Barcelona, Spain — As baby boomers continue to age, the demand for cosmetic surgical procedures, such as neck contouring, continues to grow.
"My goal is to provide the best neck contour that I can for the patient," says Bahman Guyuron, M.D., a plastic surgeon and clinical professor at Case Western Reserve University in Cleveland.
"With some necks, we can remove the excess portion of the fat partially, and that will suffice," he says. "That can be achieved while working above the platysma."Speaking at the Biennial Plastic Surgery Cruise/Aesthetic Surgery on the Mediterranean, organized by the American Society for Plastic Surgeons, Dr. Guyuron discussed the subject of subplatysmal procedures for neck contouring and submaxillary gland management.
"Most of the time I remove some of the fat from the central portion of the neck in the subplatysmal plane," Dr. Guyuron explains. "You need to remove all of the fat from this site in order to have a meaningful change. When you do that, however, you will have a depression in the center of the neck. It is particularly evident when the patient swallows. To prevent that, it is necessary to remove the anterior belly of the digastric muscles. It is the bulk of the muscles that results in a discernible depression."
Proprietary technique Dr. Guyuron also discussed his experience with his own technique, the suspension of the submaxillary gland. He has performed the technique, which involves suspension of the gland from the lower jaw, on about 20 gland patients in recent years.
According to Dr. Guyuron, the procedure has yielded lasting results, and he plans to publish his data in using the suspension technique of the submaxillary gland in a peer-reviewed journal.
Both substantial deposits of subplatysmal fat or submandibular-gland enlargement can create a jowly, full look in patients that makes them appear overweight or older than their age, an undesirable effect which patients want to change, according to Dr. Guyuron. In the majority of patients, microscopic evaluation of a large submaxillary gland indicates a diseased condition such as siladenitis, Dr. Guyuron adds.
Important points One of the important points for the plastic surgeon when performing a neck contouring procedure is to differentiate between the hypertrophic or enlarged submaxillary gland and the ptotic submaxillary gland, he says.
"The hypertrophic submaxillary gland is very large and protruding," Dr. Guyuron explains. "The ptotic submaxillary gland is not large, but it may migrate because of a gravity effect. The ideal way to manage that condition is to lift the gland. It works if we choose patients who have a normal-sized gland or small-sized gland that is in a wrong position. We have followed many of these patients very closely, and we have found that it is successful as long we choose the right operation.
"When I do a secondary lower face and neck rejuvenation on my own patients many years subsequent to a previous surgery, I usually don't have to remove the fat, the digastric muscle or glands again," he says. "Neither the muscle nor the fat grows back. Also, the glands that have been partially or completely removed do not become hypertrophic years later. If we deal with these imperfections completely, the effect is everlasting."
Dr. Guyuron says patients do not experience any adverse effects from the reconstructive neck contouring procedure and that the incisions are made from under the chin to minimize the risk of scar visibility.
His first patient, where the suspension of the submaxillary gland technique was employed, developed an infection because a permanent suture was placed through an incision in the mouth. However, no infections have been encountered since he switched the incision to under-the-chin only. He cautioned that removal of the submaxillary gland is contraindicated in older patients who are wearing dentures.