A

Ablation threshold, of biologic tissue, 209

Ablative CO ₂ laser, in neck skin rejuvenation, 205–206, 208, 210–214

fractional vs., 207. See also Fractional CO ₂ laser.

pulse duration effect on treatment density, 210–212

Absorption spectra, for Nd:YAG fiber lasers, 218

Adipocytes, Nd:YAG fiber laser interactions with, 218–219

Adiposity. See Fat/fatty tissue .

Adjunctive procedures, in neck rejuvenation, 231–242

chin augmentation as, 234, 236–240

expanded polytetrafluorethylene in, 234

grafts for, 234

indications for, 234

intraoral approach to implant placement, 237

mersilene mesh in, 237

outcomes of, 238–240

polyamide mesh in, 234, 236

porous polyethylene in, 234

post procedure care of, 238

silicone rubber in, 237

submental approach to implant placement, 238

fibrin sealants as, 231–236

authors’ experience with, 232–233

coagulation cascade and, 231–232

drains vs., 231

historical use of, 232

outcomes of, 234–236

procedure for, 233–234

for platysma, 248–250

laser skin resurfacing as, 248–249

neuromodulators as, 248

submental liposuction as, 249–250

hyoid bone position and, 239–240

introduction to, 231

key points of, 231

Nd:YAG interstitial fiber laser as, 217–218, 224, 226–228

submandibular gland ptosis and, 238–239

summary overview of, 240–241

in vertical neck lifting, 292

submental, 303–304, 309, 311, 313

Advance-and-spread technique, in extended SMAS rhytidectomy, 260–261

Aesthetics, of neck lift, 285–286

with intense focused ultrasound, 200

of neck rejuvenation, 171, 174, 180, 253

with deep-plane approach, 274, 280–281

Aging neck, anatomy and physiology of, 161–170

aging patterns and, 161–162

by structure, 161–169

deep plane, 169, 270–271

cartilaginous structures in, 169

cervical fascia in, 163–164

superficial vs. deep, 163–164

cervicomental angle in, 161, 163, 166–167, 169, 269

hyoid in, 169

introduction to, 161

key points of, 161

lymphatics in, 165

mandible in, 169

platysma in, 165–166

radiographic imaging indications for, 169, 244, 257

skin in, 162–164

histologic features of, 163

subcutaneous fat in, 164–165

subplatysmal deep compartment in, 166–169

deep plane defined by, 166–167, 271

digastric muscle and, 167

facial nerve and, 168–169

great auricular nerve and, 168

sternocleidomastoid muscle and, 161–162, 164, 168

submandibular glands and, 168

subplatysmal fat and, 166–167

summary overview of, 169–170

superficial muscular aponeurotic system in, 165, 270–271

triangular sections in, 162

youthful neck vs., 161–162, 164, 171, 174, 243, 269–270, 285

classification of. See Aging patterns.

lines in, 172. See also Banding.

rejuvenation of. See Neck skin rejuvenation; Rhytidectomy .

preoperative evaluation of, 171–176

clinical neck procedure evaluation and, 173–175

history taking in, 172–173, 181

physical examination in, 173–175

introduction to, 171–173

key points of, 171

summary overview of, 175–176

surgical candidate selection and, 163, 172–173

process of. See Aging process.

rejuvenation of. See Neck rejuvenation.

Aging patterns, of neck, 161

classification systems for, 180–181

3-tier, 161–162

4 subtypes, 243–244

components of, 171–172

Aging process, of neck, 269–271

chronologic, 162–163, 172

classification of. See Classification of aging process .

deep plane anatomy and, 271–273

photoaging, 161–163, 172

Anatomic variants, of neck, in vertical neck lifting, 292

Ancillary procedures. See Adjunctive procedures.

Anesthesia, for vertical neck lifting, 294

general, for deep-plane neck rejuvenation, 274

infiltrative. See Local anesthesia.

