The two-layer rhytidectomy.

In order to consider segmental correction of the aging face, pertinent disfigurements and underlying anatomy must be analyzed. Bony structures such as chin and malar eminence might be augmented. Submental exploration should be considered when fatty herniation or anterior platysmal banding is diagnosed. The superficial muculoaponeurotic system (SMAS)-platysmal muscle system should be undermined and plicated posteriorly when excessive laxity is noted intraoperatively. Thus, SMAS rotation flap is best for the cheek region, and imbrication may have a place in the neck. We are all witness to the classic techniques that have stood the test of time. However, more radical surgery may be indicated in certain patients. At present we feel there are few indications for complete horizontal platysmal incision and muscle flap rotation. No long-range study has been reported showing the complication rate or the endurance of this platysmal section technique. We feel that the more conservative platysmal surgery, combined with submental surgery and secondary "tuck-up" procedures as required, is the procedure of choice.