Feldman Neck Lift

1. Auflage 2006
ISBN: 978-1-63853-543-0
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 548 Seiten, ePub

Neck lift is a popular procedure for patients desiring facial rejuvenation to restore youthful contours. A sagging neck and developing jowls are often the first visible signs of aging, and thus adequate correction of the neck becomes a primary concern for most patients. For many patients, particularly younger ones, a neck lift alone is sufficient to provide the lift they desire. For others, this procedure is combined with a more extensive face-lift procedure.

is a landmark work by one of the recognized pioneers in face and neck-lift surgery. Dr. Feldman's corset platysmaplasty technique has revolutionized the way surgeons approach the neck. His ongoing innovations continue to advance the field. In this comprehensive, semi-atlas work, Dr. Feldman presents his dramatic technique for rejuvenating the aging neck and correcting ancillary problems such as jowling, bulging submandibular glands, and other gravitational changes in the mid to lower face and neck. Beautiful color illustrations and numerous preoperative, intraoperative, and postoperative images help the reader visualize the steps of each procedure and appreciate the excellent long-term results that can be achieved. Special emphasis is given to the tips and tricks that distinguish an excellent result from an ordinary one and to the critical maneuvers that are key to each procedure.

Written in a personal and thoroughly inviting style, this remarkable book is both educational and enjoyable. It is destined to become a valued part of your library. To complement this book, a DVD with a video of operative technique is included.

Autoren/Hrsg.

Feldman, Joel

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Plastische, Rekonstruktive & Kosmetische Chirurgie

Inhaltsverzeichnis

1 Central concepts
2 Surgical antomy of the neck
3 Incisions
4 The patient in consultation
5 Surgery's sequence of events
6 Neck flap dissection and subcutaneous lipectomy
7 Corset platysmaplasty
8 Subplastysmal aesthetic surgery
9 Submandibular salivary gland bulges
10 The ptotic chin
11 Earlobe shaping
12 Correcting problems from a previous neck lift

Leseproben

1	Central Concepts

REGARDING THE OUTCOME,

THE DOC DID CONFESS,

WHAT DEFIES DUSTY LOGIC

MAY SUCCEED IN THE FLESH.

Aesthetic surgery of the neck is an elastic art. It seeks to shape tissues that not only stretch and strain, but also contract and adapt, in ways that sometimes surprise even seasoned plastic surgeons. It is also an empirical discipline, in which observation rather than calculation, testing rather than theory, best gauges the value of practiced measures. It is that elasticity and empiricism that have brought me to an unconventional approach to neck lift surgery. I believe that:

• Excising skin is often the least important part of a neck lift.
• Modifying the central subplatysmal tissues is often the most important part.
• Skin incisions often need not leave the shelter of the postauricular sulcus.
• Open lipectomy, rather than closed liposuction, is generally preferred, because it affords precise control of the subcutaneous padding of the neck.
• The platysma is preferentially tightened at the front of the neck, not the back.
• The platysma need not be cut to eliminate muscle bands, deepen the hyoid angle, or give shape to a thick neck.
• Excess jowl fat is usually discarded rather than repositioned back in the cheek.
• The bulge of a submandibular salivary gland may at times be dealt with by a partial gland excision, rather than attempting to camouflage it, or trying to ignore it.
• A cheek lift is often unnecessary for patients who only want and only need the neck and jowl improved.

I have used neck lift for this book’s title simply because it has come to mean a surgical procedure that recontours or rejuvenates the neck. Ironically, when applying my usual methods of neck lifting, nothing is actually lifted. In most cases, there is no posterior pull on the skin, no neck skin excision, and no backward tightening of the platysma muscle. Rather, a lift is simulated by redistribution of lax neck skin, anterior tightening of the platysma, and a resolute, albeit customized, reshaping of the subcutaneous and subplatysmal tissues.

This patient, for example, had a liftless neck lift. In addition to a submental incision, a periauricular incision was used. It started behind her tragus and then ran three quarters of the way up the postauricular sulcus. These incisions provided access for a subcutaneous defatting of the lower cheek and neck, a subplatysmal lipectomy, a perihyoid fascia release, a low partial transection of the anterior digastric muscles, a partial resection of the submandibular salivary glands, and correction of her chin ptosis. No skin was removed from her neck.

But why is it that we don’t have to lift the neck as we usually lift the fallen face—with an upward repositioning of the subcutaneous and musculoaponeurotic tissues, and the excision of excess skin? The answer is topography.