Anticoagulants, in neck rejuvenation, surgical candidate selection and, 172–173

Anti-inflammatory preparations, in neck rejuvenation, surgical candidate selection and, 172–173

to promote recovery, 186

Appendages, in aging skin, 163

ARTISS, as fibrin sealant, 232–233

outcomes in neck rejuvenation, 234–236

Aspiration cannula, for laser-assisted facial contouring, 220–221

for laser-assisted neck contouring, 224

Atrophy, subcutaneous, following vertical neck lifting, 309

Auricular nerve, great, in aging neck, 168, 250, 264, 318

B

Baker-Gordon peel, in neck skin rejuvenation, 204

Banding, in aging neck, 166, 172, 286

submental wattle related to, 246, 248, 250

in neck rejuvenation, 182

persistent, as complication, 319

preoperative evaluation of, 173–176, 180

with deep-plane approach, 282

in neck skin rejuvenation, 203, 282

in platysma rejuvenation, 246, 248, 250

in rhytidectomy classification, 254–256

Bard Parker blade, #15, in extended SMAS rhytidectomy, 258–260

Baske suspension, of submandibular gland, 238

Bidirectional technique, for neck rhytidectomy, vertical neck lift vs., 286

Botulinum toxins, in neck skin rejuvenation, 203

Brow lift, Ulthera system for, 192, 198

Brown-Adson forceps, in vertical neck lifting, 296, 301

Bruising, with neck rejuvenation, from intense focused ultrasound, 194

from rhytidectomy, 185

Buccal fat pad, in deep-plane neck rejuvenation, 273, 277–278

pseudoherniation of, 270–271, 278–280

Burns/burning. See Thermal injury.

B

Baker-Gordon peel, in neck skin rejuvenation, 204

Banding, in aging neck, 166, 172, 286

submental wattle related to, 246, 248, 250

in neck rejuvenation, 182

persistent, as complication, 319

preoperative evaluation of, 173–176, 180

with deep-plane approach, 282

in neck skin rejuvenation, 203, 282

in platysma rejuvenation, 246, 248, 250

in rhytidectomy classification, 254–256

Bard Parker blade, #15, in extended SMAS rhytidectomy, 258–260

Baske suspension, of submandibular gland, 238

Bidirectional technique, for neck rhytidectomy, vertical neck lift vs., 286

Botulinum toxins, in neck skin rejuvenation, 203

Brow lift, Ulthera system for, 192, 198

Brown-Adson forceps, in vertical neck lifting, 296, 301

Bruising, with neck rejuvenation, from intense focused ultrasound, 194

from rhytidectomy, 185

Buccal fat pad, in deep-plane neck rejuvenation, 273, 277–278

pseudoherniation of, 270–271, 278–280

Burns/burning. See Thermal injury.

C

Cartilaginous structures, in aging neck, 169

Cellular processes, in aging neck, 162–163

Cervical branch, of facial nerve, in aging neck, 168, 318

Cervical dermatochalasis, platysma rejuvenation and, 248–250

Cervical fascia, in aging neck, 163–164, 169

deeper structures of, 169, 270–273

deep-plane neck rejuvenation and, 277–278, 281

superficial vs. deep, 163–164, 271

vertical neck lifting and, 299

Cervical retaining ligaments, release of, in vertical neck lifting, 290, 292, 299–300, 306, 309

Cervical rhytidectomy, in platysma rejuvenation, 244–246

Cervicofacial rhytidectomy, complications of, 318–319

for aging neck. See Neck rejuvenation.

Cervicofacial skin flap, in midline imbrication platysmaplasty, 228

Cervicomental angle (CMA), in aging neck, anatomy and physiology of, 166–167, 169

