Cosmetic Restoration of the Lower Facial Envelope

Anthony P. Sclafani, M.D., F.A.C.S.

On this he aimed a deadly arrow at Antinous, who was about to take up a 2-handed gold cup to drink his wine and already had it in his hands…The arrow struck Antinous in the throat, and the point went clear through his neck, so that he fell over and the cup dropped from his hand, while a thick stream of blood gushed from his nostrils. He kicked the table from him and upset things on it, so that the bread and roasted meats were all soiled as they fell over onto the ground. -Homer; Butler S, trans. The Odyssey. Book 22; lines

The neck and jawline have caused many a downfall, including some for those who held the sharp blade rather than fell by it. Traditional manipulation of the superficial musculoaponeurotic system and platysma remains the mainstay of treatment of the aging neck and lower face. However, modifications and alternatives to the standard SMAS/platysma rhytidectomy have gained popularity as patients seek longer lasting results through less invasive procedures with quicker recovery at a younger age.

This issue of Facial Plastic Surgery is devoted to methods of rejuvenating the soft tissues of the lower face and neck. The articles herein cover not only traditional surgical approaches but also minimally invasive, chemical, and alternative surgical management techniques. Common to all approaches is a considered analysis of the patient’s structural requirements as well as stated concerns. With focused examination of specific areas, a combination of smaller, potentially less invasive procedures may be synthesized into a comprehensive approach to meet the patient’s needs. Alternatively, new technologies or surgical approaches can be applied to produce an appropriate aesthetic result with less “downtime.” Finally, traditional rhytidectomy may be the most appropriate treatment for a patient; however, an initial, considered evaluation of each individual facial element allows the surgeon to produce a more rational construct of aesthetic needs. As surgeons of the 21st century, we need to see the fine details but appreciate the full portrait of the face to choose and execute accurately the right procedure for our patients.