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Total Neck Rejuvenation, Harnessing the Platysma in the Lower Neck and Décolletage

  • Innovative Techniques
  • Facial Surgery
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Abstract

Background

Efforts to rejuvenate the lower neck and décolletage have not been adequately addressed by neck lift techniques which predominantly focus on improving the cervicomental angle and correcting fullness in the submental and submandibular region. Disappointment with a lack of initial result in the lower neck and early relapse of laxity led the author (DJH) to adopt the Fogli/Labbé vertical neck lift with a fixation of the platysma muscles to Loré’s fascia Fogli (Aesthet Plast Surg 32:531–541, 2008), Labbé et al. (Plast Reconstr Surg 117:2001–2007, 2006). Over the past 8 years, since the original “modified” Fogli description was published by Hodgkinson (Aesthet Plast Surg 36:28–40, 2012), the technique has evolved with a specific aim to improve the initial results of the neck lift in the lower half of the neck and have the result maintained in follow-up.

Methods

The clinical photographs of female patients who underwent face and neck rejuvenation utilising a modified Fogli vertical platysma advancement technique were evaluated as to the improvement of the rejuvenation in the lower neck and décolletage and compared with the photographs obtained by the original pexy technique. The review was restricted to patients operated on in the prior extant three-year period and compared with the results of patients having surgery in that preceding five years prior to the review period.

Results

The results of the recent technical modifications of the vertical lift by the platysma flap advancement were superior to the previous pexy technique and attributable to the advent of the surgical auricular-platysmal flap advancement. This flap, which in continuity with the distal platysma was affixed with permanent sutures to Loré’s fascia after definitive release of the cervical retaining ligaments of the platysma.

Conclusion

The modifications of the vertical platysma fixation to Loré’s fascia after mobilisation of the distal platysma by detachment of the cervical retaining ligaments utilising an advancement of the platysma led to improvement in the rejuvenation of the lower neck and décolletage when compared to the pexy technique of the original Fogli/Labbé description.

Level of Evidence IV

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References

  1. Hodgkinson DJ (2012) Five year experience with modified Fogli (Loré’s Fascia Fixation) platysmaplasty. Aesthet Plast Surg 36:28–40

    Article  Google Scholar 

  2. Hermanson T (2020) The vulnerable neck. www.threadforthought.net/vulnerable-neck/, Accessed 9 Mar 2020

  3. Chatel A (2020) 31 hottest (unexpected) erogenous zones. Glamour Magazine. 2020, July 24. www.glamour.com/story/hottest-erogenous-zoneswomen

  4. Goddard AJ (2015) Women on fire. Avery, New York, NY

    Google Scholar 

  5. Fogli AL (2008) Skin and platysma muscle anchoring. Aesthet Plast Surg 32:531–541

    Article  CAS  Google Scholar 

  6. Labbé D, Franco RG, Nicolas J (2006) Platysma suspension and platysmaplasty during neck-left and analysis of 30 cases. Plast Reconstr Surg 117:2001–2007

    Article  Google Scholar 

  7. Hodgkinson DJ (2014) Total neck rejuvenation using a modified Fogli approach and selective resection of anterior platysma bands. Clin Plast Surg 41:73–80

    Article  Google Scholar 

  8. Auersvald A, Auersvald L (2014) Hemostatic net in rhytidoplasty: an efficient and safe method for preventing hematoma in 405 consecutive patients. Aesthet Plast Surg 38:1–9

    Article  Google Scholar 

  9. Hodgkinson DJ (2018) The fate of Fogli’s Loré’s fascial platysma fixation optimalising the results of Fogli’s neck lift procedure. Aesthet Plast Surg 42:1002–1012

    Article  Google Scholar 

  10. Koda H (2004) Extreme beauty: the body transformed. Metropolitan Museum of Art, New York, NY

    Google Scholar 

  11. Lightoller GS (1940) The comparative morphology of the platysma: a comparative study of the sphincter colli profundus and the trachelo-platysma. J Anat 74:390–396

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Huber E (1931) Evolution of facial muscles and facial expression. Arno Press, New York Times Company, New York (Reprint 1972)

    Google Scholar 

  13. Mendelson BC, Jacobson SR (2008) Surgical anatomy of the midcheek: facial layers, spaces, and the midcheek segments. Clin Plast Surg 35:395–404

    Article  Google Scholar 

  14. Charafeddine AH, Drake R, McBride J, Zins J (2019) Facelift: history and anatomy. Clin Plast Surg 46:505–514

    Article  Google Scholar 

  15. Furnas DW (1983) The retaining ligaments of the cheek. Plast Reconstr Surg 83:11–16

    Article  Google Scholar 

  16. O’Brien J, Rosen W, Whitaker I, Ashton M (2012) Loré’s Fascia and the auriculo-platysmal ligament are distinct structures. Plast Reconstr Aesthet Surg 65:E241–E245

    Article  Google Scholar 

  17. Mustoe TA, Rawlani V, Zimmerman H (2011) Modified deep plane rhytidectomy with a lateral approach to the neck: an alternative to submental incision and dissection. Plast Reconstr Surg 127:357–370

    Article  CAS  Google Scholar 

  18. Jacono AA, Malone MH (2017) Characterization of the cervical retaining ligaments during subplatysmal facelift dissection and its implications. Aesthet Surg J 37:495–501

    Article  Google Scholar 

  19. Labbé D, Rocha CSM, de Rocha FS (2017) Cervicomental angle suspensory ligament: the keystone to understand the cervicomental angle and the ageing process of the neck. Aesthet Plast Surg 41:832–836

