Platysmal Bands Research Articles

Modified Lateral Surgical Approach to the Pterygopalatine Fossa for Safe Preservation of the Peripheral Branch of the Marginal Mandibular Nerve

In cases where oral cancer spreads toward the maxillary tubercle, surgery may extend to the pterygopalatine fossa. There are 2 main extraoral approaches: anterior and lateral. Previously, we introduced a modified lateral approach with a mouth corner incision from the lower lip, that preserves the mental and marginal mandibular nerves. Now, we present a further modification that allows safer preservation of the peripheral branches of the marginal mandibular nerve around the mouth. The procedure has 2 key points. The first is to follow the course of the marginal mandibular nerve from the submandibular incision. The second is to begin the mouth corner incision from the upper lip. Deploying the cheek flap ensured the marginal mandibular nerve was contained within a preserved platysma band. The postoperative contours and unremarkable scar on the face were acceptable to the patient. Paralysis of the facial and mental nerves was almost nonexistent. In conclusion, this newly modified lateral approach is useful in fully exposing the pterygopalatine fossa while preserving the mental nerve and not only the main trunks of the marginal mandibular nerves but also the peripheral branches around the mouth.

Neck Lift to Treat Platysma Bands and Defining Cervical Angle: A Systematic Review and Pooled Analysis.

Many surgical techniques have been proposed to address the submental-cervical angle in neck lift. Despite the several advances, obstacles persist when dealing with platysma bands and redefinition of the obtuse cervical angle. The aim of this study was to quantify platysma bands recurrence, any neurovascular damage, and other complications following neck lift procedures involving platysma muscle. After the approval and registration on the International Prospective Register of Systematic Reviews (PROSPERO), the systematic review was performed in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A series of specific keywords and predefined MeSH terms were utilized in different search engines (Medline, PubMed, Google Scholar, and the Cochrane library databases). Primary outcome was the recurrence of platysma bands; secondary outcomes included any postoperative complications, including any nerve damage. Pooled analysis was performed using a random effects model. Twelve articles, encompassing 2,106 patients, were relevant to this issue and included data on neck lift surgery with any platysma transection outcomes. Twenty-six patients had a recurrence of platysma bands during the follow-up, with a pooled rate of 1.4%. The pooled overall nerve damage rate was 0.9%. At the reported follow-up, the pooled hematoma percentage was 1.8%, and the pooled sialoma rate was 0.3%. Even less common complications were long-lasting edema, dehiscence of the submental suspension, and skin necrosis. Cervicomental angle redefinition remains a controversial and complicated procedure, which can be approached with different maneuvers. However, more long-term outcome reports as well as standardized complication outcomes are warranted in order to compare different and new techniques. LEVEL OF EVIDENCE: III.

Fixation of Superolateral Platysma Flap to the Mastoid Fascia: A Novel Isolated Neck Lift Technique.

This study aimed to evaluate the utility of a novel neck lift technique based on fixation of superolateral platysma flap to the mastoid fascia in terms of postoperative aesthetic outcome and patient satisfaction within an 18-month follow-up period. A total of 145 female patients who underwent isolated neck lift operation with the superolateral platysma flap technique were included. Global Aesthetic Improvement Scale (GAIS) scores (by the investigator) and the patient reported outcomes were recorded in terms of improvement in the cervicofacial angle, jowls, platysmal bands and malpositioned cervical fats, at 6 and 18 months, postoperatively. The complications were recorded at early postoperative period and at 1, 6 and 18 months, postoperatively. The median duration of follow-up was 18 months (range, 6-48months). GAIS scores at 18th months, revealed exceptional improvement in the cervicofacial angle (82.8%), the jowls (93.1%), platysmal bands (93.1%) and malpositioned cervical fat (97.2%). Majority of patients were very satisfied with the treatment in terms of the aesthetic improvement. Complications involved the minor ecchymosis (17.2%) and minor skin circulatory problem (11.7%) in the early postoperative period, suture exposure (12.4%) in the postoperative 1st month, and cervical band reformation in the 6th (0.7%) and 18th (1.4%) months. In conclusion, lateral displacement and fixation of superolateral platysma flap to the mastoid fascia seems to be a useful neck lift technique for correction of platysma- and skin-derived aging sings with minor and manageable complications, immediate return to everyday activities and a high patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Anatomical Guidelines and Technical Tips for Neck Aesthetics with Botulinum Toxin.

