Vincent C. Giampapa

Neck recontouring with suture suspension and liposuction: An alternative for the early rhytidectomy candidate

The authors present a new technique that uses liposuction of the submental and submandibular areas to remove fat and initiate skin contracture. The technique also includes platysmal resection and the use of interlocking sutures running through a subcutaneous tunnel immediately below the submandibular border. The results of the procedure are a recontoured neck and highlighted mandibular border.The authors present a new technique that uses liposuction of the submental and submandibular areas to remove fat and initiate skin contracture. The technique also includes platysmal resection and the use of interlocking sutures running through a subcutaneous tunnel immediately below the submandibular border. The results of the procedure are a recontoured neck and highlighted mandibular border.

Suture Suspension Platysmaplasty for Neck Rejuvenation Revisited: Technical Fine Points for Improving Outcomes

BackgroundThe suture suspension platysmaplasty technique for neck rejuvenation was introduced more than 13 years ago. Over the years and after a large number of procedures performed for all classes of neck deformities, a number of technical fine points evolved that resulted in even more aesthetically pleasing and predictable results. These technical fine points are presented in detail, and their direct anatomic effects are analyzed. Finally, the points that constitute the youthful neck are redefined with detailed schematic presentation.Anatomic ConsiderationsAll aspects of neck rejuvenation with the suture suspension platysmaplasty are analyzed, with a focus on the changes that occur in terms of the following six key anatomic points: cervicomental angle depth, mandibular border definition, mandibular angle definition, labiomandibular fold prominence (jowling), mental prominence, and neck width.Technical Fine PointsAdditional technical fine points have evolved over the past 13 years to optimize the results and produce a more natural appearing and aesthetically pleasing neck: the “angle loop” of the suspension sutures, anatomic suction-assisted lipectomy using appropriate cannulas, application of moderate tension to the interlocking suspension suture to avoid the “overcorrected neck,” imbrication of the midline platysma, conservative skin excision, and augmentation of the chin to increase the depth of the cervicomental angle.ConclusionThe interlocking suture technique, by creating an artificial permanent “ligament” under the mandible, corrects the anatomic components of the neck (points 1 to 6) with excellent long-term outcomes and patient satisfaction rates. The additional technical fine points have made the aesthetic results more natural and pleasing, while making the technique more simple, safe, and reproducible.

Long-Term Results of Suture Suspension Platysmaplasty for Neck Rejuvenation: A 13-Year Follow-up Evaluation

BackgroundNeck rejuvenation has been one of the most important components in treatment for the aging face because the neck frequently is the first feature to show signs of aging. Several techniques have been described, but assessment of the long-term effects, although limited, has shown frequent recurrence of neck ptosis and the need for reoperation. The suture suspension technique was introduced 13 years ago. This article presents the long-term results for this technique, illustrating the different neck types, their classification, and their outcomes.MethodsFor this study, 100 patients who underwent neck rejuvenation using the suture suspension platysmaplasty technique were randomly selected. They represented the four patient groups examined: 5-year group (47 patients), 7-year group (28 patients), 10-year group (19 patients), and 13-year group (6 patients). The key anatomic points for each patient were evaluated preoperatively and postoperatively by five independent observers who analyzed the outcomes with a simplified scoring system (1 to 10 for each anatomic point). The scoring system was used for all the patient age groups and applied to all six key anatomic points of the neck: cervicomental angle depth, mandibular border definition, mandibular angle definition, labiomandibular fold prominence (jowling), mental prominence, and neck width. Patient satisfaction surveys were offered to all patients included in the study.ResultsAll the patient groups showed significant aesthetic improvement (in terms of their scores) for all the anatomic points (1–6) evaluated. Specifically, the long-term effect of the procedure was the most impressive for the cervicomental angle (with improvement ranging from 82% to 95% for the four groups of patients). The least degree of improvement was noted for the labiomandibular fold (with improvement ranging from 12% to 53% for the four groups of patients). The remaining anatomic variables showed an overall improvement ranging from 61% to 85%.ConclusionThe suture suspension technique is a safe, reproducible technique that allows for a staged rejuvenation of the neck. As an alternative for the early rhytidectomy candidate, it produces excellent patient satisfaction outcomes with long-term corrections for the majority of patients. As compared with previously described platysmaplasty techniques, suture suspension platysmaplasty has the benefit of endurance. This article documents that the corrections can last at least 13 years with virtually unchanged aesthetic results.

