Modified deep plane rhytidectomy with a lateral approach to the neck: an alternative to submental incision and dissection.

Abstract

A "composite" type subplatysmal dissection with lateral advancement of the platysma-skin flap to lift the neck during rhytidectomy has been advocated by several authors. However, the limited subplatysmal dissection described in these techniques restricts the degree of mobilization of the flap. Therefore, most investigators rely on supraplatysmal dissection and medial plication of the platysma to achieve satisfactory cervical contours, especially in patients with difficult necks. To allow for greater mobilization of composite neck flaps, the senior author (T.A.M.) extends the subplatysmal dissection to incorporate release of cervical retaining ligaments. The dissection is carried medially to just beyond the region defined by the inferomedial portion of the parotid gland, and inferiorly to where the superficial musculoaponeurotic system-platysma layer and greater auricular nerve cross the posterior border of the sternocleidomastoid muscle. Dissection of the composite flap is followed by use of fine cannula submental liposuction. Experience with 742 rhytidectomies performed over a 10-year period indicates that this operation can be completed safely with satisfactory results and a low incidence of complications. The use of a submental incision and medial platysma plication can be avoided almost entirely. Identification and release of the cervical retaining ligaments permits significant platysma-skin flap mobilization. When complemented with submental liposuction, complete cervical rejuvenation can be achieved without need for medial platysma plication. The full integration of the neck and facial plane of dissection results in a very even tension and a natural appearance, even in repeated face lifts.