Submental Lipectomy Research Articles

Surgery first in cosmetically driven orthognathic surgery

Surgery first is an option in orthognathic surgery that meets the demands of patients with dentofacial deformity looking for an expedited solution to their esthetic concerns. These cosmetically driven patients are also looking to maximize facial esthetics with the surgical procedures. Ancillary surgical procedures such as implants in the malar region, mandibular angle region, and chin are some of the options to enhance the surgical result. Fat grafting and submental lipectomy are also minimally invasive procedures that can add volume in certain areas of the face and reduce in others such as the submental region to achieve better facial contours. Rhinoplasty also is a major cosmetic adjunct to orthognathic surgery that often is done in an asynchronous manner to enhance facial esthetics. In some instances, rhinoplasty is required to correct the undesired soft tissue effects in the nasomaxillary complex with orthognathic surgery.

A Systematic Review of Subsurface Radiofrequency Treatments in Plastic Surgery.

BackgroundSubsurface radiofrequency (RF) treatments produce skin contraction by causing coagulation of the underlying subcutaneous fat. This method is marketed to fill a treatment gap for patients who do not wish to have surgery. A systematic review of this subject has not been previously published.MethodsAn electronic search was performed using PubMed to identify the literature describing subsurface RF treatments.ResultsThirty articles were evaluated. An InMode device was used in 23 studies, and a Thermi device was used in 6 studies, with or without liposuction. Treatment areas included the face, neck, body, breasts, and labia. Most studies relied on patient satisfaction scores and physician review of photographs. The most frequent complications were induration and nodules. Most patients experienced prolonged swelling and numbness. Several studies reported marginal mandibular neuropraxias. The skin response after treatment of the abdomen was poor, and seromas were common. The incidence of burns improved after modification of the InMode device. Breast treatment did not appear to be effective in treating ptosis. Patient satisfaction scores were modest. Most studies (77%) were published by authors with a known conflict of interest. In some studies, the photographs did not accurately depict the treatment result. Institutional review board approval and disclosure of off-label regulatory status were often missing.DiscussionThermal treatment of the subcutaneous tissue introduces extra risks without a compensatory benefit. Comparisons in terms of safety, cost, recovery time, results, and complications do not favor energy-based devices. A treatment gap may be fictitious; properly informed patients may be treated with existing surgical procedures at all ages.ConclusionsLittle evidence supports the efficacy and safety of subcutaneous RF treatments as an improvement over results that may be obtained using traditional surgical methods such as submental lipectomy, liposuction, and abdominoplasty. Photographic integrity is often lacking. Financial conflict of interest is pervasive. Marketing precedes the science. Plastic surgeons need to be aware of these serious limitations and the off-label regulatory status of these devices, before purchasing expensive equipment and recommending subsurface RF treatments to patients.

Plication of Neck Strap Muscles and Platysma for Double Chin Correction - A Retrospective Study.

Introduction:There is an increased need for recontouring chin and submental areas for esthetic reasons. Reports of such surgeries across the world are present in the literature. India too has its share of chin and neck reconstruction needs. This study was carried out to document a single-center experience of authors' approach in isolated submentoplasty.Materials and Methods:A retrospective analysis of case records of submentoplasty during 2012–2017 was collated. Cases fulfilling inclusion and exclusion criteria were selected for this study. A qualitative assessment of the outcomes was performed.Results:Sixteen cases who had undergone isolated submental lipectomy with platysma plication formed the study group. The mean age was 44.38 ± 5.49, with a range of 37–54 years. There were 9 females and 7 males. The mean age of females was 42.89 ± 4.01, while for males, it was 46.29 ± 6.79 years. The mean follow-up ranged for 16.2 ± 3.4 months (14–20 months). None of the patients had major complications.Discussion and Conclusion:The modified mini-neck lift approach for an isolated submental lipectomy and strap muscles of suprahyoid group with platysma plication is presented. Careful manipulation of the fat removal, plication of platysma, strap muscle and positioning of incision would help to a greater extent. The anatomical challenges for this variation are discussed.

Neck Contouring Without Rhytidectomy in the Presence of Excess Skin.

