Treatment of Anterior Neck Aging without a Submental Approach: Lateral Skin-Platysma Displacement, a New and Proven Technique for Platysma Bands and Skin Laxity.

BACKGROUND: A high rate of recurrence of anterior platysma bands and anterior skin laxity was reported at the 1-year follow-up of 150 patients who underwent complete neck undermining and full-width platysma transection for neck rejuvenation. The authors propose a new technique-lateral skin-platysma displacement-to treat these two aesthetic problems using only a lateral approach to avoid "opening" the anterior neck. The authors' objective was to compare outcomes following full-width platysma transection technique and lateral skin-platysma displacement technique in terms of patient satisfaction, complications, and long-term effectiveness in the treatment of bands and anterior skin laxity. METHODS: A prospective study was carried out on 100 patients. All patients were operated on by the senior surgeon (M.P.C.). Patient questionnaires were used to assess their levels of satisfaction. RESULTS: Patient satisfaction was extremely high following both techniques. Successful correction of bands at 1 year was observed in 83.5 percent of the lateral skin-platysma displacement patients and 56 percent of the full platysma section patients. Regarding recurrent skin laxity, 68 percent of those who underwent lateral skin-platysma displacement did not show any obvious recurrence of excess skin at 1 year compared with 52 percent of the full platysma section group. Prolonged edema was the main complication and was considerably more frequent in the patients undergoing complete neck undermining. CONCLUSIONS: The 1-year patient satisfaction ratings were higher for those treated with the lateral skin-platysma displacement technique. The lateral skin-platysma displacement technique has proved to have a much shorter recovery and better outcomes in the correction of platysma bands and of the anterior neck skin laxity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Complete Platysma Transection in Neck Rejuvenation: A Critical Appraisal.

BACKGROUND: The most common features of aging in the anterior neck are skin laxity and anterior platysma bands. Most neck correction techniques fail to obtain lasting correction of these despite promising early improvement. The authors use a major procedure to obtain the best results, combining full neck undermining with complete platysma transection and midline platysma approximation. Even using this technique, the authors have had concerns about the long-term results, and are aware of the lack of published studies of results using this technique. METHODS: A prospective study was conducted on 150 consecutive neck-lift patients operated on by the same senior surgeon (M.P.C.) between 2010 and 2014 to evaluate patient satisfaction and recurrence rates of anterior skin laxity and platysma bands. Patients were reviewed at 3 months (138 cases) and 1 year (96 cases). At both time points, patients completed questionnaires on level of satisfaction and eventual complaints regarding their surgical treatment, and were objectively evaluated for skin excess and recurrent bands. RESULTS: At 1 year, 76 percent of the patients were satisfied with the outcome using this technique, although satisfaction had been 100 percent at 3 months. However, only 52 percent showed no anterior neck skin excess and 55 percent had no recurrence of bands 1 year after surgery. CONCLUSIONS: Despite obtaining satisfactory results in most patients, this technique has several downsides: it is time consuming, there is the risk of iatrogenic deformities unless it is carried out precisely, the postoperative recovery is often very long, and there is a significant failure to maintain long-term correction. After 25 years' experience with these deficiencies, a reconsideration of the most appropriate procedure for correction of the anterior neck is warranted. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Alar batten cartilage graft: treatment of internal and external nasal valve collapse.

BACKGROUND: The aim of this study was to describe the efficacy of alar batten graft in correcting internal and external nasal valve collapse (i.n.v. and e.n.v.) and evaluate the functional and aesthetic results. METHODS: From July 2006 to September 2008, 80 patients (54 females and 26 males) underwent alar batten cartilage grafting. The patients were divided into three groups: (1) 55 patients with iatrogenic nasal valve collapse (80% i.n.v., 20% e.n.v.), (2) 15 patients with posttraumatic nasal valve collapse (45% i.n.v., 55% e.n.v.), and (3) 10 patients with congenital nasal valve collapse (100% e.n.v.). Patients were evaluated at 6, 12, 24, and some at 36 months after surgery. The final follow-up was at least 24 months. RESULTS: The results of this study revealed a significant increase in the size of the aperture at the internal or external nasal valve after the application of alar batten grafts. All the patients noted improvement in their nasal airway breathing and in their cosmetic appearance. No major complication was observed. CONCLUSION: The alar batten graft is a simple, versatile technique for long-term reshaping, repositioning, and reconstruction of the nasal valve collapse.