New Orleans — At the recent American Society for Aesthetic Plastic Surgery's (ASAPS) Aesthetic Meeting 2005 here, Patrick K. Sullivan, M.D., demonstrated his anatomic approach to treating difficult and unattractive necks. This included contouring of ptotic submandibular glands and unattractive fat deposits in the neck.
Dr. Sullivan, associate professor of plastic surgery at the Brown University School of Medicine, gave his presentation as part of a scientific session that included other presentations dealing with deep facial tissue plication, such as those using cogged polypropylene threads, and aptos thread facial rejuvenation.
The doctor has previously presented at the ASAPS Meeting, discussing his experience with submandibular gland resection and contouring in patients who display an unpleasant looking fullness to the neck, which are often the result of prominent submandibular glands. He says some patients also can have unattractive fat deposits in the neck, located at various planes and sometimes at a deeper plane beneath the platysma muscle."These fat deposits can be approached through a small submental incision, and the fatty deposits can be contoured to give a more aesthetically pleasing appearance," Dr. Sullivan tells Cosmetic Surgery Times. "These patterns of fat accumulation often are inherited and are noticeable even when the patient is quite young and even when the body weight is at an ideal level. Many of my patients have told me that their parents or other relatives had the same neck appearance — a loss of normal neck contour and definition."
Fatty abnormalities According to Dr. Sullivan, an MRI study currently is under way at Brown University School of Medicine, under the supervision of an MRI head and neck specialist.
The objective of the study is to assess the location of fatty abnormalities of the neck, as well as the size and position of the submandibular gland in patients who suffer from the abnormality. He says the study's preliminary results suggest that in such patients, the gland becomes ptotic, or abnormally drooped, over time; the gland appears to change position, slowly falling over the years from its normal position higher in the neck to a more prominent, visible position lower in the neck.
"The study's preliminary results seem to show that there is no actual increase in size of the submandibular gland in these patients, but rather a laxity issue exists that causes the gland to droop more inferiorly," Dr. Sullivan says. "The effect is an unpleasant looking fullness to the neck."
New technique Dr. Sullivan says he has devised a technique that he describes as a "type of thread lifting" of the submandibular gland.
The technique involves creating sutures that lift the gland from its visible position in the neck and suspend it underneath the mandible, affixed to the periosteum of the inner surface of the mandible. The sutures come up along the lingual surface of the mandible, then are looped down and underneath the gland.
"I then use a figure-eight suture configuration that cinches the submandibular gland and brings it up underneath the mandible," Dr. Sullivan explains. "Additional layers of sutures are then placed below the submandibular gland, in the capsule and surrounding structures, to help suspend the gland in its new position and to prevent from falling back down again."
Dr. Sullivan says that when done correctly, this anatomic approach to treating such difficult neck fullness and ptosis of the submandibular gland can result in high success rates and patient satisfaction. He adds that he plans to continue applying his technique of suture-lifting not only in the neck, but in facial procedures, where it can have similarly high levels of success and high patient satisfaction with postoperative results.