Skip to main content
SpringerLink
Log in

Cone-Beam Computed Tomography for Objective Diagnosis of Age-Related Soft Tissue Changes in Lower Face and Neck

  • Original Article
  • Facial surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

An objective assessment of the causes of age-related contour deformities of the soft tissues of the face and neck is very important in esthetic surgery, especially as minimally invasive techniques gain increasing popularity.

Methods

To visualize the tissues that cause age-related soft tissue changes, we performed cone-beam computed tomography (CBCT) in 37 patients who underwent facial and neck rejuvenation procedures in 2021–2022.

Results

Vertical CBCT enabled visualization of the causes and degree of tissue involvement in age-related changes in the lower third of the face and neck. CBCT showed the location and condition of the platysma (hypo- [ptosis], normo-, or hyper-tonus), position, thickness, and location (above and/or below the platysma) of fat tissue, presence of ptosis of the submandibular salivary glands, condition of the anterior bellies of the digastric muscles, and the degree of their participation in contours of the cervicomandibular angle, and location of the hyoid bone. Moreover, CBCT enabled demonstrating for the patient the facial and neck contour deformations and discussing the suggested corrective methods using a clear objective visual image.

Conclusions

CBCT in the upright position enables objective assessment of each soft tissue in the age-related deformity of the cervicofacial region and provides an opportunity to plan the appropriate impact on the particular anatomical structures during rejuvenation procedures and estimate their results. This is the only study to date to objectively and clearly visualize the entire topographic anatomy of the soft tissues of the face and neck vertically for plastic surgeons and patients.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lu PH, Yang CH, Chang YC (2017) Quantitative analysis of face and neck skin tightening by microfocused ultrasound with visualization in Asians. Dermatol Surg 43:1332–1338. https://doi.org/10.1097/DSS.0000000000001181

    Article  CAS  PubMed  Google Scholar 

  2. Hwang K, Kim JY, Lim JH (2017) Anatomy of the platysma muscle. J Craniofac Surg 28:539–542. https://doi.org/10.1097/scs.0000000000003318

    Article  PubMed  Google Scholar 

  3. Rohrich RJ, Rios JL, Smith PD, Gutowski KA (2006) Neck rejuvenation revisited. Plast Reconstr Surg 118:1251–1263. https://doi.org/10.1097/01.prs.0000209406.80690.9f

    Article  CAS  PubMed  Google Scholar 

  4. Baker DC (2001) Minimal incision rhytidectomy (short scar face lift) with lateral SMASectomy: evolution and application. Aesthet Surg J 21:14–26. https://doi.org/10.1067/maj.2001.113557

    Article  CAS  PubMed  Google Scholar 

  5. Jacono AA, Malone MH (2017) Characterization of the cervical retaining ligaments during subplatysmal facelift dissection and its implications. Aesthet Surg J 37:495–501. https://doi.org/10.1093/asj/sjw274

    Article  PubMed  Google Scholar 

  6. Jacono AA, Bryant LM (2018) Extended deep plane facelift: incorporating facial retaining ligament release and composite flap shifts to maximize midface, jawline and neck rejuvenation. Clin Plast Surg 45:527–554. https://doi.org/10.1016/j.cps.2018.06.007

    Article  PubMed  Google Scholar 

  7. Sykes JM, Riedler KL, Cotofana S, Palhazi P (2020) Superficial and deep facial anatomy and its implications for rhytidectomy. Facial Plast Surg Clin North Am 28:243–251. https://doi.org/10.1016/j.fsc.2020.03.005

    Article  PubMed  Google Scholar 

  8. Quatela V, Montague A, Manning JP, Antunes M (2020) Extended superficial musculoaponeurotic system flap rhytidectomy. Facial Plast Surg Clin North Am 28:303–310. https://doi.org/10.1016/j.fsc.2020.03.007

    Article  PubMed  Google Scholar 

  9. Auersvald A, Auersvald LA, Oscar Uebel C (2017) Subplatysmal necklift: a retrospective analysis of 504 patients. Aesthet Surg J 37:1–11. https://doi.org/10.1093/asj/sjw107

    Article  PubMed  Google Scholar 

  10. Geister TL, Bleßmann-Gurk B, Rzany B, Harrington L, Görtelmeyer R, Pooth R (2013) Validated assessment scale for platysmal bands. Dermatol Surgery 39:1217–1225. https://doi.org/10.1111/dsu.12240

    Article  CAS  Google Scholar 

  11. Patel S, Brown J, Pimentel T, Kelly RD, Abella F, Durack C (2019) Cone beam computed tomography in endodontics - a review of the literature. Int Endod J 52:1138–1152. https://doi.org/10.1111/iej.13115

    Article  CAS  PubMed  Google Scholar 

  12. Zhang Y, Wang Y, Zhang Y, Li S, Wang L, Qian Y (2019) Cone-beam computed tomography evaluation of skeletal deformities and pharyngeal airway in Chinese han individuals with nonsyndromic unilateral cleft lip and palate. Cleft Palate-Craniofacial J 57:65–72. https://doi.org/10.1177/1055665619860700

