Comparing Lateral Rhytidectomy With and Without Neck Suture Suspension

Abstract

Background: Characteristic aesthetic changes of the aging neck include skin laxity and rhytid formation, submental fat deposition, plastysmal banding, and ptosis of underlying structures that lead to the development of an obtuse cervicomental angle (CMA). Cervical rejuvenation techniques that aim to restore the CMA are widely discussed in the literature, and share variable outcomes. The aim of this study is to compare the restoration of the CMA in patients undergoing the addition of midline platysmal plication using a modified Giampapa stitch with absorbable PDS suture, to those patients undergoing standard deep plane lateral rhytidectomy alone. Methods: A retrospective cohort study was performed by a single surgeon in a private facial plastics practice. 264 patients undergoing rhytidectomy were included in the study. Pre and postoperative measurement differences in CMA degree and depth were compared in patients undergoing only traditional deep plane lateral rhytidectomy (TDPLR) in isolation, with those who also had modified suture suspension and platysma plication (MSSPP). The primary outcome in the study was the change in the degree of the CMA taken from standardized preoperative and postoperative surgical photos in the Frankfort profile view. Secondary outcomes include the change in the depth of the CMA as determined by the hyomental distance between study and control groups. Results: A total of 264 patients were identified who met the study criteria. A total of 134 (123 female; 11 male; average age, 62.66 ± 8.19) underwent TDPLR with MSSPP, and 130 (127 female; 3 male; average age, 63.09 ± 7.75) underwent TDPLR alone. All patients in the study underwent preoperative photographic evaluation in Frankfurt profile view and the same postoperative photographic evaluation at an average of 436.56 days (14.4 months) after surgery. Patients in the cohort study group were found to have a statistically significant increase in the depth of the CMA by an average of 13.9 degrees ± 6.26 and increase in the hyomental distance of 1.38 cm ± 0.87, compared to the control group who underwent traditional lateral rhytidectomy with an average CMA change of 6.87 degrees ± 6.7 ( P = .00146) and hyomental distance increase of 0.75 ± 0.68 ( P = .00031), respectively. Statistical significance was taken at P < .05. Conclusions: The results from this study indicate that the addition of a relatively minimally invasive approach to neck rejuvenation using a modified Giampapa stitch with absorbable PDS suture is helpful in restoring the CMA in an aging neck.

Arcade Sutures to Minimize Ear Displacement in Rhytidectomy

“…Arcade horizontal mattress sutures are used to resuspend the SMAS in the anterior face to the DTF maximizing the vertical vector of lift, while the lateral platysma is lifted and anchored to the postauricular mastoid fascia in standard fashion. 13 The resulting SMAS sling that is created lifts the ear in a cephalad fashion, counteracting any age-related caudal migration. Tension-free layered closure is then accomplished by closing the SMAS first followed by the skin.…”

“…All patients underwent deep plane rhytidectomy with the release of SMAS retaining ligaments and suspension sutures used to resuspend the SMAS composite flap in the anterior face, and standard techniques to resuspend the subplatysmal cervical dissection to the postauricular mastoid fascia. 13 Patients had measurements taken intraoperatively of their baseline auricular position at the superior auricle (level of the helix), mid auricle (level of the triangular fossa) and inferior auricle (level of the tragus). The amount of ear displacement in each of these three locations when suspension sutures were placed at the preauricular fascia during rhytidectomy was first taken (►Fig.…”