Preoperative analysis should address three distinct areas of the face: forehead and brows, cheeks and jowls, and neck and submentum. Surgical correction of deformities in these areas often requires different techniques that may be combined in a single surgical encounter for an optimal outcome.

Evaluation of the forehead begins with a description of the horizontal and vertically oriented rhytids. Horizontal rhytids are formed by the action of the frontalis muscle. The corrugator supercilii muscles form vertical glabellar rhytids, and horizontal rhytids at the root of the nose are formed by the action of the procerus muscle. In women, the aesthetic forehead and glabella complex is smooth with few rhytids; in men some furrowing and rhytids are acceptable. The next step in analysis is evaluation of eyebrow and glabella position. The aesthetic guide to eyebrow position in men is that the brow should lie on the supraorbital rim, while in women the brow should follow or lie slightly above the rim and arch at the lateral limbus of the pupil (13). Brow ptosis or descent bunches the skin over the upper eyelid creating a hooding effect (Fig. 8). This must be appreciated during the preoperative evaluation for blepharoplasty. In women, glabellar and medial brow ptosis disrupts the aesthetically pleasing gently curving line formed along the nasal sidewall and eyebrow.

Analysis of the cheeks and jowls for a traditional rhytidectomy includes an eva- »

luation of the melolabial folds and the position of the sideburns. No exact geometric c method is used clinically to describe the position or depth of the melolabial fold. The ^

o position of the sideburns, especially in men, should be documented and used in planning preauricular incisions; however, usually no normative relationship is applied. The sideburn should extend below the level of the root of the helix and this relationship should be maintained in treatment planning. The jowls are also assessed qualitatively.

Figure 8 Typical ptotic eyebrow lying well below the superior bony rim.

The ideal mentocervical angle is between 80 and 95 degrees (14) (Fig. 9). Qualitatively, in an anterior-posterior view, the pogonion should clearly delineate the chin from the underlying neck; a weak chin gives the illusion of a short neck. On lateral view, the submentum should be flat and end abruptly at a highly placed hyoid bone. Platysmal banding, resulting from the loss of tone and medial migration of the platysmal muscle (the actual cause is controversial), is a prominence of the medial

Mentocervical Angle
Figure 9 The mentocervical angle.

border of the platysmal muscle causing unattractive vertical lines in the midline of the neck. There may also be senile ptosis of the submandibular glands from laxity of the supporting fascia. A useful classification system for neck/submentum analysis is Dedo's classification of cervical abnormalities (15). The classes are as follows

Dedo Classification

Figure 10 Dedo's classification system of cervical abnormalities. (Adapted from Dedo DD. ''How I do it''—plastic surgery. Practical suggestions on facial plastic surgery. A preoperative classification of the neck for cervicofacial rhytidectomy. Laryngoscope 1980;90:1894-6).

I. Minimal deformity with an acute cervicomental angle, good platysmal tone, and little accumulation of fat

II. Lax cervical skin

III. Fat accumulation

IV. Platysmal banding

V. Congenital or acquired retrognathia

VI. Low hyoid

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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