Section Head of Facial Plastic and Reconstructive Surgery at North Shore University Hospital, Manhasset, NY.
Division of Facial Plastic and Reconstructive Surgery, New York Eye and Ear Infirmary, and the Albert Einstein College of Medicine, New York, NY.
Aesthet Surg J. 2019 Nov 13;39(12):1265-1281. doi: 10.1093/asj/sjy292.
Jawline aging is a complex process. We believe loss of posterior jawline definition and volume depletion is an underappreciated factor in the aging face.
The aim of this study was to describe a novel composite, rotational flap modification of an extended deep-plane rhytidectomy. We evaluated long-term efficacy on improving jawline contour and volumization of the posterior mandibular region overlying the gonial angle.
We performed a prospective study on patients who underwent our modification of extended deep-plane rhytidectomy. We define and introduce the mandibular defining line, a new anatomic metric in evaluating the mandibular contour. We define the area of the posterior lower face overlying the gonion and mandibular angle as the gonial area. Using 3-dimensional photography, we quantify contour changes along the mandibular border and volume change along the gonial area.
Eighty-nine patients (178 hemifaces) were analyzed. The mean gonial area volume gained was 3.5 cc. Average follow-up was 19 months. There was a statistically significant change in the mean mandibular defining line from 7.1 cm preoperatively to 9.8 cm postoperatively. This represents a lengthening of the visual perspective of the mandibular contour of 2.7 cm.
Composite, rotational flap modification of extended deep-plane rhytidectomy provides significant long-term augmentation of volume to the posterior mandibular region and lengthens the visual perspective of the inferior mandibular contour, creating a more youthful jawline. In selected cases, this may obviate the need for other volumization procedures used to improve jawline contour, such as autologous fat grafting.
下颌线老化是一个复杂的过程。我们认为，后下颌线定义的丧失和体积耗竭是面部老化中被低估的一个因素。
本研究旨在描述一种新的复合、旋转皮瓣改良的广泛的深层平面除皱术。我们评估了长期改善下颌线轮廓和覆盖下颌角的后下颌区域体积的效果。
我们对接受我们改良的广泛深层平面除皱术的患者进行了前瞻性研究。我们定义并引入了下颌线定义线，这是一种评估下颌轮廓的新解剖学指标。我们将覆盖下颌角和下颌角的后下面部区域定义为下颌角区域。通过三维摄影，我们量化了下颌缘沿线的轮廓变化和下颌角区域沿线的体积变化。
分析了 89 例患者（178 侧）。下颌角区域的平均体积增加了 3.5 立方厘米。平均随访时间为 19 个月。术前平均下颌线定义线为 7.1 厘米，术后为 9.8 厘米，有统计学意义的变化。这代表了下颌轮廓的视觉角度延长了 2.7 厘米。
广泛深层平面除皱术的复合、旋转皮瓣改良可显著长期增加后下颌区域的体积，并延长下颌轮廓的视觉角度，塑造更年轻的下颌线。在选择的病例中，这可能可以避免其他用于改善下颌线轮廓的体积填充程序，如自体脂肪移植。
