Figure 1 - In A, demarcation of vector I for treatment of the platysma in the midcervical region, by 2 parallel and vertical lines along the bands, even when there is a single visible band. In B, similar demarcation of vector II along the mandible and parallel to it, from the mastoid to the projection of the sublingual salivary gland. The border of vectors III, IV, and V is the same, located in the zygomatic arch and along the helical root, with different orientation, different lengths, and similar widths from 2 to 2.5 cm.
Figure 2 - Lines in red, on the face and neck, mark the borders of a large dissection.
Figure 3 - Both hands below the skin layer illustrate the extent of skin commonly dissected in the face and neck.
Figure 4 - Vector I for plication of the platysma muscle in the midline, following a common procedure described in the literature for 1 or 2 bands.
Figure 5 - Suturing of vector II from the mastoid to the projection of the sublingual salivary gland, approximately 1.5 to 2 cm below the border of the mandible and parallel to it. Continuous suture with 3-0 nonabsorbable thread, "back-and-forth" type, along the upper line of demarcation and returning to the lower, with a node in the projection of the mastoid.
Figure 6 - Suturing of vector III with 3-0 nonabsorbable thread, oriented from the helical root to the midline of the nasolabial folds to the border of the dissected area, along the 2 lines of demarcation in a "back-and-forth" direction, with a node in the region of the helix.
Figure 7 - Continuous suture of vector IV with nonabsorbable thread in a "back-and-forth" direction with a node in the region of the helix, oriented in the midline between the corner of the mouth and the border of the mandible.
Figure 8 - Continuous suture of vector V in a single direction with 3-0 nonabsorbable nylon thread, starting from the opposite border to the helical root.
Figure 9 - Orientation of the 3 vectors sutured in the middle segment of the face.
Figure 10 - Female Caucasian patient, 46 years old, submitted to rhytidoplasty and blepharoplasty in the same operation. Maintenance of the mandibular and neck lines with a natural appearance. In A and B, front view, in the preoperative period and 1 year 10 months postoperatively, respectively. In C and D, profile view, in the preoperative period and 1 year 10 months postoperatively, respectively.
Figure 11 - A 59-year-old patient, submitted to blepharoplasty and rhytidoplasty in the same operation. Natural maintenance of the mandibular line, without recurrence of platysma bands. In A and B, front view, in the preoperative period and 2 years 9 months postoperatively, respectively. In C and D, profile view, in the preoperative period and 2 years 9 months postoperatively, respectively.
Figure 12 - A 65-year-old patient, submitted to blepharoplasty and rhytidoplasty in the same operation. Natural maintenance of the mandibular line, without recurrence of platysma bands. In A and B, front view, in the preoperative period and 4 years 2 months postoperatively, respectively. In C and D, profile view, in the preoperative period and 4 years 2 months postoperatively, respectively.
Figure 13 - A 75-year-old patient, submitted to blepharoplasty and rhytidoplasty in the same surgery. Natural maintenance of the mandibular line, without recurrence of platysma bands. In A and B, front view, in the preoperative period and 2 years 1 months postoperatively, respectively. In C and D, profile view, in the preoperative period and 2 years 1 months postoperatively, respectively.
Figure 14 - Patient submitted to blepharoplasty and rhytidoplasty at 79 years old, without treatment of SMAS. In A and B, front view, in the preoperative period and 9 years postoperatively, respectively. In D and E, profile view in the preoperative period and 9 years postoperatively, respectively. In C and F, at 88 years old, new face and neck lift following the procedures described.
