Submental Recontouring: An Adjunctive Maxillofacial Aesthetic Procedure

Abstract

Introduction: The chin and submental region contribute to facial balance. Inadequate jaw projection and neck definition may compromise the aesthetic results of cosmetic surgical procedures. It was hypothesized that adjunctive mandibular setback procedures and reduction genioplasty would improve the aesthetic results of cosmetic surgery. Materials and Methods: A triangular excision for a V–Y advancement is outlined in the submental region using methylene blue. The triangle is oriented with the apex facing the chin and the base toward the thyroid cartilage in a natural neck crease. The triangle, oriented so that the base is toward the chin at the submental crease, left a small bulge at the apex of the vertical limb of the Y in the neck midline, which required a secondary excision to correct. Incisions in the shape of a pentagon or an ellipse can also be used. Local anesthetic with vascoconstrictor is deposited along the lines of the planned excision. The geometric skin is excised. If the platysma muscle is dehiscent, it can be sutured and platysmaplasty performed. The subplatysmal fat may be removed if visible only in the midline region with caution taken at this juncture not to be too aggressive to avoid potential profuse hemorrhage. The skin flaps are widely undermined. The fat excision is feathered. A two-layer closure is then performed. Discussion: In patients with adequate skin elasticity and thickness, liposuction may be indicated. Submental excision and direct lipectomy is another technique that can address the ptotic chin, lax skin, and submental lipomatosis. This technique is indicated for those patients in whom there is excess submental fat or skin laxity and in whom there is a contraindication or a lack of patient desire to undergo formal neck-lifting procedures. Conclusion: Submental recontouring is a useful adjunctive aesthetic procedure that can be readily performed in the office setting with instrumentation and technique currently available.