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      Ritidoplastia y manejo del cuello postbariátrico: técnica con disección cervical extendida Translated title: Rithydoplasty and postbariatric neck management: extended cervical disection technique

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          Abstract

          Resumen Introducción y objetivo. La ritidoplastia ha tenido una evolución constante desde su descripción, sin embargo, siempre ha estado dirigida a pacientes que la solicitan por envejecimiento natural, enfocándose a la región centrofacial. El objetivo de este trabajo es describir una técnica quirúrgica dirigida a pacientes sometidos a cirugía bariátrica que, tras perder masivamente peso, presentan secuelas severas no solo en cara sino también en cuello. Material y método. Técnica de ritidoplastia con disección cervical extendida (hasta borde supraclavicular) para liberar piel y obtener mayor tracción, que junto a plicatura lateral del platisma, corrigen el aspecto de cuello pesado característico de los pacientes con pérdida ponderal importante mediante supracorrección de ángulo mentocervical y surco cervicofacial. Evaluamos la eficacia por los resultados obtenidos y la seguridad por las complicaciones presentadas. Resultados. Recogemos 65 pacientes que cumplieron protocolo perioperatorio postbariátrico y presentaron secuelas severas que ameritaron el procedimiento. El 97.4% mujeres, edad promedio de 44.7 años; 98.7% sometido a bypass gástrico con pérdida promedio de 52.55 kg. En el 67.69% practicamos ritidoplastia como tercer tiempo quirúrgico (tras contorno inferior y superior). Tiempo quirúrgico promedio de 3.7 horas y complicaciones generales del 9.18%. En cuento a la satisfacción en la corrección de secuelas, el 84.6% reportó un resultado satisfactorio alto y el 12.3% moderado. Conclusiones. La técnica de ritidoplastia con disección extendida de cuello en pacientes postbariátricos resulta eficaz, segura y sobre todo, reproducible.

          Translated abstract

          Abstract Background and objective. Rithydoplasty had a constant evolution since its description, however, it has always been directed at patients who request it due to the natural aging process, with all techniques focusing on the central facial region. The objective of this paper is to describe a surgical technique aimed at patients who underwent bariatric surgery and who, after losing weight on a massive scale, had severe sequelae not only on the face but also on the neck. Methods. A rithydoplasty technique was performed with extended dissection of the cervical region (up to the supraclavicular edge), to free the skin from the area and achieve greater traction, which, together with a lateral plication of the platysma, correct that aspect of heavy neck characteristic of patients with significant weight losses through over correction of the menthocervical angle and the cervicofacial sulcus. Efficacy was evaluated by the results obtained and safety according to the complications presented. Results. Sixty-five patients who complied with the postbariatric perioperative protocol and with severe sequelae were included; 97.4% were women, average aged 44.7 years; 98.7% underwent gastric bypass, with an average loss of 52.55 kg. The 67.69% underwent rhytidoplasty as the third surgical time (after lower and upper body lifting). The average surgical time was 3.7 hours and the general complications were 9.18%. Regarding satisfaction in the correction of sequelae, 84.6% reported a high satisfactory result and 12.3% moderate. Conclusions. Rhytidoplasty with extended neck dissection in postbariatric patients is an effective technique, safe and, most of all, a reproducible technique.

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          Most cited references25

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          Corset platysmaplasty.

          Contemporary surgery to rejuvenate the aging neck commonly includes some type of platysma modification. Most currently used methods of platysmaplasty involve upper midline plication, muscle resection, or transection. These methods, however, have their shortcomings, often producing necks that display persistent or recurrent paramedian muscle bands, visible submandibular gland bulges, and various contour irregularities. Corset platysmaplasty was developed to avoid these postoperative imperfections. After an adequate subcutaneous and subplatysmal lipectomy has been performed, the two medial edges of the platysma are joined together with a continuous suture that runs down, and up, and down almost the full-height of the neck to create a smooth, flat, multilayered seam, leaving no free muscle edges to return as visible bands. Progressive side-to-side tightening along the midline seam defines the "waistline" of the neck. Additional submandibular suturing is then done to create strong, flat, vertical muscle pleats that correct submandibular gland bulging and refine the jawline and anterolateral neck contours. Corset platysmaplasty is useful for all patients with visible paramedian muscle bands and all patients who would benefit from having a decussated upper neck platysma opened for submuscular defatting, including patients with oblique, palpably firm necks that suggest a vertically short platysma muscle or low-lying hyoid bone. The paper is based on the results with 75 patients having undergone corset platysmaplasty, most having been followed for 1 to 3 years.
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            Limited incision submental lipectomy and platysmaplasty.

            D M Knize (1998)
            Thirty years ago, submental fat deposition and platysma band formation were inadequately addressed by surgeons attempting facial rejuvenation procedures. Simple skin envelope tightening as practiced commonly at that time resulted in reappearance of submental bands within months, disappointing both patient and surgeon. During each subsequent decade, existing techniques for aesthetic surgical treatment of the submental and neck areas were refined, and new techniques were introduced. The earliest in this evolution of surgical approaches to rejuvenate the aging submental region was direct excision of redundant anterior cervical skin and platysma muscle bands. Later, periauricular incision approaches without anterior skin excision were used to address platysma muscle bands and remove excess submental fat. Today, the standard approach for submental and anterior neck rejuvenation is some variation of "corset" platysmaplasty and suction-assisted lipectomy both superficial and deep to the platysma muscles. The introduction of endoscopy to plastic surgery has stimulated interest in performing many surgical procedures through limited-incision approaches. While endoscopic techniques may not have a clear application for the submental area, redundant submental soft tissues producing obliquity of the cervicomandibular angle may be treated through a single submental incision approach under direct vision. A technique practiced by the author since 1981 for performing submental lipectomy and platysmaplasty through a single limited anterior submental incision without skin excision is described and discussed. Postoperative compression of the submental area with an elastic garment facilitates smooth skin contraction and redraping for all patients except those with poor or no residual skin elasticity.
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              SENILITY OF THE FACE--BASIC STUDY TO UNDERSTAND ITS CAUSES AND EFFECTS.

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                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                September 2021
                : 47
                : 3
                : 261-274
                Affiliations
                [1] Ciudad de México orgnameHospital General Tláhuac orgdiv1Servicio de Cirugía Plástica Postpérdida Masiva de Peso México
                Article
                S0376-78922021000300006 S0376-7892(21)04700300006
                10.4321/s0376-78922021000300006
                e6fe7cb2-e023-4589-8e18-755e8c5e2256

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 10 August 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 25, Pages: 14
                Product

                SciELO Spain

                Categories
                Estética

                Ritidoplastia,Cuello postbariátrico,Pérdida masiva de peso,Cirugía bariátrica,Cirugía postbariátrica,Rithydoplasty,Postbariatric neck,Massive weight loss,Bariatric surgery,Postbariatric surgery

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