Cervicoplasty: nonexcisional anterior approach

The purpose of this paper is to demonstrate a technique of cevicoplasty by means of a submental incision exclusively, without removal of skin. This technique is indicated in patients with good-quality skin that has adequate capacity for contraction and redraping. The neck is approached by means of a 3- to 4-cm incision posterior to the submental crease. A thick subcutaneous flap is developed. Initial "open" dissection is continued with dissection using the endoscope. All the fat over the platysma muscle is dissected off. The dissection follows a triangle outlined by the sternocleidomastoid muscles. An insulated suction coagulator is used for hemostasis. Conservative defatting of the subcutaneous layer is done, and no suction lipectomy is used routinely. However, all the fat pad between the platysma borders and the fat pad between the mylohyoid and the digastric muscles are removed. The digastric muscles are either "shaved off" or plicated in the midline with 3-0 nylon sutures. This provides a smooth and flat contour to the submental area. Subplatysmal dissection beyond the submaxillary salivary gland is done with the aid of the endoscope. After a trial of advancement, the medial borders of the platysma are resected, and plication in the midline is performed from the level of the thyroid cartilage to the symphysis of the mandible. In most cases, a backcut on the platysma from the thyroid cartilage level in an oblique direction for about 3 to 4 cm is done to avoid secondary lateral platysma bands. If no good definition on the submental angle is obtained, an interlocked suture suspension with anchoring to the mastoid fascia is performed. The relative value of this maneuver will be discussed. The skin is allowed to redrape. Usually, after medial advancement of the platysma, an additional platysma-skin separation is needed in some segments to allow smooth contour on the surface of the skin. The suture suspension may leave minimal rippling laterally. This usually disappears in a few days. The technique described has been used for several years as an isolated procedure or as a part of a full endoscopic face lift without skin excisions. If used in the right patient, the result is comparable with that of the open excisional approach and has a high rate of satisfaction. The long-term durability remains to be seen.