Traditional midline platysmal surgery involves making an incision under the chin and opening the neck to cosmetically address neck ptosis and central neck vertical banding — a long and potentially risky cosmetic procedure. Andrew A. Jacono, M.D., a New York City-based facial plastic and reconstructive surgeon, has researched when surgeons can accomplish neck lifting without opening the neck, therefore, avoiding potential complications.
Dr. Jacono presented “Neck lift: When to open the neck?” today at the Global Aesthetics Conference, in Miami Beach, Fla.
The surgical neck lift typically involves making an incision under the chin, opening the center of the neck and manipulating the midline platysma muscle. Tightening the midline platysma has the consequence of limiting the amount of face and neck lifting laterally, as pulling the platysma medially anchors the SMAS of the face and platysma in the neck in an anti-gravitational vector, opposite of a lift. Additionally, over-operating the middle of the neck can create submental irregularities, including fullness in the cervicomental angle from transferring excess platysma muscle to the central neck, according to Dr. Jacono, assistant clinical professor of facial plastic surgery, New York Eye and Ear Infirmary and Albert Einstein College of Medicine, New York, N.Y.
By asking the question about when and when not to open the neck for neck rejuvenation, conducting studies with cadavers and drawing from clinical experience, Dr. Jacono has uncovered guidelines for when plastic, cosmetic and facial plastic surgeons can avoid neck lift surgery. Making the right choice saves patients from potential complications, reduces operative time and creates a better result, according to Dr. Jacono.
NEXT: Dr. Jacono’s 4 Tips
Dr. Jacono’s 4 Tips
Dr. Jacono’s first guideline is based on a paper he and colleagues published in 2011. In essence, surgeons should start by lifting the platysmal muscle of the neck laterally where it is tethered by cervical retaining ligaments to the sternocleidomastoid muscle.
“Releasing the cervical ligaments that limit re-draping the drooping platysma muscle, the midline platysma bands can be redraped by 1.5 cm in our cadaveric studies. If the bands at the center of the neck have an anterior to posterior dimension of 1.5 cm or less, you can actually rejuvenate the neck without having to open it,” Dr. Jacono says. “If the patient’s neck bands are greater than 1.5 cm, you need to do the open technique.” [SOURCE: Jacono AA, Parikh SS, Kennedy WA. Anatomical comparison of platysmal tightening using superficial musculoaponeurotic system plication vs deep-plane rhytidectomy techniques. Arch Facial Plast Surg. 2011 Nov-Dec;13(6):395-7. http://www.ncbi.nlm.nih.gov/pubmed/22106184]
Second is fat.
If a patient doesn’t have a lot of extra subplatysmal fat in the center of the neck, surgeons can avoid opening the neck.
“If you have to remove that fat underneath the platysmal muscle, then, you have to perform midline platysmaplasty to prevent the creation of a ‘cobra neck’ deformity,” he says.
Third, when examining a patient before surgery, if the surgeon can lift up vertically on the neck, from the angle of the jaw, and the vertical platysma bands in the center of the neck flatten, the neck can be mobilized without having to do a midline neck procedure, according to the facial plastic surgeon.
Dr. Jacono’s fourth tip: Men
“Generally speaking, with male patients I open the neck the majority of the time. This is because men’s muscle compliance and skin elasticity is very different than women’s—it’s very redundant. If you don’t do midline platysmaplasty in men, my experience is you tend to see a higher failure rate after surgery with recurrent neck ptosis within one to three years,” Dr. Jacono says.
Read more from Global Aesthetics Conference 2015.