Botulinum toxin can be used for various purposes to enhance neck aesthetics, addressing concerns such as platysmal bands, optimizing the cervicomental angle, preventing worsening of horizontal neckline and decolletage lines during aging, submandibular gland hypertrophy, and hypertrophied superior trapezius muscle. Understanding the anatomy of muscles such as the trapezius, platysma, and submandibular gland is crucial for achieving desirable outcomes with botulinum toxin administration. Techniques for injecting botulinum toxin into these muscles are discussed, emphasizing safety and efficacy. Specific injection points and methods are detailed for treating platysmal bands, optimizing the cervicomental angle, addressing submandibular gland hypertrophy, and managing hypertrophied superior trapezius muscle. Careful consideration of anatomical landmarks and potential complications is essential for successful botulinum toxin injections in these areas.

Adverse events related to botulinum toxin type A, reported in Brazil between 2019 and 2022

The International Society of Aesthetic Plastic Surgery estimates that 18,857,311 non-invasive aesthetic procedures were carried out worldwide in 2022. This represents an increase of 7.2% compared to 2021 and 57.8% compared to 2018. Brazil is the second country in the world, just behind the United States, in the number of aesthetic procedures, with 3,020,552. Of these, 971,294 were non-invasive, with the administration of botulinum toxin, at 433,263, being the most frequent procedure. In aesthetics, it is used for the treatment of facial asymmetries, expression lines, hyperhidrosis in the hands, feet, armpits, face, and inguinal region, and in the treatment of gummy smile, attenuation of forehead wrinkles, perioral wrinkles, mental creases, glabellar lines, periorbital wrinkles, nasal wrinkles, wrinkles found on the décolletage, nasal tip stabilization, drooping lips, eyebrow lifting, and platysma bands. The most common adverse reactions associated with the use of botulinum toxin are burning, pain, swelling, irritation at the application sites, hypersensitivity, anaphylaxis in extreme cases, blurred vision, dry mouth, rarely respiratory failure, and muscle weakness. The objective of the study was to describe the adverse events (AEs) reported in the Vigimed system between 2019 and 2022. In the period analyzed, only 50 possible AEs were reported, with the female gender and the age group of 18 to 44 years being the most frequent. The pharmaceutical industry was responsible for 82% of the notifications analyzed, however, when evaluating the reporting professional, it was observed that pharmacists reported in only 8% of the cases. When evaluating the most reported AEs, swelling and pain were the most frequent, at 30% and 24% respectively. The underreporting of these events and the need for public and private incentives to raise awareness among health professionals and users about the need for identification and reporting of AEs is clear.

Isolated Medial Platysmaplasty and Harmonization of the Lower Third of Face with Local Fat Autograft: A Case Report.

One of the most common complaints of patients seeking plastic surgery is the presence of age-related changes in the lower third of the face. These often include vertical platysmal bands, a double chin, Venus rings, the absence of the cervico-mental angle, hypertonicity of the muscles in the mental area, and insufficient projection of the chin. The development and implementation of less-traumatic methods of correction of the lower third of the face and harmonization of the projection of the cervico-mental region remain relevant. This article discusses a comprehensive and individualized approach with minimally invasive techniques for correcting age-related changes in the lower third of the face and harmonizing the definition of the jawline. Isolated platysmaplasty with autologous local fat grafting to the chin is effective, safe, minimally invasive, and has a short rehabilitation period, with stable long-term aesthetic outcomes.

Comparison the Effect of Conventional and Nanofat Injection Methods on Nasolabial Fold Lipofilling: A Case- Control Study.