Patients with severe neck skin laxity due to excess submental adipose tissue have required either standard rhytidectomy or direct excision of neck skin with Z-plasty and submental lipectomy. Our recent experiences with four patients who declined cervicofacial rhytidectomy demonstrate that submental lipectomy and platysmarrhaphy appear to obtain sufficient improvement. The submental area, submandibular area, and lateral neck are injected with local anesthetic. An incision is made in the submental area anterior to the existing crease, and the incision is taken through the subcutaneous tissue to the underlying fat. The skin is undermined in the deep subcutaneous plane. The lateral fat that cannot be visualized directly is suctioned using a number 2 cannula. Supra-platysmal and subplatysmal excess fat are excised under direct vision. The anterior bellies of the digastric muscle are excised partially or completely to obtain a flat contour if necessary. The submaxillary gland is partially or totally removed as indicated. The platysmarrhaphy is performed, and a TLS drain is placed in position and brought out through the left post-auricular sulcus using the attached trocar. The submental incision is then closed without skin excision. Non-excisional surgical neck rejuvenation was performed on four patients with significant skin laxity. There was adequate improvement in the cervicomental angle and neck profile contour in all patients, indicating that significant improvement may be achieved without skin excision. Patients with excess skin can achieve acceptable results with submental lipectomy and platysmarrhaphy without rhytidectomy or direct excision of neck skin. 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 .

Morphometrics of the Anterior Belly and Intermediate Tendon of the Digastric Muscle: Sexual Dimorphism and Implications for Surgery.

The anterior belly of the digastric muscle (ABDM) is important in a variety of surgeries including submental lipectomy, rhytidectomy, alteration of the cervicomental angle via muscle resection, the "digastric corset" procedure for submental rejuvenation, the submental artery flap, and reanimation of the mouth after facial nerve palsy. Despite its clinical significance, little information exists regarding the morphometrics of the ABDM or its associated intermediate tendon. This study analyzed a total of 35 intact ABDMs and 43 intact intermediate tendons from 23 cadavers. Measurements were taken of the following parameters: muscle belly area, muscle belly length, intermediate tendon length, and intermediate tendon width at mid-tendon. Normative descriptive statistics are included within the report. Males were found to have significantly longer left-sided muscle bellies than right-sided bellies from males (U = 23.0; P = 0.044), left-sided bellies from females (U = 19.0; P = 0.020), and right-sided bellies from females (U = 12.0; P = 0.035). The morphometry, including sexual dimorphism, presented in this report can aid in the surgical planning and execution of numerous operations performed in head and neck, especially digastric muscle transfer surgery.

The Importance of Variant Anterior Digastric Musculature in Head and Neck Surgery

Anterior belly of the digastric muscle (ABDM) variations have been reported to occur in as few as 2.7% to as many as 69.6% of individuals. ABDM variants may cause confusion during surgeries including submental lipectomy, rhytidectomy, surgical alteration of the cervicomental angle via partial resection of the ABDM, muscle transfer for reanimation of the mouth, and submental artery flap procedures. Therefore, knowledge of ABMD variants may aid in surgical planning and prevent confusion and disorientation during operations in the submental region. This report presents examples of ABMD variants and promotes novel ideas for the utilization of variant ABDM transfer to reanimate the mouth after marginal mandibular branch of facial nerve (MMBFN) palsy. Also presented is a unique perspective with regard to exclusion of normal and variant ABDM from the submental artery flap as a surgical contingency plan in the event of MMBFN palsy occurring as a result of flap surgery. Research was supported by funding from the WV Research Challenge Fund [HEPC.dsr.14.13].

