Submental rhytidoplasty following rhytidectomy and platysmaplasty.Excessive midline mid·line n. A medial line, especially the medial line or plane of the body. midline, n the line equidistant from bilateral features of the head. submental laxity laxity /lax·i·ty/ (lak´si-te) 1. slackness or looseness; a lack of tautness, firmness, or rigidity. 2. slackness or displacement in the motion of a joint.lax´ laxity looseness. can be problematic following rhytidectomy rhytidectomy /rhyt·i·dec·to·my/ (rit?i-dek´tah-me) excision of skin for elimination of wrinkles. rhyt·i·dec·tomy n. See face-lift. with platysmaplasty in patients with features of rhytidosis facialis with extreme midline submental laxity and moderate submental fat (figure 1). These challenging cases can often benefit from a secondary procedure: submental rhytidoplasty. We treated a patient with persistent submental redundancy by performing rhytidectomy with platysmaplasty (figure 2). [FIGURE 1-2 OMITTED] In cases of extreme midline laxity, it is often the case that the two different vectors of pull provided by each side in a posterosuperior direction are not sufficient. In such circumstances, a direct submental skin excision with an anterior vector of pull provides a third direction, which results in resolution of the laxity. Direct access is obtained via a submental incision that extends laterally to the mid-mandibular body (figure 3). Supraplatysmal flaps are elevated, and a long ellipse ellipse, closed plane curve consisting of all points for which the sum of the distances between a point on the curve and two fixed points (foci) is the same. It is the conic section formed by a plane cutting all the elements of the cone in the same nappe. of excess skin and subcutaneous tissue is excised. The incision is closed with vertical mattress sutures and heals well. Significant improvement of soft-tissue laxity and favorable postoperative scarring are typical with this procedure (figure 4). [FIGURE 3-4 OMITTED] There are three key points to keep in mind with regard to submental rhytidoplasty: * It tightens the laxity by providing a third vector of pull. * Making the incision long and tapering it to the mid-body of the mandible mandible /man·di·ble/ (man´di-b'l) the horseshoe-shaped bone forming the lower jaw, articulating with the skull at the temporomandibular joint.mandib´ular man·di·ble n. will prevent the dog-ear deformity that typically occurs following standard submental excision. * Placement of the incision at the inferior aspect of the mandible means that the scar fails into the shadow area on anteroposterior anteroposterior /an·tero·pos·te·ri·or/ (-pos-ter´e-er) directed from the front toward the back. an·ter·o·pos·te·ri·or adj. Abbr. AP 1. Relating to both front and back. view. This, coupled with excellent healing in this area, makes for an incision that is extremely well tolerated by patients. We perform submental rhytidoplasty in approximately 5% of our patients, and we find that it is an effective and cosmetically appealing means of addressing a challenging deformity. From the Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Rochester The University of Rochester (UR) is a private, coeducational and nonsectarian research university located in Rochester, New York. The university is one of 62 elected members of the Association of American Universities. (N.Y.) Medical Center. |
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