Nasolabial folds are a common sign of aging, accompanied by various manifestations such as skin and tissue loosening, wrinkles, lip corner drooping, mandibular angle loss, platysmal bands, and skin pigmentation changes. Limited research has explored Nanofat injection methods. this study was done with the aim of comparing the effect of fat injection by two methods, conventional and Nanofat, in nasolabial folds. The study conducted in 2020-2021 at the skin clinic in Ilam, western Iran was a case-control study. Participants were divided into two groups, and lipofilling procedures were performed using conventional and nanofat methods with autologous fat. Data collection utilized a researcher-made questionnaire and radiographic results. Follow-up visits occurred on the 30th, 90th, and 180th days to assess complications and recovery rates. After 6 months, participant's photographs were taken and compared with pre-intervention photographs using the GIAS criteria. Data analysis was conducted using SPSS22 version software. The average age of the participants was 37.80±8.30 yr. The treatment response in the conventional fat injection group was significantly better than the nanofat group (P<0.05). Both groups were satisfied with the treatment methods, but high satisfaction was reported in the conventional group, but there was no statistically significant difference between the groups. Both methods of improving wrinkles were effective, but the improvement and response to treatment in the conventional method was better than the Nanofat method, and its effect was felt by the participants for an average period of 3 months.

Facelift: Assessment of Total Platysma Muscle Transection to Prevent the Recurrence of Platysmal Bands

IntroductionDetermining which facelift technique yields the most effective long-term rejuvenation results and ensures optimal stability over time remains a significant question in cosmetic surgery: Does the most invasive surgery lead to the best long-term outcomes? This study aims to evaluate the authors’ approach using total platysma muscle transection to prevent platysma band recurrence, and to provide anatomical observations supporting and justifying their procedure.Material and MethodsA preliminary study in anatomical basic sciences was conducted to establish the rationale for our method. A prospective single-blind study was conducted, involving eighty patients seeking facial rejuvenation with platysmal band correction. They underwent face and neck-lift procedures with total platysma transection by the same surgeon between May 2013 and May 2016. Cosmetic outcomes were assessed using the Face and Neck-Lift Objective Photo-Numerical Assessment Scale. Scores by three blind evaluators before surgery, at 1 and 5 years postoperatively, were compared using a matched T Test (p < 0.05).ResultsThe preliminary anatomical study revealed a consistent anastomotic system between the cervical branch of the facial nerve and the branches of the cervical plexus. Incomplete platysma section during a facelift might contribute to platysma band recurrence. The clinical study demonstrated satisfactory outcomes, with significant overall appearance improvement (p < 0.00001) and no platysma band recurrence. Complication rate was low.ConclusionThe authors’ technique achieved satisfactory long-term results with minimal complications. However, due to the lengthy operating time and steep learning curve, it should be reserved for highly motivated patients.Level of Evidence IIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The deep cervical fascia neck lift

The main and more frequent problem in face lift is recurrence of neck bands. To improve face lift stability, a new aging analysis is proposed. The visible sign of face aging is skin excess. Superficial musculo aponeurotic system (SMAS) retraction is a much less visible sign. Nevertheless, botulinum toxin injections elongate muscles of the SMAS and rejuvenate the face. In the Face Recurve Concept, MRI studies prove the mimic muscles retraction that comes with aging. Face lift techniques include SMAS plication, traction or excision, which increases discrepancy between the envelope, the skin and the core, the SMAS. As skin excision is poorly efficient because performed posteriorly, far from the anterior skin excess located at the medial neck, the association to SMAS retraction exacerbates the gradient difference between envelop and core. This analysis shows that it is paramount to preserve the SMAS. (1) The sub-skin dissection has to be executed moving beyond the marionette fold and the paramedian neck bands; (2) no action is performed on the SMAS, only an horizontal section of the platysma at the hyoid height that will avoid platysma band recurrence. A botulinum toxin injection performed herein just after, blocks muscle regeneration; (3) the skin is pulled backward with a clear posterior transposition to the platysma. The skin at the cervico-mental angle and all along the cervico-mental crease is fixed to the deep cervical fascia, in the gap between the edges of the sectioned platysma, blocking muscle recreation. A resorbable barbed thread is used, with a first bite made at the cervico-mental angle through the deep cervical fascia then in the direction of the mastoid, with long bites through the deep cervical fascia versus short subcutaneous bites. Thanks to this strong shift, the cervico-mental crease is definitely recreated with no need of pre-auricular skin tension. Thirty-two patients have been operated with this technique on a one-year period. The results are a lot more stable and swelling is lowered down to the minimum.

