Dr. Little’s Philosophies
Restoration of a clean jawline, under jaw, and neck, of course, is also critical in overall facial rejuvenation. The plane of the under jaw should appear nearly transverse, and unsightly neck bands and cords should disappear. Dr. Little has found, however, that if the jowl complex is properly targeted and elevated during facelift, direct surgery on the central neck structures (through a scar under the chin) can be avoided in most patients. Such neck correction without direct surgery under the chin saves not only operative time and scars, but also further reduces the low overall risks of facelift surgery. Half the patients receive a brief liposuction to the neck region, as most also receive a suspensory suture to the back border of the neck muscle (platysma) below the ear. The patient with a particularly challenging neck (with enlarged salivary glands, for example) may need to be treated in the conventional matter, however, with full dissection of the neck skin and direct surgery on the central neck structures through a scar under the chin.
Illustration: detail from Leonardo da Vinci (?), “Portrait of a Young Woman (Beatrice d’Este ?),” ca. 1490, Pinocoteca Ambrosiana, Milan
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