CERVICOPLASTY - NONEXCISIONAL ANTERIOR APPROACH

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.