The volume of the jowls and the cheeks is repositioned in a cranial direction with a second, slightly oblique purse-string suture. The descent of the midface is corrected by suspending the malar fat pad in a nearly vertical direction. In 23 cases (5.1%), the result in the neck was unsatisfactory, and additional work had to be done secondarily, or in later cases, primarily. The problem that appeared was unsatisfactory correction of platysmal bands (resolved with an additional anterior cervicoplasty) or vertical skin folds that appeared in the infralobular region (corrected with an additional posterior cervicoplasty). This article describes two ancillary procedures that, although not frequently necessary, can optimise the result of MACS lifting.

Optimising Results from Minimal Access Cranial Suspension Lifting

Over the past 40 years, about 1,000 rejuvenating surgical techniques to correct the aging face have been described. The methods that have survived the test of time to be used in everyday practice are efficient, logical, and reliable, with few complications. In fact, many techniques are good, but a technique is nothing if it is not adapted to a particular case. We must adapt good methods to good patients. In other words, we must identify the indications, so we must be aware of all the procedures. As I said in a recent ISAPS meeting, my technique for the middle face is the result of many procedures taken from almost 10 different surgeons. The precapillary incision I sometimes use was described by B. Connell, and the preauricular incision is from I. Pitanguy. Another technique I use inside the sideburn was performed by B. Guyuron. My retroauricular incision was described by S. Hoefflin, and my primary liposuction of the neck was used by Y. Illouz. The skin undermining I have adopted was reported by Skoog, Aufricht, and Mac Indoe, and my deep muscular plane treatment is the one used by G. Jost and me. Often I use a deep undermining of the fat to suspend the malar pad, as described by S. Hamra, and I often add a transconjunctival approach associated with light erbium laser abrasion of the inferior eyelid skin, as advocated by T. Roberts. I could add that I suspend the platysma angle without undermining the neck skin, as done by D. Labbe, and I could also use a vertical purse suture, as shown by P. Tonnard. Why not? It is also an effective technique when appropriate. In fact, these are the logical findings by the authors of this article. Platysma suspension by a purse suture to the deep plane or to the Lore s fascia is not sufficient in the presence of significant anterior platysma bands. Therefore, it is logical in these cases to include an anterior cervicoplasty. The vertical suspension of a minimal access cranial suspension (MACS) lift cannot deal with excess posterior skin on the neck. Therefore, in these cases, a posterior cervicoplasty is also mandatory. Consequently, we must adapt our techniques to the patient, to her or his skin conditions, hair situation, former operations, shape of the platysma on the neck, particular excess of skin, and the like. One single procedure is not sufficient to please the patient, and one technique is never completely adapted to one case. We always need additional procedures for the finesse of a result. The authors of the article have shown this perfectly.

Rajeunissement du tiers inférieur du visage et du cou

One of the marks of the youth of a face is the absence of ptosis of the cheek and the perfect delimitation of the neck with an angle well defined. The objective of this work is to present our surgical technique for the treatment of the lower third of the face and the neck. After a degreasing of the neck and lower part of the cheek, we carry out an extensive cutaneous separation of these areas. The cervical face lift is performed in different layers. A suspension with posterior direction of the platysma is systematic. It is associated or not, according to the importance with the platysma bands, with an anterior approach or with counter side incisions. A reinforcement of the angles is obtained by a fat grafting. One fills the mandibular ligament and one underlines the relief of the chin.

Managing Adverse Events Associated with Botulinum Toxin Type A

Botulinum toxin A (BTXA) has become a widely used drug in cosmetic dermatology, not only to treat focal hyperhidrosis but also hyperkinetic facial lines, platysma bands, décolleté bands, and other skin features. The spectrum of possible adverse effects of BTXA is broad but fortunately those that have been observed with cosmetic use of this product are generally mild and transient. The major tools for preventing adverse effects from BTXA are knowledge and skill. Use of correct injection techniques is mandatory since most unwanted effects are caused by incorrect technique. Knowledge of the target structures, e.g. the facial and extrafacial muscles, allows physicians to select the optimal dose, time and technique. The most common adverse effects are pain and hematoma. In the periocular region, lid and brow ptosis are important adverse effects. Adverse effects such as pain, hematoma, ecchymosis, and bruising may also occur in the upper and lower face and at extrafacial sites. Other possible adverse effects seen in other indications that the user of BTXA in cosmetic dermatology should be wary of include induction headaches and possible interaction with concomitant medications. Induction of neutralizing antibodies due to cosmetic BTXA treatment has not been observed. This article also outlines recommendations regarding use of BTXA. Of these, the most important for avoiding most unwanted adverse effects are the proper techniques of dilution, storage, and injection, as well as the careful exclusion of patients with any contraindications. Pain, hematoma, ecchymosis, and bruising can be prevented by cooling the skin before and after BTXA injection. Upper lid ptosis may be partly corrected using apraclonidine or phenylephrine eyedrops. If simple rules relating to the indications for and application of BTXA are followed, this is a safe and effective drug in cosmetic dermatology.