    Article  CAS  Google Scholar 

  13. Lentzen MP, Zirk M, Riekert M, Buller J, Kreppel M (2020) Anatomical and volumetric analysis of the sphenoid sinus by semiautomatic segmentation of cone beam computed tomography. J Craniofacial Surg 32:1166–1170. https://doi.org/10.1097/scs.0000000000007209

    Article  Google Scholar 

  14. Bellity P, Bellity J (2017) Facial rejuvenation enhancing cheek lift. Arch Plastic Surg 44:559–563. https://doi.org/10.5999/aps.2016.01858

    Article  Google Scholar 

  15. Busso M (2021) A new approach to thread facelifting. J Drugs Dermatol 20:1085–1090. https://doi.org/10.36849/jdd.6139

    Article  PubMed  Google Scholar 

  16. Gasperoni C, Gasperoni P, Pino V (2021) Conservative neck rejuvenation. Facial Plast Surg 37:400–406. https://doi.org/10.1055/s-0041-1725167

    Article  CAS  PubMed  Google Scholar 

  17. Feldman JJ (2017) Discussion: platysma bands: is a change needed in the surgical paradigm? Plast Reconstr Surg 139:48–49. https://doi.org/10.1097/prs.0000000000002895

    Article  CAS  PubMed  Google Scholar 

  18. Knipper P, Mitz V (2017) Platysma bands: is a change needed in the surgical paradigm? Plast Reconstr Surg 140:755e. https://doi.org/10.1097/prs.0000000000003783

    Article  CAS  PubMed  Google Scholar 

  19. Trévidic P, Criollo-Lamilla G (2017) Reply: platysma bands: is a change needed in the surgical paradigm? Plast Reconstr Surg 140:755e–756e. https://doi.org/10.1097/prs.0000000000003784

    Article  PubMed  Google Scholar 

  20. Matarasso A, Matarasso SL, Brandt FS, Bellman B (1999) Botulinum a exotoxin for the management of platysma bands. Plast Reconstr Surg 103:645–652. https://doi.org/10.1097/00006534-199902000-00043

    Article  CAS  PubMed  Google Scholar 

  21. Trévidic P, Criollo-Lamilla G (2019) Surgical denervation of platysma bands. Plast Reconstr Surg 144:798e–802e. https://doi.org/10.1097/prs.0000000000006148

    Article  PubMed  Google Scholar 

  22. Daher JC (2011) Closed platysmotomy: a new procedure for the treatment of platysma bands without skin dissection. Aesthet Plast Surg 35:866–877. https://doi.org/10.1007/s00266-011-9782-0

    Article  Google Scholar 

  23. Pelle-Ceravolo M, Angelini M (2019) Lateral skin-platysma displacement. Clinics in Plast Surg 46:587–602. https://doi.org/10.1016/j.cps.2019.06.006

    Article  Google Scholar 

  24. Cotofana S, Lachman N (2019) Anatomy of the facial fat compartments and their relevance in aesthetic surgery. JDDG: J der Deutschen Dermatologischen Gesellschaft 17: 399-413. https://doi.org/10.1111/ddg.13737

  25. Okuda I, Yoshioka N, Shirakabe Y, Akita K (2019) Basic analysis of facial ageing: the relationship between the superficial musculoaponeurotic system and age. Exp Dermatol 28:38–42. https://doi.org/10.1111/exd.13827

    Article  PubMed  Google Scholar 

  26. Gierloff M, Stöhring C, Buder T, Gassling V, Açil Y, Wiltfang J (2012) Aging changes of the midfacial fat compartments: a computed tomographic study. Plast Reconstr Surg 129:263–273. https://doi.org/10.1097/prs.0b013e3182362b96

    Article  CAS  PubMed  Google Scholar 

  27. Tower JI, Seifert K, Paskhover B (2018) Patterns of superficial midfacial fat volume distribution differ by age and body mass index. Aesthet Plast Surg 43:83–90. https://doi.org/10.1007/s00266-018-1249-0

    Article  Google Scholar 

  28. Wysong A, Joseph T, Kim D, Tang JY, Gladstone HB (2013) Quantifying soft tissue loss in facial aging: a study in women using magnetic resonance imaging. Dermatol Surg 39:1895–1902. https://doi.org/10.1111/dsu.12362

    Article  CAS  PubMed  Google Scholar 

  29. Schenck TL, Koban KC, Schlattau A (2018) The functional anatomy of the superficial fat compartments of the face: a detailed imaging study. Plast Reconstr Surg 141(6):1351–1359. https://doi.org/10.1097/prs.0000000000004364

