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

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

3. CLASSIFICATION l Diagnosis –skin –muscle –fat –skeletal l Dedo classification

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

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

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

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

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

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

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