eMedicine Specialties > Plastic Surgery > Rhytidectomy

Facelift, Platysmaplasty

Author: Adam J Cohen, MD, Consulting Surgeon, Eyelid and Oculofacial Aesthetic and Reconstructive Surgery, Diseases and Surgery of Orbit and Lacrimal System, Director, Center for Facial Rejuvenation
Coauthor(s): Michael Mercandetti, MD, MBA, FACS, Consulting Staff, Department of Surgery, Doctors Hospital of Sarasota
Contributor Information and Disclosures

Updated: Feb 18, 2009

Introduction

Correction of submental ptosis is sometimes necessary to reverse the effects of senescence. Although this is usually undertaken in tandem with facial rhytidectomy, surgeons may find themselves addressing only the cervical region at times. 

History of the Procedure

Skoog first described the modern surgical technique. Millard subsequently advocated a horizontal submental incision for lipectomy, excision of hypertrophic anterior platysmal bands, and wide subcutaneous cervical dissection.1,2 Owsley later supported a procedure where the platysma was elevated in conjunction with the superficial muscular aponeurotic system (SMAS).3

Etiology

Weakening of the retaining ligaments of the face contributes to age-related changes. In 1989, Furnas provided a description of these ligaments.4 These ligaments suspend the more superficial and mobile anatomical structures to the deeper and akinetic facial constituents.

Fasciocutaneous ligaments extend from the dermis to the facial fascia, and osseocutaneous ligaments extend from the dermis to the periosteum.

Other reported causes of skin sagging and drooping over the facial skeleton include loss of bone, loss of skin elasticity, and atrophy of facial fat.

Indications

Platysmaplasty is used to reverse the effects of aging, sun exposure, and smoking on the cervical region.

Relevant Anatomy

Fewer pilosebaceous units populate the integument of this region compared with other facial regions. If laser resurfacing is considered, the presence of fewer pilosebaceous units can increase the risk of pronounced scarring, increase healing time, and increase pigmentary changes. For information on laser resurfacing techniques, see eMedicine articles Skin Resurfacing, Laser: Carbon Dioxide and Skin Resurfacing, Laser: Erbium YAG.

Adipose tissue is segregated into subcutaneous and subplatysmal. Increased amounts of subcutaneous fat can be observed with weight gain, aging, and lipodystrophies. Subplatysmal fat is far more vascular and fibrous than subcutaneous fat and is visualized after incising the platysma muscle. This difference results in reduced efficacy of liposuction of subplatysmal fat.

Originating from the pectoralis major muscle fascia, the platysma is a layer of muscle that has multiple insertions. Moving anterior to posterior, the muscle is anchored to the mentum and the inferior mandibular border and meets the orbicularis oris laterally and then the depressor anguli oris. Platysmal meshing with the depressor anguli oris contributes to the superficial muscular aponeurotic system (SMAS), highlighting its importance when attempting to reverse facial aging.

Ventral rami of cervical nerves II-IV provide the tactile sense of the anterior neck. Tracking along the posterior surface of the sternocleidomastoid muscle, these sensory nerves approach the anterior neck.

The lesser occipital nerve moves posteriorly to innervate the posterior upper otic surface and retroauricular scalp; the greater auricular nerve innervates the auricle and mandibular angle. The latter is 6-6.5 mm inferior to the external auditory canal while coursing over the sternocleidomastoid muscle. The anterior triangle of the neck receives the transverse cervical nerve for sensory innervation of the region within the boundaries of the sternum and mandible. This nerve branches out over the anterior surface of the sternocleidomastoid muscle and is found within the deep cervical fascia.

The external and the anterior jugular veins are deep to the platysma. They provide vascular conduits to the facial, retromandibular, and posterior auricular veins.

The submandibular glands are lateral to the anterior belly of the digastric muscles.

Contraindications

This procedure is contraindicated in patients who are not medically stable or those who cannot tolerate anesthetic agents.

Patients who do not have realistic expectations of surgical outcomes should undergo preoperative counseling or should not undergo the operation.

More on Facelift, Platysmaplasty

Overview: Facelift, Platysmaplasty
Workup: Facelift, Platysmaplasty
Treatment: Facelift, Platysmaplasty
Multimedia: Facelift, Platysmaplasty
References
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References

  1. Millard DR, Pigott RW, Hedo A. Submandibular lipectomy. Plast Reconstr Surg. Jun 1968;41(6):513-22. [Medline].

  2. Millard DR Jr, Garst WP, Beck RL, Thompson ID. Submennta and submancibular lipectomy in conjunction with a face lift, in the male or female. Plast Reconstr Surg. Apr 1972;49(4):385-91. [Medline].

  3. Owsley JQ Jr. SMAS-platysma facelift. A bidirectional cervicofacial rhytidectomy. Clin Plast Surg. Jul 1983;10(3):429-40. [Medline].

  4. Furnas DW. The retaining ligaments of the cheek. Plast Reconstr Surg. Jan 1989;83(1):11-6. [Medline].

  5. Toft K, Keller GS, Blackwell KE. Submentoplasty. An anatomical approach. Facial Plast Surg Clin N America. May 2000;8(2):183-92. [Medline].

