Surgical management of the aging face has incorporated a wide range of new techniques and developments over the past few decades. Traditional face lifting techniques have employed more aggressive methods; however, over the past years, cosmetic surgeons have designed new and less- invasive techniques to achieve similar results.1-5
A classic example is how Dr. Richard Webster modified the facelift technique, and his painstaking demonstrations comparing aesthetic outcomes from deep- plane facelifting to a less aggressive approach using a limited undermining technique and superficial musculo-aponeurotic system (SMAS) plication.1,2 His new approach clearly obtained a similar long-lasting result with fewer complications than the more traditional and aggressive deep-plane undermining lifts.2,3
Earlier intervention in the aging process allows for even less-invasive, “maintenance” techniques. For example, Botox, injectable filler materials and lasers that allow for quick recovery are used to minimize the signs of aging in 30- to 50-year-old patients who may not need a facelift. None of these treatments, however, address early jawline sagging and premature neck drooping, although Botox can temporarily help platysmal band formation.
Here, we present a new simplified and minimally invasive thread-assisted lifting method to restore a more youthful jawline. This technique re-establishes a proper cervicomental angle and reduces platysmal banding, which cannot be adequately addressed otherwise. It can be used alone for patients who may not need other interventions, or it can be used in combination with various other techniques to produce overall face and neck improvement with minimal surgery.
Materials and Methods
Listed below are the materials used to perform our platysmal banding technique.
1. 2-0 polydiaxanone absorbable suture (PDS) with a straight needle and segmented stabilizers at 90° angles (Grams Surgical Suture, GramsMed, LLC Grafton, WI [4] )
2. a 14-gauge angiocatheter
3. a number 11 blade with handle
4. a 4-mm spatula liposuction cannula and,
5. a standard facial instrument tray.
The patient is initially prepped and draped. Local anesthesia with or without supplemental sedation (depending on patient preference) is administered then followed by tumescent anesthesia.
Neck and jowl liposuction, if needed, may be performed through a nick incision in the submental area and in the periauricular areas with a number 11 blade. An incision is then made behind the earlobe, continuing posteriorly 1 cm.
The angiocatheter is advanced bluntly through the incision towards the platysmal band (see photos 3a to 3d). The trocar is removed from the angiocatheter and 2-0 PDS suture (free end) is advanced toward the platysmal band. After positioning the 2-0 PDS suture so that all the stabilizers are under the skin, the angiocatheter can be removed.
The suture is then pulled toward the periauricular incision until the platysmal bands have been smoothed. Any puckering of the skin can be easily reduced with a 4-mm spatula liposuction cannula.
After obtaining desirable resuspension of the platysmal bands, the 2-0 PDS suture is firmly sutured to the subauricular fascia. Overlying skin is then sutured with a running 5.0 Prolene. (see photos 4a to 4f).
Excellent Results
We have applied this technique to more than 50 patients in the past year with excellent results. (See photos 4 through 9). Some patients, such as the first one shown, had the technique done alone while other patients had it applied with neck and jowl liposuction and a small skin tuck. We have experienced no complications thus far; however as with any type of surgical procedure, one must be wary of bleeding, infection and scarring.
A Better Minimally-Invasive Technique
Senescent changes of the mature neck include accumulation of fat, laxity of muscular support, and the cumulative effects of photodamage and gravity. These contribute to the loss of definition of the cervicomental angle, submental fullness, sagging of the jowls, inelasticity and redundancy of the skin, along with platysmal band formation.
Traditional and less-invasive facelifts, as well as liposuction, can help address the submental fullness, sagging of the jowls, loss of definition of the cervicomental angle and the inelasticity and redundancy of the skin.5,6 However, prominent platysmal bands can still be difficult to address with these techniques.
Earlier attempts to reduce platysmal banding include:
• direct excision of submental and anterior cervical redundant soft tissue
• submental fat resection and incision of platysmal and deep fascia for Z-plasty through a submental incision, followed by transection, plication, suspension and flap transposition
• liposuction and redraping of the neck and jowls, “corset platysmaplasty”, platysmal sling and Botox.5,6
Unfortunately, some of these techniques are either significantly invasive, produce objectionable scarring, or are very temporary. Our goal by using the Grams surgical suture is to provide a minimally-invasive technique for redraping the jawline and addressing the platysmal bands in a more permanent fashion.
Because the stabilizers are larger than the barbs found in two competitors’ sutures, we have found the Grams surgical suture to also produce lasting results. Nonetheless, as with all facial surgery, time and gravity are relentless, and incremental corrections may be necessary at 3- to 5-year intervals.
A Simplified Technique
This simplified technique to improve the early sagging jawline and reduce platysmal bands provides an effective means to address problematic early aging changes of the lower face and neck. It can be done under local anesthesia or with mild intravenous sedation for maximal patient comfort.
Performed alone or combined with other non-invasive techniques, this technique can be considered minimally invasive surgery.
Done in conjunction with procedures, such as neck and jawline liposuction, a minituck, or full-face and neck lifting, the platysmal bands can now be effectively and efficiently addressed.