Suture suspension technique offers predictable, long-lasting neck rejuvination ☆

Vincent C. Giampapa, MD, Montclair, NJ, is a board-certified plastic surgeon. The underlying mechanisms involved in the aging neck include increased laxity in the skin, buildup of subcutaneous fat in the subdermal, submental, and preplatysmal planes, and a lack of tone and lengthening of the platysma muscle.1 Due to these factors, loss of a well-defined cervicomental angle and a decrease in the definition of the inferior mandibular border can be observed. Traditional surgical techniques focus on the redraping of the skin through preauricular incisions and the tightening or plicating of the muscle through a myriad of techniques, all which fail to achieve reliable long-term results.2–4 Key elements for long-term success with the suspension technique include proper patient selection and appropriate attention to the technical details of the procedure. The suture suspension technique is an excellent option for the patient who would like to avoid a face lift incision and whose primary signs of aging have occurred in the neck and mandibular area. It is also an excellent choice for a patient who has undergone a previous rhytidectomy with an unsatisfactory result at the level of the cervicomental angle and mandibular border. When I examine a patient with neck laxity, the first step is to check the depth of the natural cervicomental angle. This can be easily accomplished with a cotton applicator and gentle pressure. The deeper the cervicomental angle, the better suited the candidate for this procedure. A deep cervicomental angle will take up the excessive skin and muscle laxity and allow for a new neck contour with no postoperative redundancy of either of these key structures. The suture suspension technique is an excellent option for the patient who would like to avoid a face lift incision and whose primary signs of aging have occurred in …

Anti-aging medicine and the aesthetic surgeon: A new perspective for our specialty

1. Glycation: The cross-linking of proteins at the cellular and genetic levels is caused by unrelated glucose levels, insulin surges, and insulin-receptor insensitivity. This directly effects gene expression and protein synthesis. Glycosylation of the I.g. molecule results in modified immunoglobulin function, which may then contribute to autoimmune reactions. 2. Inflammation: Initiated by acute phase proteins, this creates an increase in key cytokines (TH1, CRP, serum amyloid A) and initiates aging changes in the vascular tissues, brain, joints, and GI tract as well as modifying gene expression and posttranslational protein formation. 3. Oxidation: The amount of free radical damage produced at the intra- and extracellular levels. This directly affects genetic structure and function, and the functions of cell membrane organelles. 4. Methylation: The addition of CH3, which affects the masking portion of specific regions of DNA and the unmasking of others. This alters how our genetic messages are translated by turning the molecular genetic switch either from on to off or from off to on, thereby modifying genetic expression.

Barbed Thread Facelift: a Personal Journey

This article is dedicated to the memory of Feliciano Blanco M.D., a young rising star in plastic surgery whose life was cut short in July 2005 in Monterrey, Mexico.

Clinical Treatment of the Aging Process Presently and Immediate Future Trends

To gauge the effectiveness of anti-aging medical therapies, surrogate markers, or biomarkers, are used instead of the improvement of specific symptoms to evaluate outcome. Traditionally, when investigators want to measure endpoints within a short time frame, instead of waiting for more clinically important endpoints, surrogate markers are employed. Although anti-aging medicine uses surrogate markers in part because experiments involving life span would be impractical in humans, this is not the primary reason for their use. Rather, surrogate markers are an important way to measure biological function: hence the portmanteau biomarker.

Aesthetic Recontouring of the Midfacial Skeleton: A Regional Approach

Aesthetic facial skeleton recontouring, whether done for traumatic, congenital, or aesthetic indications, is gaining in popularity. In the past, its success has largely depended upon the aesthetic sense of the surgeon. Through the use of cadaver dissections, the underlying bony anatomy of the midface was studied and subsequently divided into three distinct regions. The contribution of each of these regions of the midface to the oblique and frontal profiles is described. With utilization of moulages taken from the surface of skulls in these regions, anatomically contoured implants were designed. To facilitate clinical implant placement and symmetry, skin markings employing superficial landmarks of the face are described. The standard blepharoplasty incision for subperiosteal placement of the regional implants is detailed, and the benefits of this technique over previously described routes of insertion are discussed. A total of 73 malarplasties in 35 patients have been performed in a period of more than 4 years. Surgery is easily done under local anesthesia either alone or in conjunction with rhinoplasty, blepharoplasty, or rhytidectomy.