The author has modified previously described techniques of the superior suspension of the platysma muscle to Lore’s fascia by developing an auriculoplastysmal fascial flap, which detaches the posterior platysma from its retaining ligaments to the sternomastoid muscle. Anterior to this flap, the platysma muscle is undermined and suture captured with three throws of a permanent 2.0 Tevdek suture. This suture and its three throws are fixed anterior to the tragus, which includes Lore’s fascia and on tightening elevates the whole of the anterior neck as well as defines the cervicomental angle. A separate submental dissection may be required to assess and deal with pathology and resect excessive laxity of the platysma which has not been adequately addressed by the lateral superior traction suturing technique. Follow-up of fifteen cases of secondary facelift surgery with recurrent neck laxity demonstrated the fate of the suturing to Lore’s fascia. The permanent knot at the pre-tragal fixation point descended approximately 3 cm from the original position at the pre-tragal region. Secondary surgery is facilitated by capture of the knot and re-suturing it to its original primary position, restoring the neck to the approximate pre-operative condition and avoiding excessive dissection including return to the submental incision.
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Lore’s fascia Fogli platysma fixation Secondary facelift
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The author declares that he has no conflicts of interest to disclose.
The development of the auriculoplatysmal ligament from Lore (MP4 37960 kb)
The suturing of the platysma to Lore (MP4 14295 kb)
Superior traction on the auriculoplatysmal ligament tightens the whole of platysma and accentuates the cervicomental angle (MP4 18072 kb)
The knot applied in the primary operation has slipped inferiorly to the angle of the mandible and is grasped and resutured back to the pre-tragal area (MP4 9500 kb)
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