    Article  CAS  PubMed  Google Scholar 

  30. Macchi V, Tiengo C, Porzionato A (2007) Anatomo-radiological study of the superficial musculo-aponeurotic system of the face. Ital J Anat Embryol 112:247–253

    PubMed  Google Scholar 

  31. Mashkevich G, Wang J, Rawnsley J, Keller GS (2009) The utility of ultrasound in the evaluation of submental fullness in aging necks. Arch Facial Plast Surg 11:240–245. https://doi.org/10.1001/archfacial.2009.47

    Article  PubMed  Google Scholar 

  32. Agbolade O, Nazri A, Yaakob R, Ghani AA, Cheah YK (2020) Morphometric approach to 3D soft-tissue craniofacial analysis and classification of ethnicity, sex, and age. PLoS ONE 15:e0228402. https://doi.org/10.1371/journal.pone.0228402

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Windhager S, Mitteroecker P, Rupić I, Lauc T, Polašek O, Schaefer K (2019) Facial aging trajectories: a common shape pattern in male and female faces is disrupted after menopause. Am J Phys Anthropol 169:678–688. https://doi.org/10.1002/ajpa.23878

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ozsoy U, Sekerci R, Ogut E (2015) Effect of sitting, standing, and supine body positions on facial soft tissue: detailed 3D analysis. Int J Oral Maxillofac Surg 44:1309–1316. https://doi.org/10.1016/j.ijom.2015.06.005

    Article  CAS  PubMed  Google Scholar 

  35. Yamaguchi Y, Yamauchi K, Suzuki H, Sai Y, Nogami S, Takahashi T (2018) Volumetric comparison of maxillofacial soft tissue morphology: computed tomography in the supine position versus three-dimensional optical scanning in the sitting position. Oral Surg Oral Med Oral Pathol Oral Radiol 125:351–357. https://doi.org/10.1016/j.oooo.2017.12.018

    Article  PubMed  Google Scholar 

  36. Munn L, Stephan CN (2018) Changes in face topography from supine-to-upright position-and soft tissue correction values for craniofacial identification. Forensic Sci Int 289:40–50. https://doi.org/10.1016/j.forsciint.2018.05.016

    Article  PubMed  Google Scholar 

  37. Bulut O, Jessica Liu CY, Koca F, Wilkinson C (2017) Comparison of three-dimensional facial morphology between upright and supine positions employing three-dimensional scanner from live subjects. Leg Med 27:32–37. https://doi.org/10.1016/j.legalmed.2017.06.002

    Article  Google Scholar 

  38. McCleary SP, Moghadam S, Le C, Perez K, Sim MS, Roostaeian J (2022) Age-related changes in the submandibular gland: an imaging study of gland ptosis versus volume. Aesthet Surg J 42:1222–1235. https://doi.org/10.1093/asj/sjac129

    Article  PubMed  Google Scholar 

  39. Sharobaro V, Alimova S, Telnova A, Shamanaeva L (2020) Ultrasound diagnosis of age-related involutional changes in the lower third of face and neck to determine treatment techniques. Pak J Med Sci https://doi.org/10.12669/pjms.37.1.3034

  40. Alimova S, Sharobaro V, Yukhno A, Bondarenko E (2023) Possibilities of ultrasound examination in the assessment of age-related changes in the soft tissues of the face and neck: a review. Appl Sci 13:1128. https://doi.org/10.3390/app13021128

    Article  CAS  Google Scholar 

  41. Dau M, Edalatpour A, Schulze R, Al-Nawas B, Alshihri A, Kammerer P (2017) Presurgical evaluation of bony implant sites using panoramic radiography and cone beam computed tomography—influence of medical education. Dentomaxillofac Radiol 46:2. https://doi.org/10.1259/dmfr.20160081

    Article  Google Scholar 

Download references

Acknowledgments

We would like to thank Editage (www.editage.com) for English language editing.

Author information

Authors and Affiliations

  1. Department of Plastic Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia

    Sekina M. Alimova, Valentin I. Sharobaro, Alexey E. Avdeev & Dmitry A. Sidorenkov

  2. Department of Sports Medicine and Medical Rehabilitation, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia

    Tatiana S. Guseva

Authors
  1. Sekina M. Alimova
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Valentin I. Sharobaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexey E. Avdeev
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dmitry A. Sidorenkov
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tatiana S. Guseva
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sekina M. Alimova.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

The study was conducted in accordance with the Declaration of Helsinki, and approved by local Ethics Committee of Pirogov Russian National Research Medical University (protocol code 170 and date of approval 18/12/2017).

Informed Consent

Informed consent was obtained from all subjects involved in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alimova, S.M., Sharobaro, V.I., Avdeev, A.E. et al. Cone-Beam Computed Tomography for Objective Diagnosis of Age-Related Soft Tissue Changes in Lower Face and Neck. Aesth Plast Surg 47, 2370–2377 (2023). https://doi.org/10.1007/s00266-023-03401-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-023-03401-3

Keywords

Search

Navigation