Objective assessment of change in apparent age after facial rejuvenation surgery

Facial "rejuvenation" procedures make an implicit claim to provide a more youthful appearance. However, any benefit from such procedures has not been objectively evaluated and validated. This study was undertaken to investigate the effectiveness of facial rejuvenation using a deep-plane facelift and other cosmetic procedures. Seventy-five patients were included in the study - 71 consecutive patients who met the study criteria and four controls. Inclusion criteria included at least 6 months' follow-up, standardized photos with no makeup or jewelry, and no subsequent cosmetic procedures. Simultaneous procedures included submental lipectomy, fat injection, laser skin resurfacing, blepharoplasty, endoscopic forehead lift, and chin/jowl augmentation. Photographs were judged by 198 independent members of the public who were asked to rate apparent age. The mean reduction in apparent age for all surgical patients was 6.0 years (range 0.8-14.2 years) versus no change for the control patients (p < 0.01). The average reduction in apparent age after a facelift alone was 4.6 years. Laser resurfacing provided 2.5 years of apparent age reduction (p < 0.05). Eyelid surgery and an endoscopic forehead lift each contributed a 2-year reduction in apparent age (p < 0.05). There was no significant difference when patients were compared by gender, age, body mass index, or facial shape. These findings provide the first objective evidence that cosmetic surgery (or any intervention, surgical or otherwise) is effective in providing a more youthful appearance. Facelift, laser resurfacing, blepharoplasty, and endoscopic forehead lift all significantly contribute to a reduction in apparent age.

A 26-Year Experience with Vest-over-Pants Technique Platysmarrhaphy

The purpose of this article is to review the efficacy of the vest-over-pants technique for elimination of the platysma bands and improvement of the cervicomental angle. This is a retrospective chart review of 88 patients with neck aging selected randomly by a visiting fellow and a medical student. The collected information included patient demographics, cervical surgical techniques, and complications. Patient photographs obtained preoperatively and at least 8 months postoperatively were compared on front and profile views to determine the visibility of the platysmal bands and the neck contouring. Through an incision placed anterior to the submental crease, the platysma borders were identified and elevated. After completion of the other intended procedures, the platysma borders were then overlapped using the vest-over-pants technique with 4-0 Mersilene. The mean patient age was 57.56 years. There were 76 women (86.4 percent) and 12 men (13.6 percent). The average follow-up was 28.8 months. Of the 88 patients, 93.2 percent underwent concomitant rhytidectomy, 94.3 percent underwent submental lipectomy, 95.9 percent underwent submandibular contouring, 61.4 percent underwent removal of the anterior belly of the digastric muscle, and 5.7 percent underwent suspension or partial or total excision of the submandibular salivary gland. None of the patients had residual recurrence of the platysma bands during the follow-up period. On the basis of the detailed analysis of this group of patients and 26-year experience with this technique, the authors conclude that this procedure provides logical and enduring elimination of prominent platysma bands and suspension of neck structures.

The ???Anterior-Only??? Approach to Neck Rejuvenation: An Alternative to Face Lift Surgery

The ideal procedure for those patients with aging of the lower face and neck is a cervicofacial rhytidectomy. However, within this group is a subset of patients whose goals can be met with a lesser procedure. These patients must be interested in profile change only, with no desired change in the midface. Patients undergoing neck rejuvenation by means of a submental approach fall into three groups: (1) patients with obtuse cervicomental angles and good skin elasticity (who may be treated with liposuction alone); (2) patients with subplatysmal fat or mild to moderate skin and muscle laxity (these patients are best treated by anterior lipectomy and platysmaplasty); and (3) patients with marked skin excess or severe skin laxity (best treated by procedures with excised skin, i.e., traditional face lift or direct excision of neck skin and Z-plasty). Thirty-three consecutive patients with mild (grade II, 16 patients), moderate (grade III, 11 patients), and severe (grade IV, six patients) cervicomental angle deformities were treated with anterior platysmaplasty and submental lipectomy. Twenty of 33 patients improved by one grade (61 percent), whereas 12 of 33 improved by two grades (36 percent). Young patients with minimal subplatysmal fat can be treated by liposuction alone. Patients with subplatysmal fat and mild or moderate skin or muscle laxity will obtain consistent results with platysmaplasty and submental lipectomy. Skin excisional procedures are reserved for those patients with severe skin excess or laxity.

Contralateral Platysma Suspension

As we age, a number of factors distort the contour of the cervicomental angle. Submental adipose deposits, anterior laxity of the platysma muscle, and relaxation of cervical skin contribute to this undesirable result. Comprehensive rhytidectomy will frequently involve enhancement of the cervicomental angle as an adjunctive procedure. Facial aesthetic surgeons have devised numerous techniques to deal with the aging neck. Commonly, the approach combines submental adipose tissue excision with posterosuperior-based support, either by preauricular or postauricular incision. Herein, we describe a technique incorporating standard submental suction lipectomy with a novel method of contralateral midline platysma suspension that creates a dynamic support system involving both rigid suture-based and flexible muscle-based components. This technique delivers quality aesthetic results and superior postoperative patient satisfaction.

