Deep Neck Lift and SubSMAS Facial Rejuvenation

by L. Mike Nayak, MD

In this series, Dr. Nayak shares his comprehensive lamellar approach to surgical facial rejuvenation in male and female patients ranging in age from their early 30s to mid-70s.

Deep neck surgical techniques highlighted include safe identification and management of the contents of the submental and submandibular triangles: subplatysmal fat, digastric muscles, mylohyoid muscles, and submandibular salivary glands. Three different methods of platysma muscle management are demonstrated, along with pearls on appropriately selecting among these techniques to suit each patient’s needs.

Two different face-lift techniques are demonstrated. First, an extended deep plane/composite face lift with suborbicularis and subSMAS dissection and full release of all major facial and cervical retaining ligaments is demonstrated in a younger patient with good tissue quality. Special attention is paid to safely identifying, entering, and fully developing the suborbicularis/subSMAS plane. Additionally, a powerful, predictable long flap SMAS plication technique suitable for surgeons earlier in their careers, or in patients with poor tissue quality and advanced solar elastosis is demonstrated on an older revision face-lift patient.

Adjunctive techniques demonstrated include nonendoscopic, minimal incision, subperiosteal brow lift; upper and transconjunctival lower blepharoplasty; buccal fat reduction; full face fat transfer; implant mentoplasty; and CO2 laser resurfacing.

Surgeries Include:  
Case 1: 43-year-old Female Patient With Hereditary Oblique Neck and Panfacial Aging: Deep Neck Lift With Submandibular Gland Reductions; Deep Plane, Suborbicularis Face Lift; and Lower Blepharoplasty With Fat Transfer and Laser Resurfacing

Case 2: 71-year-old Female Patient With Recurrent, Advanced Facial Aging: Upper and Lower Blepharoplasty, Minimal Incision Brow Lift, SMAS Plication Face Lift and Neck Lift, Full Face Fat Transfer, and Full Face Laser Resurfacing

Case 3: 33-year-old Male Patient With Oblique Neck, Microgenia, Poor Jawline Definition, and Buccal Fullness: Mentoplasty, Deep Neck Lift (No Face Lift), and Buccal Fat Reduction

Case 4: 48-year-old Female Patient With Full, Heavy, Aging Lower Eyelids, Face, and Neck: Transconjunctival Lower Blepharoplasty With Fat Transfer and Laser Resurfacing, Deep Neck Lift (No Face Lift), and Transoral Buccal Fat Reduction