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

2. Introduction Aesthetics Anatomy cervicomental angle 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