The platysma muscle. Anatomic considerations for aesthetic surgery of the anterior neck.

Our current principles for the treatment of anterior neck deformities originally evolved from cadaver dissections and clinical observations. These principles have been applied over the past seven years in nearly 100 patients. We combine as indicated submandibular lipectomy, excision of the submental fat pad, chin implantation, creation or tightening of the platysma muscular sling, and skin tightening and resection. The muscular sling is created or tightened anteriorly by approximation or imbrication of the platysma muscle in the midline. Skin is removed posteriorly, utilizing a complete or lower facelift incision. Using these techniques, we have not found posterior tightening of the platysma muscle or the creation of platysma flaps to be necessary, although we would certainly use them if other alternatives were ineffective.