vs. youthful neck, 243, 269, 285

in neck lifting, vertical, 300, 302

with platysma rejuvenation, 245–246

with skin redraping, 286–289

in neck rejuvenation, anatomy considerations of, 161, 163, 165, 182

hyoid bone position and, 239–240

physical examination of, 174

platysma rejuvenation and, 251

with direct excision, 246–248

with neck lift, 245–246

surgical candidate selection and, 171–172

with extended SMAS rhytidectomy, 258–259, 261

change in, 267–268

Cervicomental angle-defining Z-plasty, in platysma rejuvenation, 247–248

Cheek, in vertical neck lifting, 296, 298

Chemical peels, in neck skin rejuvenation, 204

Chin augmentation, adjunctive to neck rejuvenation, 234, 236–240

expanded polytetrafluorethylene in, 234

grafts for, 234

in vertical neck lift, 312–313

indications for, 234

intraoral approach to implant placement, 237

mersilene mesh in, 237

outcomes of, 238–240

polyamide mesh in, 234, 236

porous polyethylene in, 234

post procedure care of, 238

silicone rubber in, 237

submental approach to implant placement, 238

Chin projection, in neck rejuvenation, physical examination of, 174

surgical candidate selection and, 171–172

Chronologic aging, of neck, anatomy and physiology of, 162–163

as process, 172, 270–271

rejuvenation requests related to, 203

Classification of aging process, in neck and lower face, 180–181

3-tier, 161–162

for rhytidectomy, 254–257

4 subtypes, 243–244

components of, 171–172

CO ₂ laser, ablative, in neck skin rejuvenation, 205–206, 208, 210–214

pulse duration effect on treatment density, 210–212

fractional, in neck skin rejuvenation, 207

complications case study of, 208–211

pulse duration effect on treatment density, 209–210

CO ₂ /Er:YAG laser, in neck skin rejuvenation, 207–208

Coagulation cascade, fibrin sealants and, 231–232

Collagen, in skin, intense focused ultrasound effects on, 191, 199

laser therapies effects on, 208, 218

Columnar neck length, physical examination of, 173

Contouring procedures, for aging neck. See Neck contour/contouring.

for face. See Facial contouring.

in deep-plane neck rejuvenation, subcutaneous, 280–281

with neck dissection, 280

Cording, of platysma, following vertical neck lifting, 292–293, 310–313

Corset platysmaplasty, in vertical neck lifting, 306, 308, 310–313

Cranial suspension lift, minimal access, 179, 184, 287

Cricoid, in aging neck, 169

in vertical neck lifting, 298

Croton oil peel, in neck skin rejuvenation, 204–205

D

Debulking, in laser-assisted contouring, 221, 224

in laser-assisted face and neck lift, 228

Decussation patterns, of platysma, in aging neck, 166, 172. See also Banding.

Deep compartment. See Subplatysmal deep compartment.

Deep plane, in aging face, layers of, 271

treatment regions of, 193. See also Lower third of face.

in aging neck, anatomical components of, 270–273

subplatysmal deep compartment definition of, 166–167

in neck rejuvenation. See Deep-plane neck rejuvenation.

in platysma rejuvenation, 245–246

in rhytidectomy, for neck rejuvenation, 178–179

dissection of, 182

in vertical neck lifting, dissection of, 298, 309

flap suspension in, 300–301

Deep-plane neck rejuvenation, 269–284

aftercare of, 282

aging process and, 270–271

anatomy of, 271–273

complications of, 282–283

definition of, 271

evaluation for, 273–275

intraoperative photographs of, 270, 274, 276, 278–281

introduction to, 269–272

key points of, 269

patient perspective on, 274

postprocedure care of, 281

preoperative vs. postoperative photographs of, 272, 274–275, 279, 282–283

summary overview of, 283–284

surgical procedure for, 274, 276–282

anesthesia in, 274

flap mobilization, fixation, and closure in, 280–281

hemostasis in, 280–281

midface dissection in, 276–280

neck dissection in, 270–271, 278–280

patient preparation in, 270, 274

planning as crucial to, 274

sutures in, 281–282

sutures for, 280–282

Dehiscence, platysmal, vertical neck lifting, 306

Dermabrasion, in neck skin rejuvenation, 204

Dermal striping, as intense focused ultrasound complication, 194–195

Dermis, in aging skin, 163

Digastric muscle/tendon, in aging neck, 167, 270–271

deep-plane neck rejuvenation and, 278–279

hyoid bone position and, 240, 274

Dimples, in deep-plane neck rejuvenation, 277

Direct excision, in platysma rejuvenation, 246–251

clinical outcomes of, 251–252

Direct lipectomy, in rhytidectomy, 177–178

Direct observation/assessment, of SMAS, in neck rejuvenation, 183

Direct subcutaneous elevation, of submental neck skin, in extended SMAS rhytidectomy, 259

