The "opportunistic" biplane facelift depends primarily on posterior pull of a platysmal flap for neck rehabilitation. Even anterior cervical laxity is well corrected by this procedure. However, if the patient has significant anterior platysmal banding, we do carry out an anterior platysmaplasty. If there is distinct banding, posterior platysmal pull is usually not sufficient, and it is helpful to secure the platysma in the midline. This occurs in approximately 20% of our cases.
Before surgery, we mark the platysmal bands. We make a 2-to 3-cm transverse incision in the submentum, attempting to use a natural crease. The skin is then elevated off the underlying anterior platysma muscle which is usually quite easy to identify as a result of the lipodissection. An Aufricht or small right-angle retractor is inserted into the wound for visualization. Any residual excess fat is clamped and trimmed with scissors. Silk sutures (3-0) are then placed between the platysmal bands and are secured across the midline from the chin to within 1 or 2 cm of the hyoid bone. This is rather easily done through a small incision when the surgeon is using a headlight and loops. Inspection will confirm that adequate approximation has been carried out. Wide undermining of the skin of the neck is important to allow proper draping at the end of the procedure.
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