Surgical Management of Platysma Bands: A Narrative Review of Evolving Concepts and Changing Techniques for Neck Rejuvenation.

Platysmal bands are an unappealing feature of the aging face. Incomplete understanding of anatomy and physiology of platysmal bands has led to a long period of flawed or incomplete treatment. This review aims to elucidate the correct study of platysmal bands along with the most recent surgical treatments. To identify all articles related to the topic of surgical management of platysmal bands, an extensive search was performedon PubMed and Medline databases for all articles related to platysmal bands from 1990 to 2023. The articles were then reviewed by 2 independent reviewers, and all relevant articles were selected. The search was narrowed down to clinical trials and cohort studies. 6130 articleswere identified, of which 21 articles matched the inclusion criteria and were selected for the study totaling 2331 patients. Different surgical procedures were mentioned. Assessment of results was mostly subjective and done by the surgeon. Composite platysma-skin flap repositioning as opposed to wide skin undermining with or without submental incisions is being gradually accepted as a valid approach, with closed platysma myotomy and platysma denervation emerging as effective less invasive surgical modalities. Nevertheless, merits of more extensive procedures involving wide skin undermining and anterior platysma plication must not be lightly forgotten. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Sonoanatomy of the platysmal bands: What causes the platysmal band?

The platysmal band is created by the platysma muscle, a thin superficial muscle that covers the entire neck and the lower part of the face. The platysmal band appears at the anterior and posterior borders of the muscle. To date, no definite pathophysiology has been established. Here, we observed a lack of knowledge of the anatomy of the platysma muscle using ultrasonography in this study. We conducted a descriptive, prospective study observing the platysmal band in resting and contraction states to reveal muscle changes. Twenty-four participants (aged 23-57years) with anterior and posterior neck bands underwent ultrasonography in resting and contracted states. Ten cadavers were studied aged 67-85years to measure the thickness of the platysma muscle at 12 points: horizontally (medial, middle, lateral) and vertically (inferior mandibular margin, hyoid bone, cricoid cartilage, superior margin of clavicle). The anterior and posterior borders of the platysma muscle were thicker than the middle of the platysma muscle when in a contracted state, and the muscle also had a convex shape when contracted. The thickness of the platysma muscle was not significantly different over 12 points in the resting state. During contraction, the platysma muscles contracted in the medial and lateral margins of the muscle, which was more significant in the posterior bands. The anterior and posterior platysmal bands are related to muscle thickness during contraction. These observations support the change in platysmal band treatment only at the anterior and posterior border of the muscle.

International Consensus Recommendations on the Aesthetic Usage of Ready-to-Use AbobotulinumtoxinA (Alluzience).

Alluzience (abobotulinumtoxinA RTU, Galderma; Lausanne, Switzerland) is the first ready to use (RTU) botulinum toxin-type A liquid solution approved for the treatment of glabellar lines in Europe. In this article, the authors provide consensus recommendations on the aesthetic usage of abobotulinumtoxinA RTU. Members of the International Board on Alluzience (IBA) convened to develop consensus on the treatment of glabellar lines as well as other facial wrinkles based on their own extensive experience. Consensus recommendations were developed to provide practical guidelines for injection of abobotulinumtoxinA RTU. General guidance on proper assessment, treatment planning, and patient education is provided, as well as specific injection guidelines per indication. Indications covered include glabellar lines, crow's feet, horizontal forehead lines, lateral eyebrow lift, lower eyelid wrinkles, bunny lines, drooping nasal tip, perioral wrinkles, drooping mouth corners, masseter hypertrophy, hollow cheek lines, dimpled chin, and platysmal bands. These guidelines provide a practical framework to support routine injection of facial muscles with Alluzience.