Consensus Recommendations on the Use of Botulinum Toxin Type A in Facial Aesthetics

The use of botulinum toxin type A for facial enhancement is the most common cosmetic procedure currently undertaken in the United States. Overall clinical and study experience with botulinum toxin type A treatment for facial enhancement has confirmed that it is effective and safe in both the short and long term. Nevertheless, consistent guidelines representing the consensus of experts for aesthetic treatments of areas other than glabellar lines have not been published. Therefore, a panel of experts on the aesthetic uses of Botox Cosmetic (botulinum toxin type A; Allergan, Inc., Irvine, Calif.) was convened to develop consensus guidelines. This publication comprises the recommendations of this panel and provides guidelines on general issues, such as the importance of the aesthetic evaluation and individualization of treatment, reconstitution and handling of the botulinum toxin type A, procedural considerations, dosing and injection-site variables, and patient selection and counseling. In addition, specific considerations and recommendations are provided by treatment area, including glabellar lines, horizontal forehead lines, "crow's feet," "bunny lines" (downward radiating lines on the sides of nose), the perioral area, the dimpled chin, and platysmal bands. The review of each area encompasses the relevant anatomy, specifics on injection locations and techniques, starting doses (total and per injection point), the influence of other variables, such as gender, and assessment and retreatment issues. Factors unique to each area are presented, and the discussion of each treatment area concludes with a review of key elements that can increase the likelihood of a successful outcome. Summary tables are provided throughout.

Update on botulinum toxin use in facial plastic and head and neck surgery.

The purpose of this review is to discuss current trends in the medicinal use of botulinum toxin in head and neck and facial plastic surgery. The basic science of botulinum toxin is presented along with a comparison of the subtypes currently available on the market. Site-specific applications of botulinum toxin in the head and neck region are presented. The use of botulinum toxin continues to expand, both in volume and in number of applications. The main application of botulinum toxin in facial plastic surgery is in the effacement of dynamic or hyperkinetic facial lines. The granting of US Food and Drug Administration approval for the use of Botulinum Toxin type A in the treatment of glabella lines marks a major milestone for the more widespread usage of this product in cosmetic settings. Additional cosmetic applications include crow's feet, marionette lines, and platysma banding. Noncosmetic applications in the head and neck include dystonias (including torticollis), facial and generalized muscle spasms, migraine headaches, hyperhidrosis, spasmodic dysphonia, sialorrhea, gustatory sweating, and involuntary movement disorders. The use of botulinum toxin in the treatment of hyperkinetic conditions and disorders of excessive salivation is well established and enjoys an excellent safety profile. The cosmetic use of botulinum toxin continues to expand. The chronic use of botulinum toxin specifically for cosmetic purposes is worthy of additional study.

A prospective, placebo-controlled, randomized, parallel group study of botulinum toxin type a for the treatment of mild to moderate platysmal bands

This double-blind study evaluated the safety and efficacy of botulinum toxin type A for managing mild to moderate platysmal bands in male and female patients ages 25 to 55. Platysmal bands scores had to be > +2 (thin, mild flaccidity) on the Platysmal Band Prominence Scale (PBPS). Patients meeting all eligibility criteria were randomized to receive intramuscular injections of botulinum toxin type A (n = 21) in sterile normal saline (35 U to 75 U total dose) or sterile normal saline placebo (n = 19). The study included a baseline (BL) screening/injection visit and follow up visits at 2, 4, 8, 12, 16, 24, and 32 weeks. The primary efficacy endpoint was the 5-point (0 = non-detectable to 4 = heavy, severe flaccidity, hypertrophy at rest) PBPS rated by the physician observer. Clinical improvement was defined as a shift of ≥1 point from BL to 4 weeks post treatment. Secondary endpoints included additional physician observer scales (horizontal rhytids, jaw elevation), and patient, physician, and objective observer global assessments. Treatment-emergent adverse events (AEs) were monitored throughout. There were no significant differences between the 2 treatment groups in PBPS scores at BL. A significantly higher % of botulinum toxin type A-treated patients had lower PBPS scores from week 2 to week 16 compared to placebo-treated patients (p < .05). The beneficial effect of botulinum toxin type A on this primary efficacy endpoint lasted up to week 16. At week 4, 47.7% of botulinum toxin type A-treated patients and 15.8% of placebo-treated patients achieved clinical success (p < .05). From week 2 to week 16, a higher % of patients in the botulinum toxin type A group showed improvement on the PBPS than did those in the palcebo group. A significantly higher proportion of patients in the botulinum toxin type A group improved compared to placebo-treated patients when scores were categorized as improved versus unchanged or worsened (p < .05). Differences from week 2 to week 16 were also observed between the 2 groups in the secondary efficacy endpoints, although not all were statistically significant. No AEs were reported. These results demonstrate that botulinum toxin type A is effective and safe for the treatment of mild to moderate platysmal bands.

Scarless platysmaplasty for platysmal bands

ABSTRACTTransection of plastysmal bands has required a surgical approach that leaves scars and limits patient activities for a period of time. The author has developed a sirnple method to transect the platysmal bands under local anesthesia without resorting to skin incisions. The transection is performed with the use of a Vicryl® suture that is inserted through the skin, around the platysmal band, and then out thiOugh the original entry pOint. A back and forih motion of the suture cuts through the band.

