The purpose of this paper is to demonstrate a technique of cervicoplas
ty by means of a submental incision exclusively, without removal of sk
in. This technique is indicated in patients with good-quality skin tha
t has adequate capacity for contraction and redraping. The neck is app
roached by means of a 3- to 4-cm incision posterior to the submental c
rease. A thick subcutaneous flap is developed. Initial ''open'' dissec
tion is continued with dissection using the endoscope. All the fat ove
r the platysma muscle is dissected off. The dissection follows a trian
gle outlined by the sternocleidomastoid muscles. An insulated suction
coagulator is used for hemostasis. Conservative defatting of the subcu
taneous layer is done, and no suction lipectomy is used routinely. How
ever, all the fat pad between tile platysma borders and the fat pad be
tween the mylohyoid and the digastric muscles are removed. The digastr
ic muscles are either ''shaved off'' or plicated in the midline with 3
-0 nylon sutures. This provides a smooth and flat contour to the subme
ntal area. Subplatysmal dissection beyond the submaxillary salivary gl
and is done with the aid of the endoscope. After a trial of advancemen
t? the medial borders of the platysma are resected, and plication in t
he midline is performed from the level of the thyroid cartilage to the
symphysis of the mandible. In most cases, a backcut on the platysma f
rom the thyroid cartilage level in an oblique direction for about 3 to
4 cm is done to avoid secondary lateral platysma bands. If no goad de
finition on the submental angle is obtained, an interlocked suture sus
pension with anchoring to the mastoid fascia is performed. The relativ
e value of this maneuver will be discussed. The skin is allowed to red
rape. Usually, after medial advancement of the platysma, an additional
platysma-skin separation is needed in some segments to allow smooth c
ontour on the surface of the skin. The suture suspension may leave min
imal rippling laterally. This usually disappears in a few days. The te
chnique described has been used for several years as an isolated proce
dure or as a part of a full endoscopic face lift without skin excision
s. 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.