Surgical management of the aging face has incorporated a wide range of new techniques and developments over the past few decades. Traditional face lifting techniques have employed more aggressive methods; however, over the past years, cosmetic surgeons have designed new and less- invasive techniques to achieve similar results.1-5
A classic example is how Dr. Richard Webster modified the facelift technique, and his painstaking demonstrations comparing aesthetic outcomes from deep- plane facelifting to a less aggressive approach using a limited undermining technique and superficial musculo-aponeurotic system (SMAS) plication.1,2 His new approach clearly obtained a similar long-lasting result with fewer complications than the more traditional and aggressive deep-plane undermining lifts.2,3
Earlier intervention in the aging process allows for even less-invasive, “maintenance” techniques. For example, Botox, injectable filler materials and lasers that allow for quick recovery are used to minimize the signs of aging in 30- to 50-year-old patients who may not need a facelift. None of these treatments, however, address early jawline sagging and premature neck drooping, although Botox can temporarily help platysmal band formation.
Here, we present a new simplified and minimally invasive thread-assisted lifting method to restore a more youthful jawline. This technique re-establishes a proper cervicomental angle and reduces platysmal banding, which cannot be adequately addressed otherwise. It can be used alone for patients who may not need other interventions, or it can be used in combination with various other techniques to produce overall face and neck improvement with minimal surgery.
Materials and Methods
Listed below are the materials used to perform our platysmal banding technique.
1. 2-0 polydiaxanone absorbable suture (PDS) with a straight needle and segmented stabilizers at 90° angles (Grams Surgical Suture, GramsMed, LLC Grafton, WI [4] )
2. a 14-gauge angiocatheter
3. a number 11 blade with handle
4. a 4-mm spatula liposuction cannula and,
5. a standard facial instrument tray.
The patient is initially prepped and draped. Local anesthesia with or without supplemental sedation (depending on patient preference) is administered then followed by tumescent anesthesia.
Neck and jowl liposuction, if needed, may be performed through a nick incision in the submental area and in the periauricular areas with a number 11 blade. An incision is then made behind the earlobe, continuing posteriorly 1 cm.
The angiocatheter is advanced bluntly through the incision towards the platysmal band (see photos 3a to 3d). The trocar is removed from the angiocatheter and 2-0 PDS suture (free end) is advanced toward the platysmal band. After positioning the 2-0 PDS suture so that all the stabilizers are under the skin, the angiocatheter can be removed.
The suture is then pulled toward the periauricular incision until the platysmal bands have been smoothed. Any puckering of the skin can be easily reduced with a 4-mm spatula liposuction cannula.
After obtaining desirable resuspension of the platysmal bands, the 2-0 PDS suture is firmly sutured to the subauricular fascia. Overlying skin is then sutured with a running 5.0 Prolene. (see photos 4a to 4f).
Excellent Results
We have applied this technique to more than 50 patients in the past year with excellent results. (See photos 4 through 9). Some patients, such as the first one shown, had the technique done alone while other patients had it applied with neck and jowl liposuction and a small skin tuck. We have experienced no complications thus far; however as with any type of surgical procedure, one must be wary of bleeding, infection and scarring.
A Better Minimally-Invasive Technique
Senescent changes of the mature neck include accumulation of fat, laxity of muscular support, and the cumulative effects of photodamage and gravity. These contribute to the loss of definition of the cervicomental angle, submental fullness, sagging of the jowls, inelasticity and redundancy of the skin, along with platysmal band formation.
Traditional and less-invasive facelifts, as well as liposuction, can help address the submental fullness, sagging of the jowls, loss of definition of the cervicomental angle and the inelasticity and redundancy of the skin.5,6 However, prominent platysmal bands can still be difficult to address with these techniques.
Earlier attempts to reduce platysmal banding include:
• direct excision of submental and anterior cervical redundant soft tissue
• submental fat resection and incision of platysmal and deep fascia for Z-plasty through a submental incision, followed by transection, plication, suspension and flap transposition
• liposuction and redraping of the neck and jowls, “corset platysmaplasty”, platysmal sling and Botox.5,6
Unfortunately, some of these techniques are either significantly invasive, produce objectionable scarring, or are very temporary. Our goal by using the Grams surgical suture is to provide a minimally-invasive technique for redraping the jawline and addressing the platysmal bands in a more permanent fashion.
Because the stabilizers are larger than the barbs found in two competitors’ sutures, we have found the Grams surgical suture to also produce lasting results. Nonetheless, as with all facial surgery, time and gravity are relentless, and incremental corrections may be necessary at 3- to 5-year intervals.
A Simplified Technique
This simplified technique to improve the early sagging jawline and reduce platysmal bands provides an effective means to address problematic early aging changes of the lower face and neck. It can be done under local anesthesia or with mild intravenous sedation for maximal patient comfort.
Performed alone or combined with other non-invasive techniques, this technique can be considered minimally invasive surgery.
Done in conjunction with procedures, such as neck and jawline liposuction, a minituck, or full-face and neck lifting, the platysmal bands can now be effectively and efficiently addressed.
