Submental Manoeuvres

The Scar Solution Natural Scar Removal

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Dimitrije E. Panfilov

Mostly we can achieve fairly good definition of the mento-cervical angle by lateral mobilization and fixation of skin and platysma and by liposuction of the submental region. Sometimes, however, it will not be enough to harmonize the entire neck. We can excise a spindle-like part of the submental skin and subcutaneous fat to tighten the skin.

If there are platysma bands with muscle fibres we can mobilize them, cut them, or suture them together.

We can provoke the real platysma bands by asking the patient to tighten his/her neck muscles or to a make disgusting facial expression. Skin excision, "corseting", and "notching" will improve the neck harmony.

  1. 54.1. a Preoperative look with skin bands -sufficient to achieve this result without platysma bands. b Classic face-neck-lift and submental skin excision were
  2. 54.1. a Preoperative look with skin bands -sufficient to achieve this result without platysma bands. b Classic face-neck-lift and submental skin excision were
Submental Muscle
Fig. 54.2. Submental skin excision and "corseting" of platysma bands in the upper part (platysmoraphy) and "notching" in the lower part of the neck
Photos Platysma Bands
Fig. 54.3. a Real platysma bands. b Result 2 weeks after platysmoraphy. Corseting suture c placed and d tightened

Notching is procedure popularized by Ziya Saylan which is very simple. Preoperatively we palpate pla-tysma bands and make markings where horizontal neck wrinkles cross these bands. Intraoperatively we cut the skin superficially over these markings and catch the muscle band with a small Dechemp hook. Now we cut muscle fibres preferably with radiowaves. In such a way we do not cause bleeding.

Platysma Lift

Fig. 54.4. a Real platysma bands, left more than right. b Ten days after face-neck-lift and notching of platysma bands. Stretching the skin, we clasp the muscle and divide it into c the upper and d the lower part of the neck

Sometimes the hypertrophic digastric muscle produces a turkey neck without a mento-cervical angle. In that case we detach the mental attachments of both digastric muscles in the same way as we do in notching.

When we have a "heavy neck" we must sometimes do additionally partial resection of the submandibu-lar gland (see Chap. 55 by Farzad Nahai and Foad Na-hai). This is the case in less than 1% of all our facelifts and we perform digastricus detachment in less than 2% of all cases.

Neck Platysma Surgery
Fig. 54.5. a Exposing the mental attachment of the right digas- and d after face-neck-lift, liposuction of platysmal fat, and tric muscle through the skin and platysma layer and b detach- bilateral digastricus detachment ment with radiosurgery. Patient c before this type of surgery
Obtuse Cervicomental Angle
Fig. 54.6. a "Heavy neck" with platysma bands and visible submandibular glands. b Face and neck surgery, liposuction, corseting, and partial resection of the submandibular gland
Platysma Scars Problems
Fig. 54.7. a "Turkey neck" and hypognathy; submental excision, corseting, liposuction, and bone graft planned. b Preoperative submental view. c Bone graft to be taken from the iliac crest. Patient d before and e 3 months after surgery

If the turkey neck is combined with hypognathy, we should add also chin augmentation. For this purpose we prefer a "horseshoe" silicone chin implant, but patients in Germany sometimes insist on autolo-gous bone graft, which we take from the iliac crest.

There is also a simple method of neck-tightening by "star excision" and zigzag "Zorro scar" in the middle of the neck for those patients who are ready to accept this type of scar. We should check if the patient already has unobtrusive scars somewhere else on the body. It is of some comfort that the older we are, the more cell activity decreases, and the scars we produce are less visible with increasing age.

First we palpate the skin and underlying fat with one hand and we mark an oval or spindle-like vertical picture in the middle of the neck. Then we mark the legs of distant multiple Z-plasty (see Figs. 54.8 and 54.10 and also Chap. 51 by Ulrich Kesselring). Then we cut it preferably with radiosurgery and suture it. Additionally we apply adhesive bandages to reduce the tension on the wound edges.

Direct Excision Neck Skin
Fig. 54.8. a Preoperative markings. b Incisions with radiosurgery - no bleeding! c Excision completed. d Suture completed

Both patient and surgeon should have patience for the first couple of weeks and months. After the tenth postoperative day, the scar should be hidden with cosmetic camouflage.

We can do this kind of surgery at the same time as facelift surgery, some time later, or isolated, just for neck-tightening.

Bibliography

Please see the general bibliography at the end of this book.

Surgical Patient Profile
Fig. 54.9 a-e. Patient from Fig. 54.8 en face after a 1 week, b 3 months, and c 12 months. Same patient in profile view d before surgery and e after 12 months
  1. 54.10. a Planning of isolated necklift with "star excision". b Patient 6 months after surgery. Profile view of the same patient c before and d 6 months after surgery
  2. 54.10. a Planning of isolated necklift with "star excision". b Patient 6 months after surgery. Profile view of the same patient c before and d 6 months after surgery

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