DEEP PLANE FACELIFT
Season 1, Episode 1
Debut episode of Nip Talk, where we discuss the new crevasse technique as an adjunct to the deep plane facelift.
Comprehensive Study Guide
Short Answer Questions
Instructions: Please answer the following questions in 2-3 sentences each.
What is the “deep plane” in the context of face and neck lifting?
Describe the two main benefits of the extended deep plane technique discussed in the article.
What anatomic landmarks define the boundaries of the submandibular triangle?
Explain why the authors recommend addressing the lateral neck tissues before the medial tissues during submental contouring.
Under what circumstances do the authors recommend performing a submandibular gland reduction?
Why do the authors caution against complete resection of the anterior digastric muscles?
What is the purpose of the horizontal fasciotomy performed on the deep cervical fascia?
Explain the “sailboat modification” used for deep plane entry and its benefits.
How does the mastoid crevasse technique differ from traditional platysma suspension?
What measurable endpoint does the article propose for assessing gonial angle improvement?
Short Answer Key
The "deep plane" refers to the cervicofacial gliding plane that lies beneath the superficial musculoaponeurotic system (SMAS) and platysma muscle complex. It allows for greater lifting of both the face and neck as a single unit.
The extended deep plane technique provides superior mid-face volumization and neck contour improvements, reducing the need for fat grafting or implants. It also treats the neck and face as a single unit, leading to a more natural and longer-lasting result.
The submandibular triangle is bordered by the anterior and posterior bellies of the digastric muscle and the inferior border of the mandible.
When lying supine, the lateral compartments may appear less ptotic than when upright. Starting laterally helps avoid over-reduction of the central tissues, as the midline should remain slightly fuller than the lateral triangles for a natural appearance.
Submandibular gland reduction is recommended if the gland protrudes medially or inferiorly past the digastric sling, if neck circumference at the hyoid is too broad, if the gland sits below the hyoid or mylohyoid, or if the platysma appears too weak to support the gland's contents.
Complete resection of the anterior digastric muscles should be avoided to prevent changes in chin flexion function and to preserve support for the underlying mylohyoid muscles.
The horizontal fasciotomy creates a discontinuity in the subhyoid and submental deep cervical fascia. This allows for tighter platysma approximation during plication, reducing banding, lengthening the cervicomental distance, and sharpening the cervicomental angle.
The "sailboat modification" involves drawing the SMAS entry line to mirror the incision line at a 70° angle, creating a thicker SMAS flap laterally. This minimizes skin-only dissection, reducing ischemia, improving volume, and facilitating easier suspension.
Instead of overlaying the platysma over the mastoid fascia, the mastoid crevasse technique involves creating a vertical incision along the anterior mastoid line and insetting the platysma into this crevasse. This offers a deeper, more secure fixation point and a more vertical vector of lift.
The article proposes measuring the gonial angle depth, defined as the distance between the lower posterior border of the mandible and the deepest point 10 mm caudal to it, as a measurable endpoint for assessing gonial angle improvement.
Key Terms
Deep Plane: The cervicofacial gliding plane situated below the SMAS and platysma muscle complex.
SMAS (Superficial Musculoaponeurotic System): A fibrous network connecting facial muscles to the skin, crucial in facial expression and support.
Platysma: A thin, broad muscle covering the neck, responsible for depressing the mandible and lower lip.
Submandibular Triangle: An anatomical region of the neck bordered by the mandible, anterior and posterior digastric muscles.
Submandibular Gland: A salivary gland located within the submandibular triangle, contributing to saliva production.
Anterior Digastric Muscle: A muscle pair responsible for elevating the hyoid bone and depressing the mandible.
Cervical Retaining Ligaments: Dense fibrous connections anchoring the platysma to the parotid tail fascia, impacting neck contour.
Mastoid Crevasse: A surgically created space along the anterior mastoid line used for platysma inset in neck lifting.
Gonial Angle: The angle formed by the junction of the mandible's posterior and inferior borders, defining jawline contour.
Vector: The direction and magnitude of force applied during surgical manipulation, crucial for achieving desired lifting and repositioning.
Myotomy: A surgical incision into a muscle, used to lengthen or release tension.
Parotidectomy: Surgical removal of the parotid gland, sometimes partially performed to address hypertrophy in neck lifting.
Sialocele: A collection of saliva that forms outside a salivary gland, a potential complication of parotid gland surgery.
Pixie Ear Deformity: An unnatural appearance of the earlobe caused by excessive tension during facelift procedures.