Drains, surgical, fibrin sealants vs., 231

in deep-plane neck rejuvenation, 280

in extended SMAS rhytidectomy, 261–264

in vertical neck lifting, 302

Dressings, postoperative, for deep-plane neck rejuvenation, 282

for extended SMAS rhytidectomy, 262, 264

for laser-assisted contouring, 221, 224

for neck rejuvenation/resurfacing, 185, 213

for platysma rejuvenation, 248–249, 251

Dual vector advancement and suspension, of extended SMAS flap, 260, 263

E

Earlobe, distortion of, from neck rejuvenation, 251, 261, 319

with deep-plane approach, 281

in vertical neck lifting, 296, 301

Easy spray unit, for fibrin sealant, 233

Edema, post-treatment inflammatory, from Nd:YAG fiber lasers, 219, 222–223

with extended SMAS rhytidectomy, 264

Elasticity, in aging skin, 163, 166

neck skin rejuvenation and, 172, 203

physical examination of, 172, 174

platysma rejuvenation and, 244

Embryologic cleavage plane, in facial deep plane, 271–272

Energy delivery, in laser-assisted facial contouring, 220–221, 223–224

Environment, aging skin and, 162

Epidermis, in aging skin, 163

Erb pint, 168

Er:Glass laser, nonablative 1540-nm, in neck skin rejuvenation, 207

Er:YAG laser, in neck skin rejuvenation, 205–207

CO ₂ combined with, 207–208

Excision, in platysma rejuvenation, direct, 246–251

clinical outcomes of, 251–252

linear, 251

of soft tissue, in extended SMAS rhytidectomy, 259–260

wedge, of platysma, in extended SMAS rhytidectomy, 259, 261

Expanded polytetrafluorethylene (ePTFE), in adjunctive chin augmentation, 234

Extended SMAS rhytidectomy, in neck rejuvenation, 253–268

anesthesia for, 258

complications of, 262–264

contraindications to, 257

examination criteria for, 254

incisions for, 258

introduction to, 253–254

key points of, 253

landmark markings for, 258

outcomes of, planned, 254–257

rebound relaxation in superficial tissues, 267–268

patient positioning for, 258

postprocedural care of, 264

preoperative planning and preparation for, 257–258

preoperative vs. postoperative photographs of, 255–257, 265–268

procedural approach to, 258–264

treatment goals for, 254–257

F

Facelift, Hamra, 289

in SMAS rhytidectomy, 253–268 . See also Extended SMAS rhytidectomy.

laser-assisted, 217. See also Laser-assisted facelift (LAFL).

mini-, fibrin sealants for, 233–234

outcomes of, 234–236

Facial aging. See Aging patterns; Aging process.

Facial anatomy, deep plane, 272–273. See also Deep plane.

embryology of, 270–271

layers of, 271

treatment regions of, 193. See also Lower third of face.

Facial contouring, laser-assisted, 217. See also Laser-assisted facial contouring (LAFC).

Facial implants, in adjunctive chin augmentation, indications for, 234

intraoral placement of, 237

materials for, 234–236

post procedure care of, 238

submental placement of, 238

prejowl, in extended SMAS rhytidectomy, 257

Facial nerve, damage to, in neck rejuvenation, 168, 318

with intense focused ultrasound, 194–195

with platysma rejuvenation, 250

in vertical neck lifting, 298–299, 301, 309

in aging neck, 166, 168–169

danger zones of, 168–169

deep plane anatomy of, 272–273

in extended SMAS rhytidectomy, 260

Facial rejuvenation, growing interest in, 171

in SMAS rhytidectomy, 253–268 . See also Extended SMAS rhytidectomy.

Facial treatment columns, marking of, for intense focused ultrasound, 193–194

Facial treatment regions, in neck treatment, 193. See also Lower third of face.

Fascia, in aging neck, 270–271

cervical. See Cervical fascia.

deep-plane neck rejuvenation and, 277–278, 281

parotid masseteric, in vertical neck lifting, 299, 301

platysma and, 253–254, 273

in extended SMAS rhytidectomy, 260

Fat pad, in deep-plane neck rejuvenation, 277–278

pseudoherniation of, 270–271, 278–280

in facial deep plane anatomy, 272–273

in vertical neck lifting, 298

Fat/fatty tissue, in aging neck, 269–271, 273

ablation/aspiration of, Nd:YAG fiber lasers efficiency for, 218, 220, 224

absorption, Nd:YAG fiber lasers and, 218–219

preplatysmal, 180, 273, 280

skin rejuvenation/resurfacing and, 203, 214

subcutaneous. See Subcutaneous fat.

submental. See Submental fat.

subplatysmal. See Subplatysmal fat.

