Skin and platysma muscle anchoring.

Anatomically, the platysma muscle is composed of two parts: a facial part and a cervical part. This observation allows a better understanding of the modifications due to aging. The correction of platysma bands needs nearly vertical directional vectors at the facial level. The periosteum of the malar bone and the anterior border of the parotid fascia are two solid structures that are not modified during aging. They allow the anchoring of the ptotic tissues including premalar fat pads, jowls, and platysma bands. The connections between the skin and the platysma muscle are not affected, although most of the described techniques need a detachment of the platysma muscle from the skin and a suture of the anterior border via a submental approach. Furthermore, the posterior border of the platysma muscle is not modified by aging. This explains why it is useless to detach this structure. The principles of the proposed technique are fundamentally different. Lore's fascia is used as a guide for approaching the trunk of the facial nerve. Labbé and colleagues have done an anatomic study of this procedure. It allows a solid anchoring of the platysma muscle, which is not detached from the skin. This is the key to the operation because the skin and the muscle are elevated en bloc. The author demonstrates that the absence of separation between skin and muscle, particularly at the cervical level, is a very efficient means for correcting platysma bands and for obtaining good definition of the cervicomental angle.