Patient I fig 1   Patient I fig 2 Chin/Neck Modification (Platysmaplasty) Often performed with nasal surgery to further improve one's profile this operation is usually performed in young adults. The cause of this deformity is frequently congenital in nature or may be at least partially congenital with superimposed lipodysmorphia (abnormal accumulations of fat). The hyoid bone serves as a central fulcrum to which is attached many of the vital muscles of the neck, such as the myohyoid, stylohyoid, omohyoid, and other "strap" muscles Of the neck. Patient I fig 3   Patient I fig 4 When the hyoid bone is congenitally far forward (anterior) in the neck, the normal sharp angle formed by the long axis of the neck with the jaw line is blunted and the net result is a moderate "turkey" neck. From the lateral profile the appearance is that of a recessed or "weak" chin. The degree of the chin recession is judged by dropping a perpendicular line from the most anterior (forward) point of the lower lip. This line should fall on the point of the chin. If the distance between the chin and this perpendicular is great, then chin implant may be recommended along with platybmaplasty. Patient II fig 1   Patient II fig 3 The operation is frequently performed under local anesthesia with sedation in which case the patient may return to usual activities the following day. Technical details are as follows: General anesthesia is induced or the patient is given intravenous sedation. A small skin weal is raised just beyond the crease under the chin. A one eighth inch incision is made at this point and an infusion canula is inserted in the subcutaneous space. Tumnescent solution is infused into the subcutaneous space of the neck along the jaw line out to the lobes of the ears and down to the base of the neck. A 2 mm liposuction canula is then passed through the subcutaneous space of the neck in a crisscross fashion but no suction is applied. The incision is enlarged to about 2 cm and skin hook refractors placed in the edge of the wound. Using face lift scissors a dissection in the subcutaneous plane is accomplished along the jaw line and distally to the base of the neck. A thin layer of fat is left attached to the skin. The flat "spatula" canula is then inserted and fat attached to the platybma Muscle is removed by this technique of open liposuction. The attention is then turned to the platybma muscle. A triangular excision of the platysma muscle is made with the apex directed to the chin and the base brought distally to beyond the hyoid bone. The edges of the platysma are lifted and fat is dissected out laterally to the level of the Bubmandibular salivary glands. The platysma is brought together in the midline down to the level of the hyoid bone where, using a subperiosteal stitch, it is attached. At this point some variation in the procedure is possible. Occasionally the platysma is divided out laterally and a portion dibtally removed. Frequently, however, the operation is completed at this point with closure of the platysma over the larynx (Adams Apple). Some variation, depending upon the need to feminize or masculinize is possible relative to the "Adams Apple". Obviously a more prominent Adams Apple is associated with masculinity. Subsequent to closure of the platysma the skin is reapproximated with small stitches and a compression dressing applied. The compression dressing is removed the following day and the patient may return to work. A compression strap is worn for a week. Sutures are removed at one week and the patient may resume full activities within two weeks. The first set of photos show a patient who underwent platysmaplasty without chin augmentation at the time of rhinoplasty. Note the marked increase in feminine appearance in the post-operative photos. (Patient I figure 1,2,3,4). The second patient underwent platysmaplasty associated with chin implant.
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