The male neck and T-Z-plasty: 28 years later

Background: Many men seek treatment for excess submental tissue—the so-called “turkey gobbler” deformity. However, these patients are frequently unwilling to undergo the definitive treatment, a rhytidectomy and platysmaplasty with submental lipectomy. Objective: The purpose of this article is to present an update on an alternative treatment, originally reported in 1971, called the T-Z-plasty. Methods: The procedure, which is performed with the patient under local anesthesia, entails excision of excess fat and skin, tightening of the platysma, a Z-plasty to prevent contracture, and wound closure with excision of redundant skin. Results: In a series of more than 100 patients, the results have been consistently superior with extremely low morbidity. There was 1 postoperative hematoma requiring exploration and, in the same patient, a subsequent seroma requiring multiple aspirations. In addition, 2 patients required scar revision. Conclusions: The T-Z-plasty is a simple outpatient procedure with consistently low morbidity and high rates of patient satisfaction. Although the procedure does not offer the same result as the definitive treatment, rhytidectomy and platysmaplasty, it is a reasonable compromise that directly and effectively addresses the primary complaint.

Limited incision submental lipectomy and platysmaplasty.

Thirty years ago, submental fat deposition and platysma band formation were inadequately addressed by surgeons attempting facial rejuvenation procedures. Simple skin envelope tightening as practiced commonly at that time resulted in reappearance of submental bands within months, disappointing both patient and surgeon. During each subsequent decade, existing techniques for aesthetic surgical treatment of the submental and neck areas were refined, and new techniques were introduced. The earliest in this evolution of surgical approaches to rejuvenate the aging submental region was direct excision of redundant anterior cervical skin and platysma muscle bands. Later, periauricular incision approaches without anterior skin excision were used to address platysma muscle bands and remove excess submental fat. Today, the standard approach for submental and anterior neck rejuvenation is some variation of "corset" platysmaplasty and suction-assisted lipectomy both superficial and deep to the platysma muscles. The introduction of endoscopy to plastic surgery has stimulated interest in performing many surgical procedures through limited-incision approaches. While endoscopic techniques may not have a clear application for the submental area, redundant submental soft tissues producing obliquity of the cervicomandibular angle may be treated through a single submental incision approach under direct vision. A technique practiced by the author since 1981 for performing submental lipectomy and platysmaplasty through a single limited anterior submental incision without skin excision is described and discussed. Postoperative compression of the submental area with an elastic garment facilitates smooth skin contraction and redraping for all patients except those with poor or no residual skin elasticity.

Technical Considerations In Powered Instrumentation

This article reviews some of the technical engineering aspects of the soft-tissue shavers and bone-cutting drills. An improved understanding of these principles may allow the practicing surgeon to optimize the desired aggressiveness and precision of the instrument in his or her hands. Powered instrumentation has found extended uses beyond sinus disease, such as submental lipectomy (soft-tissue shaver) and modifying the bony nasal dorsum (bone cutting bur). Changes in drill design to address these and other surgical situations are discussed.

Simultaneous osseous genioplasty and meloplasty.

A review was done of the records of 50 patients who had osseous genioplasty performed at the same sitting as face lifting and, in many cases, submental lipectomy over a 20-year period by the senior author. The types of genioplasties were sliding advancement (40), lengthening with interpositional bone graft (7), and reduction (3). In 9 patients, chin implants were removed, generally because of inadequate chin projection or implant erosion. Three patients were operated on under local anesthesia, the remainder under general anesthesia. Associated procedures, done in 46 patients, included rhinoplasty, forehead lifting, blepharoplasty, lateral canthopexy, excision of buccal fat pads, reduction mammaplasty, and abdominoplasty. In 4 patients, associated maxillofacial procedures were performed, including Le Fort I and III osteotomies, two-jaw surgery, mandibular advancement with sagittal splitting, and orbital expansion. The perceived advantages of osseous genioplasty were greater versatility in dealing with problems in other than the sagittal plane, the possibility of greater chin projection, and a tightening of the submental musculature. Complications occurred in 10 patients. These included two hematomas requiring aspiration in the office, a prolapsed submandibular gland requiring later excision, a transient weakness of the marginal mandibular nerve, a transient numbness of the lower lip on one side, four revisions of scars resulting from the face lifting, and one localized wound infection in the parasymphyseal area that resolved with oral antibiotics. The most common complaint, which came from 8 female patients at some time from 1 month to 3 years postoperatively, was that the chin was "too strong." In 6 of these patients, most of whom were operated on early in the series, some of the chin projection was reduced by burring. Osseous genioplasty can be performed safely along with face lifting and submental lipectomy. The degree of advancement necessary in aesthetic surgical patients is generally less than that required in reconstructive patients. Patient satisfaction is great unless the chin is overly advanced.

