Anatomy of the Neck and Procedure Selection

The Effect of Midline Corset Platysmaplasty on Degree of Face-lift Flap Elevation During Concomitant Deep-Plane Face-lift

“…The midline platysmal decussation pattern is variable, and 3 types have been identified: type 1 (75% of patients) with the platysma separated from the midline but in- tersecting for 2 cm from the chin; type 2 (15% of patients) with the platysma fibers joining completely in the suprahyoid region; and type 3, (10% of patients) in which the fibers are separated at the midline and do not intersect. 19 Those type 3 patients with a naturally wide platysmal dehiscence (>2 to 3 cm) have anatomically inadequate midline muscular decussation and therefore should be identified as cases that are an absolute indication for concomitant platysmaplasty. Based on the data presented herein that midline platysmaplasty limits the ability to lift the face, we advocate more aggressive face-lift dissection to garner adequate redraping of the lateral face-lift flaps.…”

Does the Approach of the Lateral Platysmal Bands Widen the Gap between the Medial Bands?

“…After patients were selected (according to their specific anatomical alterations of the neck and by considering groups 3 and 4 of the author’s classification 17 and groups 1 and 3 of de Castro’s classification), 6 , 11 they were introduced to our database, and randomization was created (using web-based software: www.randomization.com ) and performed on a 1:1 ratio. Patients were split into 2 groups (group A and group B), following this randomization.…”

“…The submental incision was placed 3 mm caudal to the submental crease, making it possible to adequately address the middle area of the neck. 6 , 9 , 11 …”

“…After all the measurements of the platysma gap have been taken (pre and post platysmal lateral approaches), the medial platysmal borders were sutured from the thyroid cartilage to the submental level through a submental incision, using absorbable 3-0 PDS sutures. 6 , 11 When the platysma muscle border was hypertrophic, it was excised by a tangential strip excision technique before suturing. However, in cases presenting a long distance between hypertrophic medial bands, performing a transversal partial myotomy below the hyoid bone has been our preference.…”

“…Later on, the authors added to these parameters the importance of the anterior projection of the chin, to the appearance of the neck. 10 , 11 The submental region is defined as a triangle, with the hyoid bone as the base, the chin as the apex, and the anterior part of the digastric muscles as the lateral walls. The submental’s floor is formed by the mylohyoid muscle.…”