Fibrin sealants, adjunctive to neck rejuvenation, 231–236

authors’ experience with, 232–233

coagulation cascade and, 231–232

drains vs., 231

historical use of, 232

outcomes of, 234–236

procedure for, 233–234

Fibroareolar tissue, in deep-plane neck rejuvenation, 277

Fibrous tissue, Nd:YAG fiber laser interactions with, 218, 220, 224

Fractional CO ₂ laser, in neck skin rejuvenation, ablative vs., 207. See also Ablative CO ₂ laser.

complications case study of, 208–211

pulse duration effect on treatment density, 209–210

G

Grafts, in adjunctive chin augmentation, 234

Gravity, aging skin and, 163, 270

Grecian Urn approach, to platysma rejuvenation, 246–251

H

Hair-bearing region, in deep-plane neck rejuvenation, 274, 276

in extended SMAS rhytidectomy, 259–260, 267

Hairline, distortion of, from neck rejuvenation, 319–320

with platysma rejuvenation, 250–251

occipital, in extended SMAS rhytidectomy, 261, 263

in vertical neck lifting, 294, 296

skin flap elevation and, 296–297

Hamra facelift, 289

Head positioning, in physical examination, for neck rejuvenation, 173–174

elements for neck, 174

Health status, in neck rejuvenation, surgical candidate selection and, 173, 181

Helical margin, in vertical neck lifting, 294

Hematoma, from neck rejuvenation, 317–318

with deep-plane approach, 282

with extended SMAS rhytidectomy, 262–264

with platysma rejuvenation, 250

with rhytidectomy, 185

Hemostasis, in deep-plane neck rejuvenation, 280–281

Histology, of aging skin, 163

of Ulthera effect on skin, 199

History taking. See Medical history; Surgical history.

Hyoid bone, in aging neck, 169

digastric muscle actions on, 167

surgical candidate selection and, 173, 274

youthful neck vs., 285

in neck rejuvenation, in extended SMAS rhytidectomy, 259

physical examination of, 174

position of, adjunctive procedures for, 239–240

in rhytidectomy classification, 254, 257

with platysma rejuvenation, 244

with deep-plane approach, 278, 280

in vertical neck lifting, 286–287, 292, 300

Hypertrophy, of submandibular glands, neck rejuvenation and, 238–239, 319

I

Imbrications, platysmaplasty, anterior, in extended SMAS rhytidectomy, 259–260

in deep-plane neck rejuvenation, 280

midline, 228, 248

SMAS, fibrin sealants and, 233

in extended SMAS rhytidectomy, 260–262

in rhytidectomy, for neck rejuvenation, 183–184

Implants, for chin augmentation. See Facial implants.

Incisions, in neck rejuvenation, indications for extension of, 181–182

local infiltration with lidocaine, 181

postoperative care of, 185–186

preoperative marking of, 181

short, 179

skin quality and quantity factors of, 180

with deep-plane approach, 274, 276

with extended SMAS rhytidectomy, 258–260, 262

with platysma rejuvenation, 245, 247

irregularities of, 250–251

in vertical neck lifting, 294–297

suture closure of, 303

Induration, from neck rejuvenation, 318

Infection, from neck rejuvenation, 318–319

with deep-plane approach, 282

Innervation, in aging neck. See Nerves.

Intense focused ultrasound, in neck treatment, 192–201

clinical results of, authors’ discussion on, 200–201

literature review of, 197–200

facial treatment columns marking, with planning card, 193–194

facial treatment regions and, 193

handpiece orientation to skin surface, 193–194

introduction to, 191–192

key points of, 191

mechanism of action, 191–192

outcomes of, 195–199

female in early 50s, 195–196

female in early 60s, 197–198

female in late 30s, 195–196

female in mid 70s, 197, 199

females in late 40s, 195, 197

females in late 50s, 197–198

male in mid 40s, 197, 199

patient positioning for, 193

planning card for, line calculation and marking with, 193–194

potential complications of, 194

preprocedure planning and preparation for, 193

procedural approach to, 193–195

Schlieren map of beam profile, 192

SMAS treatment targeting with, 192

transducers for, 194–195

treatment goals for, 192

Intense pulsed light, in neck skin rejuvenation, 207

pulse duration effect on ablative CO ₂ laser treatment density, 210–212

pulse duration effect on fractional CO ₂ laser treatment density, 209–210

Interstitial fiber laser, in face and neck rejuvenation, 217–218. See also Thermally confined micropulsed 1444-nm Nd:YAG interstitial fiber laser.

Intraoral dissection, of submandibular gland, in neck rejuvenation, 239

Intraoral placement, of implants, for chin augmentation, 237