The Soft-Tissue Shaving Procedure for Removal of Adipose Tissue: A New, Less Traumatic Approach Than Liposuction

To introduce the soft-tissue shaving cannula, a new, precise alternative to conventional liposuction that embodies an entirely different method of soft-tissue extraction and that appears to be less traumatic and more precise than methods currently used in liposuction. Nonrandomized, nonblinded comparison of the soft-tissue shaver and conventional liposuction devices in fresh cadavers, followed by clinical use of the liposhaver in selected patients undergoing cosmetic facial liposuction. Conventional liposuction devices and the soft-tissue shaving cannulas in fresh cadavers (< 8 hours old). A submental lipectomy and a melolabial fold liposhaving were performed in a clinical setting. Subjective evaluation by the operating surgeons. The fat was cleanly shaved and the contour result was even, without dimpling or asymmetry. Our early experiences suggest that this new liposhaving technique may offer a precise, less traumatic alternative to conventional liposuction. Fat can be shaved in an open fashion under direct vision. It does not rely on a vacuum seal. The soft-tissue shaving cannula shaves fat one layer at a time. The depth of each layer removed, the depth of soft-tissue injury, and the optimal settings and sizes for various procedures remain to be reported.

Patient education materials for abdominoplasty and submental suction lipectomy patients.

Patient education materials for abdominoplasty and submental suction lipectomy patients.

Esthetic contour analysis of the submental cervical region: A study based on ideal subjects and surgical patients

A cephalometric analysis of the submental-cervical region was carried out by examining and comparing 16 white adults who had ideal submental-cervical esthetics with 16 adult orthognathic surgery patients who were treated by submental lipectomy or liposuction and various orthognathic surgical procedures. A normative data base of the submental-cervical region was derived from the ideal subject group. The submental-cervical morphology of the preoperative patients differed significantly from the ideal subjects. The submental-cervical angle (SmCe) and the submental soft tissue thickness at C point (IBM-Sm) presented the greatest disparity between the ideal subjects (118.0°, 28.0 mm) and the preoperative patients (158.3°, 42.1 mm, each P < .001). After surgery, SmCe and IBM-Sm decreased to 132.8° ( P < .001) and 28.7 mm ( P < .001), respectively. By the end of 6 months postoperative, the mean values of SmCe and IBM-Sm were 131.1° and 28.6 mm. The submental soft tissue thickness of the patients 6 months after surgery was not statistically different from the ideal subjects (each P > .05). Orthognathic surgical procedures with concomitant submental lipectomy or liposuction had a significant effect on the contour of the submental and cervical soft tissues.

Distribution of submental fat in relationship to the platysma muscle

The results of submental lipectomy often remain suboptimal, and in some cases this may be due to the presence of residual fat deep to the platysma muscle. This study was undertaken to determine the relative amounts of fat superficial and deep to the platysma muscle. A dissection of the submental region of 20 cadavers revealed a mean weight of fat lying superficial to the platysma muscle of 8.4 grams. The mean weight of fat lying deep to the platysma muscle but superficial to the mylohyoid muscle was 3.7 grams. In three cases (15%), the weight of fat deep to the platysma muscle was greater than 50% of the total fat. This is of significance with respect to those submental lipectomy procedures that normally address only the fat superficial to the platysma.

Submental lipectomy with skin excision: J. M. Hamilton. Plast Reconstr Surg 1993; 92: 443–448

Submental lipectomy with skin excision: J. M. Hamilton. Plast Reconstr Surg 1993; 92: 443–448

Submental Lipectomy with Skin Excision

Submental Lipectomy with Skin Excision