Understanding Platysma Muscle Contraction Pattern and Its Relationship to Platysmal Banding: A Real-Time Ultrasound Study.

Addressing neck contouring with surgical and nonsurgical aesthetic procedures includes understanding the origin of platysmal banding. A theory was postulated to explain this phenomenon by isometric vs isotonic muscular contraction patterns. However, no scientific proof had been provided to date for its correctness. The aim of this study was to confirm the correctness of the platysmal banding theory based on isometric vs isotonic muscular contractions. Eighty platysma muscles from 40 volunteers (15 males and 25 females) were investigated (mean age 41.8; SD 15.2 years; mean BMI of 22.2; SD 2.3 kg/m2). Real-time ultrasound imaging was utilized to measure the increase in local muscle thickness inside and outside of a platysmal band as well as platysma mobility. Within a platysmal band, the local thickness of the muscle increases during muscular contractions by 0.33 mm (37.9%; P < .001). Outside of a platysmal band the thickness of the platysma muscle decreased by 0.13 mm (20.3%; P < .001). It was identified that within a platysmal band no gliding was detectable, whereas outside of a band an average muscle gliding of 2.76 mm was observed. The results confirm the correctness of the isometric vs isotonic platysma muscle contraction pattern theory: isotonic muscle contraction (gliding without increase in tension and therefore in muscle thickness) vs isometric muscle contraction (no gliding but increase in tension and therefore in muscle thickness). These 2 types of contraction patterns occur within the platysma simultaneously and are an indicator for zones of adhesion in the neck to guide surgical and nonsurgical aesthetic procedures.

Assessment and Treatment Strategies for the Aesthetic Improvement of the Lower Face and Neck.

Interest in aesthetic rejuvenation of the lower face and neck is growing, but published expert guidance is limited. Review aesthetic concerns of the lower face and neck and provide expert guidance on evaluation and treatment. Twelve international experts participated in an advisory board on lower face and neck aesthetic treatment. They completed a premeeting survey and met twice, reviewing responses and discussing patient evaluation and treatment strategies. They developed decision tree algorithms on patient assessment and treatment planning and sequencing, using clinical cases as a reference. Treatment concerns include neck and lower face skin laxity, structural bone deficiency, insufficient or excess volume, submental fat, jowls, platysma bands, and masseter muscle prominence. Advisors agreed that the lower face and neck may be the most challenging areas to assess and treat; treatment goals include lower facial contour and overall facial harmony/balance. Advisors recommended first ruling out a surgical approach, then determining whether midface treatment is needed to support the lower face, and lastly evaluating the lower face for significant submental fat, excess or insufficient volume, and structural bone deficiency. To treat the lower face and neck, an anatomical layer approach, moving from deep to superficial layers, beginning with structural support, was recommended. Assessment and treatment decision trees were based on this approach. The lower face and neck are important but underrecognized areas of aesthetic concern. This article provides expert guidance and a suggested algorithm for assessment and treatment aimed at achieving satisfying and harmonious facial aesthetic results.

