Case 23 Aging Face and Neck



Jonathan P. Brower and Patrick K. Sullivan

Case 23 Aging Face and Neck

Case 23 (a, b) A 62-year-old female requests a consultation for rejuvenation of the midface and neck, complaining that she looks “old and tired” and is self-conscious of the appearance of her neck.



23.1 Description




  • Elderly female with minimal actinic damage and glabellar rhytids, crow’s feet, perioral rhytids, and moderate tear trough deformity



  • Midface: Soft tissue descent and moderate jowling with prominence and asymmetry of nasolabial and labiomental folds



  • Neck: Blunted cervicomental angle with marked skin laxity and evidence of excess subcutaneous +/- subplatysmal fat; no evidence of platysmal bands



23.2 Work-Up



23.2.1 History




  • What are the patient’s primary aesthetic concerns?



  • Previous facial procedures and surgeries



  • Medical history




    • Special attention is paid to cardiopulmonary diagnoses including hypertension, use of anticoagulants, and smoking history



  • Ophthalmologic history, if procedure is undertaken with periorbital rejuvenation




    • Visual acuity, dry eye



23.2.2 Physical Examination




  • Aesthetic analysis of facial aging




    • Upper third




      • Brow position and symmetry



      • Dermatochalasis; skin quality and presence of rhytides



      • Lower lid laxity, fat herniation, and tear trough deformity



    • Middle third




      • Malar volume descent



      • Prominence of nasolabial folds



      • May choose to comment on nose (see Chapter 27)



    • Lower third




      • Lip fullness



      • Marionette lines; jowls



      • Chin projection



    • Neck




      • Skin laxity



      • Subcutaneous versus subplatysmal fat: Determined by a pinch test in which the tissue is gently pinched while the patient swallows. Tissue that pulls out of the examiner’s hand indicates subplatysmal fat.



      • Platysmal banding



      • Measurement of cervicomental angle (ideal 90–110 degrees)



  • Skin type and quality




    • Fitzpatrick Scale for skin type classifies response of skin to UV light




      • Useful for determining response of skin to nonsurgical adjuncts for rejuvenation (peels, lasers, etc.)



    • Overall skin quality, including pre-existing photo damage



23.3 Patient Counseling




  • It is critical to elucidate patient’s expectations and establish realistic outcomes from surgery




    • Durability and longevity of result are not guaranteed



  • Face and neck rejuvenation are contouring procedures




    • Nonsurgical treatments (neurotoxins, peels) may remain necessary to treat rhytids



  • Preoperative photos




    • Essential to document existing anatomy and asymmetry that may not be treated or even improved by surgery

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 23 Aging Face and Neck

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