This four-part video demonstration is of an isolated neck lift, a procedure indicated in patients with cervical obliquity and bands, in which the soft tissues of the cheek and jawline are well supported by the facial retaining ligaments. I perform isolated neck lifts through postauricular incisions, as well as a submental incision which allows access to contouring the anterior platysma. The dissection is begun laterally through the postauricular incision towards the midline of the neck, dissecting in the subcutaneous plane along the innerface between preplatysmal fat and the underlying platysma muscle. This allows the surgeon to keep the preplatysmal fat intact and vascularized on the cervical skin flap. After performing a similar dissection on the contralateral side, a submental incision is made caudal to the submental skin crease, and the dermal attachments of the crease are dissected from the mandibular symphysis. A through-and-through dissection of the neck is then completed. Preplatysmal fat is removed from the central neck to expose the underlying platysma muscle. In the patient on this video, a small amount of subplatysmal fat is also resected superior to the hyoid, to deepen the cervicomental angle. Interrupted 3-0 mersilene sutures are used for the platysma plication, extending from the mentum toward the base of the neck. A partial platysma myotomy is then performed from the midline toward the anterior border of the sternocleidomastoid, a distance of 5 to 6 cms. The key to platysma transection is not only to divide the muscle, but also to release the superficial fascia posterior to the platysma, to ensure adequate muscular release. Following platysma myotomy, the platysmaplasty is reinspected and additional sutures are added to define the cervicomental angle.
In summary, the advantages of an anterior approach to cervical contouring include:
1) Direct surgical access to the anterior platysma, allowing the surgeon to precisely contour the platysma muscle such that it conforms to the floor of the mouth and thyroid cartilage, thereby diminishing cervical obliquity and banding.
2) It allows the surgeon to precisely set the depth of the cervicomental angle, which is of aesthetic significance in determining both the vertical height of the neck, as well as the horizontal dimension of the jawline.
3) Precise resection of preplatysmal and subplatysmal fat
4) The obliteration of the submental crease, which allows a better blending between the chin and the neck.
Baker Gordon Symposium on Cosmetic Surgery.