Scarless platysmaplasty for platysmal bands

ABSTRACTTransection of plastysmal bands has required a surgical approach that leaves scars and limits patient activities for a period of time. The author has developed a simple method to transect the platysmal bands under local anesthesia without resorting to skin incisions. The transection is performed with the use of a Vicryl ® suture that is inserted through the skin, around the platysmal band, and then out through the original entry point. A back and forth motion of the suture cuts through the band.

Serial Notching of the Platysma Bands, Updated

Introduction: A traditional platysmaplasty almost always results in hardening and scarring at the submental region. In an attempt to avoid these complications, the author has developed a technique for serially notching the platysma bands. Materials and Methods: Patients demonstrate their platysma bands so that they can be marked with a distance of 3–4 cm between every incision. After injecting local anesthesia with epinephrine 1 mL to each incision site, a stab incision is made with a number 11 blade horizontal to the platysma band. Multiple incisions are necessary for a better result. The skin must be pinched together with the muscle between the thumb and index finger. The notching is done with an electrocautery and needle and repeated at the sites marked along the muscle. The wounds are covered with sterile dressings. Results: Serial notching of platysma bands was performed on 102 patients (10 men [9.8%] and 92 women [90.2%]). Only 5 hematomas (5%) were observed. Apart from the cases of hematoma, the other 97 cases were satisfactory (98%). In 78 cases (76.5%), the doctors also performed an S-lift or a facelift and witnessed better results. In most of the cases (80 cases, 81%), a submental liposuction was also necessary. Discussion: This technique alone, or combined with liposuction of the neck and with surgeries of the mid to lower face such as posterior necklift, S-lift, short scar facelift, or a conventional facelift, will eliminate platysma bands, especially in older patients. Since using this technique, we have not been required to perform platysma plication (platysmaplasty). This kind of notching of the platysmal bands is mainly done with liposuction. No special and expensive instruments are required, recovery time is very short, scarring is minimal and the sutures can be removed after a few days. If multiple and serial incisions and notching are done, no depressions and retracted muscles will be palpable or visible. It causes no major swelling and bruising of the neck. Also, only 1 case of hematoma was observed and there were no other complications. This technique is a very good adjuvant to a neck or lower facelift in older patients and in some younger patients Type I, II, and III).

Botulinum A exotoxin for the management of platysma bands.

Injections of botulinum A exotoxin are successfully used to treat neuromuscular disorders and to improve hyperkinetic muscles and dynamic rhytids of the upper face. Using these principles, we extended its use to the treatment of the aging neck (hypertrophic platysma muscle bands). A classification system (I to IV) based on horizontal neck rhytids, platysma bands, and skin laxity was devised to categorize the degree of deformity and serve as a guideline for suggested dosages of botulinum. The results correlated with the degree of age-related neck degeneration. Type II (mild horizontal neck rhytids; thin, mild platysma muscle flaccidity; and mild skin laxity) and III (moderate horizontal neck rhytids; thick, moderate platysma muscle flaccidity; and moderate skin laxity) patients were the most satisfied, followed closely by types I and IV. A total of 1500 patients were treated by three independent practices. The majority of them achieved good-to-excellent results, as evaluated by both the physician and patient. The degree of muscle flaccidity and hypertrophy were the factors that most influenced success rates, not the anatomic variations in muscle configuration.

Botulinum A Exotoxin for the Management of Platysma Bands

Injections of botulinum A exotoxin are successfully used to treat neuromuscular disorders and to improve hyperkinetic muscles and dynamic rhytids of the upper face. Using these principles, we extended its use to the treatment of the aging neck (hypertrophic platysma muscle bands). A classification system (I to IV) based on horizontal neck rhytids, platysma bands, and skin laxity was devised to categorize the degree of deformity and serve as a guideline for suggested dosages of botulinum. The results correlated with the degree of age-related neck degeneration. Type II (mild horizontal neck rhytids; thin, mild platysma muscle flaccidity; and mild skin laxity) and III (moderate horizontal neck rhytids; thick, moderate platysma muscle flaccidity; and moderate skin laxity) patients were the most satisfied, followed closely by types I and IV. A total of 1500 patients were treated by three independent practices. The majority of them achieved good-to-excellent results, as evaluated by both the physician and patient. The degrees of muscle flaccidity and hypertrophy were the factors that most influenced success rates, not the anatomic variations in muscle configuration.

Nonsurgical Treatment of Platysmal Bands with Injection of Botulinum Toxin A

Nonsurgical Treatment of Platysmal Bands with Injection of Botulinum Toxin A

Nonsurgical treatment of platysma bands with injection of botulinum toxin a revisited.

New York, N.Y. Received for publication December 17, 2002; revised March 11, 2003. Michael A. C. Kane, M.D. 630 Park Avenue New York, N.Y. 10021 Follow-up to: Kane, M. A. C. Nonsurgical treatment of platysmal bands with injection of botulinum toxin A. Plast. Reconstr. Surg. 103: 656, 1999. Dr. Kane has served as an advisory board member of Allergan and Elan, and owns Allergan stock.