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Secondary Neck Lift and the Importance of Midline Platysmaplasty: Review of 101 Cases

Citarella, Enzo Rivera M.D.; Condé-Green, Alexandra M.D.; Janne Hasbun, Samir M.D.

Plastic and Reconstructive Surgery: February 2017 - Volume 139 - Issue 2 - p 564e-566e
doi: 10.1097/PRS.0000000000002999
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Department of Plastic Surgery Ivo Pitanguy Institute, and Enzo Rivera Citarella Clinic Rio de Janeiro, Brazil

Department of General Surgery Division of Plastic Surgery Rutgers New Jersey Medical School Newark, N.J. Department of Plastic Surgery Ivo Pitanguy Institute, and Enzo Rivera Citarella Clinic Rio de Janeiro, Brazil

Department of Plastic Surgery Ivo Pitanguy Institute, and Enzo Rivera Citarella Clinic Rio de Janeiro, Brazil

Correspondence to Dr. Condé-Green, Department of General Surgery, Division of Plastic Surgery, Rutgers New Jersey Medical School, Newark, N.J. 07103, acondegreen@yahoo.com

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Sir:

It was with great interest that we read the article entitled “Secondary Neck Lift and the Importance of Midline Platysmaplasty: Review of 101 Cases” by Narasimhan et al.1 We congratulate the authors on the value given to open submental access and platysmaplasty, a concept we strongly share and that has proven to offer optimal results in our neck lifts.2 The authors retrospectively analyzed 101 patients of 1089 who underwent secondary or revision neck lifts. Seventy percent of the revisions were the authors’ own primary cases. More than half the patients had no midline plication in the primary procedure and, of those that had some form of submental platysmaplasty, one developed new platysmal bands. The most common deformities encountered were recurrent platysmal bands and persistent/recurrent jowling. Their technique consists of a five-step approach that includes facial/neck skin undermining; submental access with direct fat excision and midline platysmal plication; lateral platysmal window; contour assessment, which may require release of the mandibular septum; and superficial musculoaponeurotic system and skin redraping.3,4 The authors state that this technique provides long-lasting results. We would like to comment on this technique, given its similarity with our neck contouring approach, further enlightening the importance of open submental access and platysmaplasty.

After liposuction of the cervical region, we perform supraplatysmal and subplatysmal dissection through a submental incision and resect any excess muscle, preventing bulging and recurrence. Anterior platysma plication using a triple-suture technique2 is performed. A first line of interrupted 3-0 nylon sutures approximates the medial platysma edges, including the anterior belly of the digastric muscles, from the submental to the suprahyoid regions. A second suture, a single 2-0 nylon suture, is placed at the thyroid cartilage level, approximating the distal extremities of the platysma and adjacent tissues. A third line of running nylon 3-0 sutures from the level of the thyroid cartilage to the supramental region reinforces the previous ones, defining the cervicomental angle. Then, the lateral cervical region is widely undermined joining the medial region, and plication of the lateral superficial musculoaponeurotic system–platysma to the periosteum of the mastoid bone is performed, defining the cervicomandibular angle. Cutaneous traction and redraping following a superoposterior oblique vector is performed.

We present a 63-year-old patient with recurrent platysmal bands, jowling, and excess skin, 5 years after a cervicofacial lift where no midline platysmal plication was performed (Fig. 1, left). With our triple-suture technique, we were able to redefine the cervicomental angle and create a smooth cervicomandibular line (Fig. 1, right).

Fig. 1.

Fig. 1.

The platysma is a thin elastic membrane that may not hold lateral tightening sutures that are placed under tension.5 An open approach allows adequate submental access for anterior platysma plication that has been a reliable method to prevent recurrent platysma bands and jowling. We congratulate the authors on their shift in technique throughout the years. We believe that key elements of our technique, such as resection of excess medial muscles and the midline triple-suture plication including the digastric muscles and adjacent tissues, can further improve and maintain the results on a long-term basis.

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DISCLOSURE

The authors declare no conflicts of interests with respect to the authorship and/or publication of this communication. The authors received no financial support for the research and/or authorship of this communication.

Enzo Rivera Citarella, M.D.
Department of Plastic Surgery
Ivo Pitanguy Institute, and
Enzo Rivera Citarella Clinic
Rio de Janeiro, Brazil

Alexandra Condé-Green, M.D.
Department of General Surgery
Division of Plastic Surgery
Rutgers New Jersey Medical School
Newark, N.J.

Department of Plastic Surgery
Ivo Pitanguy Institute, and
Enzo Rivera Citarella Clinic
Rio de Janeiro, Brazil

Samir Janne Hasbun, M.D.
Department of Plastic Surgery
Ivo Pitanguy Institute, and
Enzo Rivera Citarella Clinic
Rio de Janeiro, Brazil

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REFERENCES

1. Narasimhan K, Ramanadham S, O’Reilly E, Rohrich RJ. Secondary neck lift and the importance of midline platysmaplasty: Review of 101 cases. Plast Reconstr Surg. 2016;137:667e675e.
2. Citarella ER, Condé-Green A, Sinder R. Triple suture for neck contouring: 14 years of experience. Aesthet Surg J. 2010;30:311319.
3. Cruz RS, O’Reilly EB, Rohrich RJ. The platysma window: An anatomically safe, efficient, and easily reproducible approach to neck contour in the face lift. Plast Reconstr Surg. 2012;129:11691172.
4. Narasimhan K, Stuzin JM, Rohrich RJ. Five-step neck lift: Integrating anatomy with clinical practice to optimize results. Plast Reconstr Surg. 2013;132:339350.
5. Feldman JJ. Neck lift my way: An update. Plast Reconstr Surg. 2014;134:11731183.
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