Surgical management of the aging face has incorporated a wide range of new techniques and developments over the past few decades. Traditional face lifting techniques have employed more aggressive methods; however, over the past years, cosmetic surgeons have designed new and less- invasive techniques to achieve similar results.1-5
A classic example is how Dr. Richard Webster modified the facelift technique, and his painstaking demonstrations comparing aesthetic outcomes from deep- plane facelifting to a less aggressive approach using a limited undermining technique and superficial musculo-aponeurotic system (SMAS) plication.1,2 His new approach clearly obtained a similar long-lasting result with fewer complications than the more traditional and aggressive deep-plane undermining lifts.2,3
Earlier intervention in the aging process allows for even less-invasive, “maintenance” techniques. For example, Botox, injectable filler materials and lasers that allow for quick recovery are used to minimize the signs of aging in 30- to 50-year-old patients who may not need a facelift. None of these treatments, however, address early jawline sagging and premature neck drooping, although Botox can temporarily help platysmal band formation.
Here, we present a new simplified and minimally invasive thread-assisted lifting method to restore a more youthful jawline. This technique re-establishes a proper cervicomental angle and reduces platysmal banding, which cannot be adequately addressed otherwise. It can be used alone for patients who may not need other interventions, or it can be used in combination with various other techniques to produce overall face and neck improvement with minimal surgery.
Materials and Methods
Listed below are the materials used to perform our platysmal banding technique.
1. 2-0 polydiaxanone absorbable suture (PDS) with a straight needle and segmented stabilizers at 90° angles (Grams Surgical Suture, GramsMed, LLC Grafton, WI [4] )
2. a 14-gauge angiocatheter
3. a number 11 blade with handle
4. a 4-mm spatula liposuction cannula and,
5. a standard facial instrument tray.
The patient is initially prepped and draped. Local anesthesia with or without supplemental sedation (depending on patient preference) is administered then followed by tumescent anesthesia.
Neck and jowl liposuction, if needed, may be performed through a nick incision in the submental area and in the periauricular areas with a number 11 blade. An incision is then made behind the earlobe, continuing posteriorly 1 cm.
The angiocatheter is advanced bluntly through the incision towards the platysmal band (see photos 3a to 3d). The trocar is removed from the angiocatheter and 2-0 PDS suture (free end) is advanced toward the platysmal band. After positioning the 2-0 PDS suture so that all the stabilizers are under the skin, the angiocatheter can be removed.
The suture is then pulled toward the periauricular incision until the platysmal bands have been smoothed. Any puckering of the skin can be easily reduced with a 4-mm spatula liposuction cannula.
After obtaining desirable resuspension of the platysmal bands, the 2-0 PDS suture is firmly sutured to the subauricular fascia. Overlying skin is then sutured with a running 5.0 Prolene. (see photos 4a to 4f).
Excellent Results
We have applied this technique to more than 50 patients in the past year with excellent results. (See photos 4 through 9). Some patients, such as the first one shown, had the technique done alone while other patients had it applied with neck and jowl liposuction and a small skin tuck. We have experienced no complications thus far; however as with any type of surgical procedure, one must be wary of bleeding, infection and scarring.
A Better Minimally-Invasive Technique
Senescent changes of the mature neck include accumulation of fat, laxity of muscular support, and the cumulative effects of photodamage and gravity. These contribute to the loss of definition of the cervicomental angle, submental fullness, sagging of the jowls, inelasticity and redundancy of the skin, along with platysmal band formation.
Traditional and less-invasive facelifts, as well as liposuction, can help address the submental fullness, sagging of the jowls, loss of definition of the cervicomental angle and the inelasticity and redundancy of the skin.5,6 However, prominent platysmal bands can still be difficult to address with these techniques.
Earlier attempts to reduce platysmal banding include:
• direct excision of submental and anterior cervical redundant soft tissue
• submental fat resection and incision of platysmal and deep fascia for Z-plasty through a submental incision, followed by transection, plication, suspension and flap transposition
• liposuction and redraping of the neck and jowls, “corset platysmaplasty”, platysmal sling and Botox.5,6
Unfortunately, some of these techniques are either significantly invasive, produce objectionable scarring, or are very temporary. Our goal by using the Grams surgical suture is to provide a minimally-invasive technique for redraping the jawline and addressing the platysmal bands in a more permanent fashion.
Because the stabilizers are larger than the barbs found in two competitors’ sutures, we have found the Grams surgical suture to also produce lasting results. Nonetheless, as with all facial surgery, time and gravity are relentless, and incremental corrections may be necessary at 3- to 5-year intervals.
A Simplified Technique
This simplified technique to improve the early sagging jawline and reduce platysmal bands provides an effective means to address problematic early aging changes of the lower face and neck. It can be done under local anesthesia or with mild intravenous sedation for maximal patient comfort.
Performed alone or combined with other non-invasive techniques, this technique can be considered minimally invasive surgery.
Done in conjunction with procedures, such as neck and jawline liposuction, a minituck, or full-face and neck lifting, the platysmal bands can now be effectively and efficiently addressed.