80. The Over-tightened Neck: Causes, Complications, and Management

PURPOSE: The over-tightened neck following necklift procedures is a clinical problem that has received little attention in plastic surgical literature. Possibly, plastic surgeons are either reluctant to discuss it or see few cases. Also, an overtightened neck reflects both the subjective and objective opinions of the patient along with objective clinical findings. METHODS: A retrospective review of 250 consecutive necklift procedures from 2013 to 2020 was performed, of whom 211 (84%) had a submental crease incision with anterior neck tightening of platysmal bands combined with a lateral neck plication. Follow-up continued was at least one year. RESULTS: A total of five patients (2%) presented with complaints of an over-tightened neck that caused pain (5) and difficulty swallowing, interference with speech (1), dyspnea (1), and fat necrosis (1). Three patients had anatomical evidence of a long neck that measured 11cm. Three patients complained throughout and at the end of the first year. Two other patients who had a necklift elsewhere which included anterior platysmaplasty were referred for evaluation. Their procedures has been performed one and one and a half years previously. All five patients were evaluated by neck CT (3) and neck MRI (2). Two patients had videofluroscopy and barium swallow studies that were negative. CONCLUSION: The overtightened neck is an uncommon postoperative sequel to a necklift procedure that may be difficult to assess because of its subjective nature. It can, however, be associated with severe symptoms requiring recognition and appropriate diagnostic work-up.

The Functional Anatomy and Innervation of the Platysma is Segmental: Implications for Lower Lip Dysfunction, Recurrent Platysmal Bands, and Surgical Rejuvenation.

Despite the central role of the platysma in face and neck rejuvenation, much confusion exists regarding its surgical anatomy. This study was undertaken to clarify the regional anatomy of the platysma and its innervation pattern and to explain clinical phenomena, such as the origin of platysmal bands and their recurrence, and the etiology of lower lip dysfunction after neck lift procedures. Fifty-five cadaver heads were studied (16 embalmed, 39 fresh, mean age 75 years). Following preliminary dissections and macro-sectioning, a series of standardized layered dissections were performed, complemented by histology and sheet plastination. In addition to its origin and insertion, the platysma is attached to the skin and deep fascia across its entire superficial and deep surfaces. This composite system explains the age-related formation of static platysmal bands, recurrent platysmal bands after complete platysma transection, and recurrent anterior neck laxity after no-release lifting. The facial part of the platysma is primarily innervated by the marginal mandibular branch of the facial nerve, whereas the submandibular platysma is innervated by the "first" cervical branches, which terminate at the mandibular origin of the depressor labii inferioris. This pattern has implications for postoperative dysfunction of the lower lip, including pseudoparalysis, and potential targeted surgical denervation. This anatomical study, comprised of layered dissections, large histology, and sheet plastination, fully describes the anatomy of the platysma including its bony, fascial, and dermal attachments, as well as its segmental innervation including its nerve danger zones. It provides a sound anatomical basis for the further development of surgical techniques to rejuvenate the neck with prevention of recurrent platysmal banding.

556 Minimally Invasive Contracture Release Improves Function in Patients with Burn Contractures

Abstract Introduction Scar contracture bands after burns are a persistent problem that cause discomfort and physical and aesthetic limitation. Standard treatment for contracture bands in burn scars involves physical therapy, stretching, splinting and laser treatment, as well as surgical releases with local/distant flaps and grafting. A minimally invasive transcutaneous approach for the release of scar bands was initiated in our institution 6 years ago. The method was derived from techniques pioneered by Jose Daher and Raul Gonzalez to interrupt platysma bands in neck rejuvenation. With IRB approval we evaluated this new approach regarding long term outcomes. Methods A retrospective review of 45 patient charts was conducted for those with burn scars who received subcutaneous contracture release from May 1, 2016, through March 31, 2022. The procedure involves introducing a braided suture to loop the contracture band and moving it in a sawing motion until it cuts through the band in multiple sites along the contracture. Demographic data, total burn surface area (TBSA), location, amount of contracture release increments, scar size, and duration of treatment was recorded. Concurrent scar treatments and whether performed under anesthesia was also noted. In follow up visits 3-12 months post release patients were surveyed on satisfaction with the treatment and whether they noticed increased mobility after the procedure. The Vancouver Scar Scale was administered pre- and post-treatment. Patient range of motion was measured pre-and post treatment to assess for change in mobility at treated sites. Results Male to female ratio was 51%:49%, average age was 38.8(6 to 68), 58% were white . TBSA ranged from 0.5% to 85%, with an average of 36.1 ± 22.3. The release was applied to 11 different sites spanning the entire body, 39% on the neck . The procedure involved an average of 19.0 ± 8.8 incremental releases, and the average scar size for treatment was 174.4 ± 140.0 cm2. 93% of the procedures involved laser treatment, 76% were done under anesthesia because of the laser, and 84% involved a site that was skin grafted. Only one of the 45 patients reported bleeding post-discharge, and none had an infection at a puncture site. Out of 20 responses, 13 patients reported being “satisfied” and 3 “very satisfied”; none reported being “dissatisfied”. 19 noted an increase in mobility at the contracture site and one did not. On average, patient range of motion increased by 13.6 degrees. Conclusions The minimally invasive contracture release described is a versatile, safe, and well-tolerated procedure that can help patients regain form and function after a burn injury. It was successfully applied to a large range of age groups, burn sizes, and scar contracture sites. Encouraging data regarding patient recovery and gain in mobility supports the use of this contracture release technique. Further studies should include prospective multicenter trials. Applicability of Research to Practice Immediate

