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THE AGING NECK

THE AGING NECK. Carl Schreiner, MD Byron Bailey, MD October 10,1997. Introduction. Aesthetics cervicomental angle Anatomy SMAS platysma skin attachments vector forces “sling effect” ?depressor of lower lip. CLASSIFICATION. Diagnosis skin muscle fat skeletal Dedo classification.

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THE AGING NECK

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  1. THE AGING NECK Carl Schreiner, MD Byron Bailey, MD October 10,1997

  2. Introduction • Aesthetics • cervicomental angle • Anatomy • SMAS • platysma • skin attachments • vector forces • “sling effect” • ?depressor of lower lip

  3. CLASSIFICATION • Diagnosis • skin • muscle • fat • skeletal • Dedo classification

  4. PATIENT SELECTION • Expectations • Photography • Asses hyoid • Assymetries • Prior Bells palsy • Smoking

  5. SURGICAL OPTIONS • SMAS Rhytidectomy • Submental liposuction • Submentoplasty • Mentoplasty • Combined procedure

  6. RHYTIDECTOMY • Cornerstone operation for the neck • Class I and II • Flap elevation • SMAS plication vs imbrication • Deep plane and subperiosteal lifts

  7. SUBMENTAL LIPOSUCTION • Class III patients - “double chin” • Better than direct excision • Complications • submental deformities • platysmal banding • ? Beneficial alone

  8. SUBMENTOPLASTY • Class IV patients • Sharp supraplatysmal dissection • Platysma manipulation • reaproximation vs imbrication • Complications • marginal n. injury • masculinization of female neck • submandibular gland ptosis

  9. DIRECT SKIN EXCISION • “Turkey Gobbler” deformity • Submental scar • Males only • Address platysma separately • Z, A-T, T-Z closure

  10. COMPLICATIONS • Hematoma • Facial nerve injury • Great auricular nerve injury • Skin slough • Submandibular gland ptosis • Submental deformities • depression, pseudobanding, “cobra”deformity

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