    Article  Google Scholar 

  20. Brandt M, Agniezka H, Roth K, Wehrli B (2012) The hyoplatysmal ligament: characterization and biomechanical properties. Arch Facial Plast Surg 14:369–371

    Article  Google Scholar 

  21. Le Louarn CA (2016) New approach to functional anatomy of the lower face; Role of the hypoplatysmal ligament, of the platysma and of the depressor labii lateralis. Annales de Chirurgie Plastique Esthetique 61:101–109

    Article  Google Scholar 

  22. Connell BF (1978) Contouring the neck in rhytidectomy by lipectomy and a muscle sling. Plast Reconstr Surg 61:376–383

    Article  CAS  Google Scholar 

  23. Guerrerosantos J (2008) Managing platysma bands in the aging neck. Aesthet Surg J 28:211–216

    Article  CAS  Google Scholar 

  24. Owsley JQ Jr (1983) SMAS-platysma facelift. Plast Reconstr Surg 71:573–579

    Article  Google Scholar 

  25. Aston S, Walden J (2009) Facelift with SMAS techniques and FAME. Aesthetic Plastic Surgery. Saunders and Elsevier, pp. 76-77

  26. Marten TJ (2008) High SMAS facelift: combined single flap lifting of the jawline, cheek and midface. Clin Plast Surg 35:569–603

    Article  Google Scholar 

  27. Botti G, Pelle-Ceravolo M (2012) Midface and neck aesthetics. Aeta Medica Edizione, Parma, IT

    Google Scholar 

  28. Feldman JJ (2006) Neck lift. Quality Medical Publishing, St Louis, MO

    Book  Google Scholar 

  29. Auersvald A, Auersvald L, Uebel CO (2017) Subplatysmal necklift: a retrospective analysis of 504 patients. Aesthet Surg J 37:1–11

    Article  Google Scholar 

  30. Jones BM, Grover R (2004) Avoiding hematoma in cervicofacial rhytidectomy: a personal 8-year quest. Reviewing 910 patients. Plast Reconstr Surg 113:381–387

    Article  Google Scholar 

  31. Narasimhan K, Stuzin J, Rohrich R (2013) Five-step neck lift: integrating anatomy with clinical practice and optimize results. Plast Reconstr Surg 132:339–350

    Article  CAS  Google Scholar 

  32. Guyuron B, Sadek E, Ahmadian R (2010) A 26-year experience with vest-over-pants technique platysmarrhaphy. Plast Reconstr Surg 126:1027–1034

    Article  CAS  Google Scholar 

  33. Matarasso A (2014) Managing the components of the aging neck. Clin Plast Surg 41:85–98

    Article  Google Scholar 

  34. Park MS, Moon SH, Lee LM (2013) The effect of age on cervical sagittal alignment: normative data on 100 asymptomatic subjects. Spine 19:141–159

    Google Scholar 

  35. Trévidic P (2019) Surgical denervation of platysma bands: a novel technique in rhytidectomy. Plast Reconstr Surg 144:798e–802e

    Article  Google Scholar 

  36. Sinno S, Thorne CH (2019) Cervical branch of facial nerve: an explanation for recurrent platysma bands following necklift and platysmaplasty. Aes Surg J 39:1–7

    Article  Google Scholar 

  37. Pelle-Ceravolo M, Angelini M (2019) Lateral skin-platysma displacement—a new approach to neck rejuvenation through a lateral approach. Clin Plast Surg 46:587–602

    Article  Google Scholar 

  38. Warren R Personal Communication, "the lower neck - the final frontier"

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Authors and Affiliations

  1. Double Bay Day Surgery, Sydney, NSW, Australia

    Darryl Hodgkinson

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  1. Darryl Hodgkinson
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Correspondence to Darryl Hodgkinson.

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Supplementary Information

Incision of the auriculo-platysmal ligament flap and detachment from the anterior border of the sternomastoid (MP4 9447kb)

Auriculo-platysmal ligament flap elevated showing access behind the platysma in front of the sternomastoid placement for vertical suture placement (MP4 3816kb)

Traction of the auriculo-platysmal ligament flap elevates the lower neck and asserts horizontal traction underneath the mandible (MP4 4894kb)

Traction of the auriculoplatysma flap shows elevation of the lower neck and decolletate (MP4 15998kb)

3 cable suture vertical fixation of the platysma to Loré’s fascia (MP4 6126kb)

Replacement and reattachment of the auriculo-platysmal ligament flap to cover the 3-cable fixation suture (MP4 4617b)

23-year-old female with forced contraction shows no anterior bands (MP4 12612kb)

18-year-old female with a congenital platysmal band exaggerated on contraction of the platysma. Patient underwent a resection of the band via a submental incision (MP4 8895kb)

Same patient as video 8, 8 years after resection of the band (trachelo platysma) with no recurrence of the band on contraction (MP4 8717kb)

Secondary platysma surgery elevation by recapturing the 3-cable fixation knot and resuspending it to Loré’s fascia **Tevdek–Teleflex Medical, 3015 Carrington Mill Blvd, Morrisville NC 27560 USA, ***Vicryl–Ethicon, Sommerville, NJ, USA (MP4 18616kb)

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Hodgkinson, D. Total Neck Rejuvenation, Harnessing the Platysma in the Lower Neck and Décolletage. Aesth Plast Surg 46, 161–172 (2022). https://doi.org/10.1007/s00266-020-02068-4

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