D43. The Over-tightened Neck: Causes, Complications, and Management

PURPOSE: The over-tightened neck following necklift procedures is a clinical problem that has received little attention in plastic surgical literature. Possibly, plastic surgeons are either reluctant to discuss it or see few cases. Also, an overtightened neck reflects both the subjective and objective opinions of the patient along with objective clinical findings. METHODS: A retrospective review of 250 consecutive necklift procedures from 2013 to 2020 was performed, of whom 211 (84%) had a submental crease incision with anterior neck tightening of platysmal bands combined with a lateral neck plication. Follow-up continued was at least one year. RESULTS: A total of five patients (2%) presented with complaints of an over-tightened neck that caused pain (5) and difficulty swallowing, interference with speech (1), dyspnea (1), and fat necrosis (1). Three patients had anatomical evidence of a long neck that measured 11cm. Three patients complained throughout and at the end of the first year. Two other patients who had a necklift elsewhere which included anterior platysmaplasty were referred for evaluation. Their procedures has been performed one and one and a half years previously. All five patients were evaluated by neck CT (3) and neck MRI (2). Two patients had videofluroscopy and barium swallow studies that were negative. CONCLUSION: The overtightened neck is an uncommon postoperative sequel to a necklift procedure that may be difficult to assess because of its subjective nature. It can, however, be associated with severe symptoms requiring recognition and appropriate diagnostic work-up.

Novel, Validated 5-Point Photonumeric Scales for Assessment of the Neck and Décolleté.

There is a scarcity of scales that assess platysmal bands, wrinkles in the décolleté, and horizontal neck lines in the digital and live setting. The objective of this investigation was to create and validate 5-point photonumeric scales that assess horizontal neck lines, platysmal bands, and wrinkles in the décolleté. A medical team created 3 different novel 5-point photonumeric scales for the assessment of horizontal neck lines, platysmal bands, and décolleté wrinkling. Eleven international raters were involved in the digital validation, and 4 raters performed a live validation. The Croma (Leobendorf, Austria) Horizontal Neck Lines Assessment Scale showed substantial interrater agreement and almost perfect intrarater agreement in the digital and live validations, respectively. The Croma Platysmal Bands Assessment Scale showed substantial intrarater agreement in both digital and live validations. For the décolleté, a static scale and a dynamic scale were created and validated. The Croma Static Décolleté Wrinkles Assessment Scale showed substantial and almost perfect interrater agreement in the digital and live validations, respectively, and the intrarater agreement in both was almost perfect. The Croma Dynamic Décolleté Wrinkles Assessment Scale showed almost perfect agreement in both validation settings for both interrater and intrarater measures. The Croma Horizontal Neck Lines Assessment Scale and the Croma Static and Dynamic Décolleté Wrinkles Assessment Scales have sufficient interrater and intrarater agreement for justifiable use in clinical and research settings.

Efficacy and safety of Relatox for correction of platysmal bands: a clinical trial

Efficacy and safety of Relatox for correction of platysmal bands: a clinical trial