Key points

Editor Commentary: I met Patrick when he kindly asked me to participate in a anatomy laboratory teaching session in Paris. We have remained close friends and I have learned a lot from him. In addition to this contribution, his books on the anatomy of Botulinun toxin injetions and facial fillers provide safe, sound methods to chemically rejuvenate the face and neck. His treatment of the submaxillary glands and recurrent platysma bands with Botulinum Toxin, included in this chapter is important to have in our list of procedures .

Incision

Typically, for the young female patient with a thin neck, I use only the classical skin incision of face lifting, with no anterior approach.

For the older male patient with a heavy neck, platysma bands and retrogenia, I begin with an anterior approach and I add a classical face lifting incision.

I never use only an anterior approach in a patient who is undergoing facelift for the first-time, but I sometimes do in cases of recurrence of neck ptosis following a first facelift.

Incision

Typically, for the young female patient with a thin neck, I use only the classical skin incision of face lifting, with no anterior approach.

For the older male patient with a heavy neck, platysma bands and retrogenia, I begin with an anterior approach and I add a classical face lifting incision.

I never use only an anterior approach in a patient who is undergoing facelift for the first-time, but I sometimes do in cases of recurrence of neck ptosis following a first facelift.

Defat and fat grafting

To defat the neck I use only liposuction, but extensively, systematically including the jowl above the platysma and between the anterior platysma’s bands, ceasing the liposuction at the mandibular line.

I leave skin only with no fat above the neck platysma. This is done to reinforce the angle between the mandibular line (where I keep the fat) and the neck (where there is no more fat above the platysma).

I do not perform a fat resection because, between the anterior bellies of the digastric muscle, it is impossible to avoid the lymphatic nodes and vessels located in the sub mental area. Moreover, fat resection can create irregularity, asymmetry, bumps and hardness in the area, making patient follow up and recurring visits challenging.