Unlike the face above it, with its two relatively flat and relatively small-surfaced cheek plateaus divided by a nasal and mental mountain range and a lip-edged oral barrier sea, the anterior neck below presents a very different landscape: a curved, undulating plane resembling a half-cylinder with no midline obstacles separating the two sides—a surface big enough to absorb a good deal of surgically freed skin.

Because the neck and the face have different shapes and different surfaces, the surgical maneuvers needed to effectively treat each can differ. In the neck, excess fat can always be discarded, whereas in the cheek, excess fat is often best repositioned to restore deficient or displaced tissue volume. It means that the platysma of the neck can be reefed at the front, rather than at the back, thereby joining forces with gravity instead of pulling against it. It means that in most patients, the excess skin of the neck can be freed and dispersed without the need for excision, allowing the incisions used for subcutaneous access to be kept well hidden. And it means that by focusing on a remodeling of the neck tissues, rather than concentrating on simply hiking these tissues upward, a longer-lasting and more refined improvement in neck appearance can often be realized.

THE INTEGRATED NECK LIFT

Most of the neck lifts that I perform are combined with cheek lifts—what most surgeons and most patients would call a face lift or a face-neck lift. As such, the approach to neck-lift surgery described in this book could be integrated, in whole or in part, into most face-lifting techniques—whether a one-layer subcutaneous lift,5,32,46,57,84 a two-layer subcutaneous and sub-SMAS lift,* a one-layer sub-SMAS lift,9,18,38-41 a subperiosteal lift,† or one of the small-sear cheek lift procedures‡—although several of the small-scar methods make a point of severely limiting the extent of skin undermining in the neck.

The dissection plane in the cheek was confluent with the dissection plane in the neck, as shown on the right, in this patient who had a subcutaneous face-neck lift.

*References 3, 4, 15, 16, 60, 75, 91.

†References 1, 10, 28, 43-45, 83, 103.

‡References 2, 6, 24, 49, 62, 88, 95.

These two patients had a neck lift as part of a subcutaneous face lift without neck skin excision.

This intraoperative photo shows the sub-SMAS dissection plane in the cheek and the supraplatysmal dissection plane in the neck separated by the platysma-SMAS layer extending up into the composite one-layer cheek flap. This patient underwent a deep plane face-neck lift.

This woman had a neck lift integrated into a deep plane face lift without neck skin excision.

This man also had a deep plane face lift and concomitant neck lift without neck skin excision.

All of the subcutaneous, platysmal, and subplatysmal tissue modifications used in my approach to neck-lift surgery can be accomplished through a submental incision. That means that any or all of those maneuvers could be performed with a short-scar face lift—in which the preauricular incision usually ends at or just behind the earlobe. At the annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) in 2000, I presented my 10-year experience with face or neck lift without a post-auricular incision.24 In looking back on that decade of experience, however, I discovered that my efforts to end the incision at the earlobe occasionally left a permanent and visible upward advancement flap dog-ear below the earlobe, or a gathered pleat behind the earlobe, in patients with lax tissues in the jawline region.

It may well be that I encounter more skin redundancy around the ear than other short-scar surgeons because I undermine more extensively in the lateral neck and behind the ear. Regardless, I now usually continue the small-incision cheek-lift incision well up into the postauricular sulcus where there is enough room to comfortably chase away a fold or pleat—but more about that later.

This patient had a short-scar cheek lift with the preauricular incision ending at the anterior base of the earlobe. The lift was primarily in a vertical direction. She also had a concomitant neck lift that included a corset platysmaplasty using a submental incision. Although some skin was removed from her cheek along the preauricular and lower sideburn-edge incision, no skin was removed from the patient’s neck.

GLOBALISTS VERSUS REGIONALISTS

Globalists generally favor an all-or-none approach to facial rejuvenation. They believe that once a person is past 45 or 50 years of age, the face and neck, brows and eyelids all more or less show their age. Consequently, for surgery to achieve a natural and harmonious result, the whole face and neck should be treated at the same time. For them, lifting a sagging neck without also lifting the face (which some globalists think is technically impossible) is like painting just one room in an old house: once done, all the other rooms will immediately, and loudly, cry out for a fresh coat as well. Certainly, there is often something to be said for sprucing up the entire place at one time.

Regionalists, on the other hand, believe that different regions of the face and neck age in different ways, at different rates, according to differing genetic and environmental determinants. Therefore we would commonly expect to see, as we do, men and women who never had cosmetic surgery, who display a sag to the cheek while sporting a relatively youthful-looking neck, and others with fallen necks, who display tidy faces, as we see as well. We don’t...