  6. Brissett AE, Hilger PA. Male face-lift. Facial Plast Surg Clin North Am. Aug 2005;13(3):451-8. [Medline].

  7. Watson D. Submentoplasty. Facial Plast Surg Clin N Am. 2005;13:459-467.

  8. Bitner JB, Friedman O, Farrior RT, Cook TA. Direct submentoplasty for neck rejuvenation. Arch Facial Plast Surg. May-Jun 2007;9(3):194-200. [Medline].

  9. Labbe D, Franco RG, Nicolas J. Platysma suspension and platysmaplasty during neck lift: anatomical study and analysis of 30 cases. Plast Reconstr Surg. May 2006;117(6):2001-7; discussion 2008-10. [Medline].

  10. Fuente del Campo A. Midline platysma muscular overlap for neck restoration. Plast Reconstr Surg. Oct 1998;102(5):1710-4; discussion 1715. [Medline].

  11. Gentile RD. Purse-string platysmaplasty: the third dimension for neck contouring. Facial Plast Surg. Nov 2005;21(4):296-303. [Medline].

  12. Gryskiewicz JM. Submental suction-assisted lipectomy without platysmaplasty: pushing the (skin) envelope to avoid a face lift for unsuitable candidates. Plast Reconstr Surg. Oct 2003;112(5):1393-405; discussion 1406-7. [Medline].

  13. Cohen AJ, Mercandetti M, Chang EW. Rhytidectomy, Subperiosteal Facelift. eMedicine from WebMD [serial online]. Updated October 13, 2008;Available at http://emedicine.medscape.com/article/841787-overview.

  14. Giampapa V, Bitzos I, Ramirez O, Granick M. Suture suspension platysmaplasty for neck rejuvenation revisited: technical fine points for improving outcomes. Aesthetic Plast Surg. Sep-Oct 2005;29(5):341-50; discussion 351-2. [Medline].

  15. Knize DM. Limited incision submental lipectomy and platysmaplasty. Plast Reconstr Surg. Apr 1 2004;113(4):1275-8. [Medline].

  16. Mercandetti M, Cohen AJ. Facelift, SMAS Plication. eMedicine from WebMD [serial online]. Updated April 30, 2008;Available at http://emedicine.medscape.com/article/1294486-overview.

  17. Mercandetti M, Mirante JP. Aesthetic facial surgery. In: Krause JH, Mirante JP, Christmas DA, Donley S, eds. Office-Based Surgery in Otolaryngology. Philadelphia, Pa: WB Saunders; 1999:143-55.

  18. Noone RB. Suture suspension malarplasty with SMAS plication and modified SMASectomy: a simplified approach to midface lifting. Plast Reconstr Surg. Mar 2006;117(3):792-803. [Medline].

  19. Owsley JQ Jr. Platysma-facial rhytidectomy: a preliminary report. Plast Reconstr Surg. Dec 1977;60(6):843-50. [Medline].

  20. Ruiz-Esparza J. Near [corrected] painless, nonablative, immediate skin contraction induced by low-fluence irradiation with new infrared device: a report of 25 patients. Dermatol Surg. May 2006;32(5):601-10. [Medline].

  21. Tonnard PL, Verpaele A, Gaia S. Optimising results from minimal access cranial suspension lifting (MACS-lift). Aesthetic Plast Surg. Jul-Aug 2005;29(4):213-20; discussion 221. [Medline].

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Further Reading

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Keywords

facelift, platysmaplasty, rhytidectomy, facial rejuvenation, facial plastic surgery, cosmetic surgery, aesthetic surgery, submental ptosis, submentoplasty, cervicofacial rejuvenation, sagging neck, turkey neck, submentoplasty, facelift with platysmaplasty, face lift, face-lift with platysmaplasty, face-lift, aging changes, wrinkles, wrinkling, facial surgery, senescence, submental ptosis, cervicofacial surgery, age-related facial changes

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Contributor Information and Disclosures

Author

Adam J Cohen, MD, Consulting Surgeon, Eyelid and Oculofacial Aesthetic and Reconstructive Surgery, Diseases and Surgery of Orbit and Lacrimal System, Director, Center for Facial Rejuvenation
Adam J Cohen, MD is a member of the following medical societies: American Academy of Ophthalmology and American College of Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Michael Mercandetti, MD, MBA, FACS, Consulting Staff, Department of Surgery, Doctors Hospital of Sarasota
Michael Mercandetti, MD, MBA, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Ophthalmology, American College of Surgeons, American Society for Laser Medicine and Surgery, American Society of Ophthalmic Plastic and Reconstructive Surgery, Association of Military Surgeons of the US, and Sarasota County Medical Society
Disclosure: Nothing to disclose.

Medical Editor

David W Furnas, MD, Clinical Professor Emeritus, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California at Irvine
David W Furnas, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Head and Neck Society, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society for Surgery of the Hand, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society of Transplantation, California Medical Association, Phi Beta Kappa, Plastic Surgery Research Council, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, and Society of University Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Deepak Narayan, MD, FRCS, Associate Professor of Surgery (Plastic), Yale University School of Medicine; Chief of Plastic Surgery, West Haven Veterans Affairs Medical Center
Deepak Narayan, MD, FRCS is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Indian Medical Association, Plastic Surgery Research Council, Royal College of Surgeons of Edinburgh, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

 
 
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