Trampoline Platysmaplasty

Editors-In-Chief: Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org]; Michel C. Samson, M.D., FRCSC, FACS [mailto:samsonm1@ccf.org]

Overview
The Trampoline Platysmaplasty, also sometimes called neck rejuvenation, lower facelift, lower rhytidectomy or necklift, is a specific cosmetic surgery technique to elevate neck muscles and glands to give a more youthful jawline. It usually involves the removal of excess fatty tissue under the jaw and neck region after which a support system is placed through a small incision under the chin. The Trampoline Platysmaplasty differs from other traditional techniques as it incorporates a permanent elastic, dynamic support matrix which spans the entire area underneath the jawline. This support matrix is constructed with a braided nylon suture material commonly used in other areas of surgery including heart surgery, hand surgery, hernia repair, and chest wall repair, etc. Therefore, this support structure is permanent, maintaining the elevation of the deeper structures of the neck, which are heavier than skin and can cause the neck to age and sag prematurely. This can also improve neck contours inherited through genetics.

In the traditional Trampoline Platysmaplasty, an incision is made underneath the chin, through which the surgery is performed. The incision is usually less than one inch in length.

After the skin incision is made, the area underneath the chin and neck is injected with local anesthetic. In patients with excess fatty tissue, this area is often treated with liposuction to remove the excess fat underlying the jaw region. The skin is then separated from the deeper muscle tissue with scissors (also called undermining). At this point, the surgeon visualizes the platysma muscle underneath the jawline. Using the double-armed braided polyester suture material, the surgeon places the trampoline support system in the superficial muscle by criss-crossing the suture, similar to a shoelace. This sewing technique begins at the cervical mental angle (where the vertical neckline meets the horizontal under surface of the chin and jaw) and continues forward to the point of the original incision under the chin. This placement results in restoring a sharper, more youthful angle to the region, most notable from a profile view of the patient.

The suture is then tightened until the desired contour is achieved. The surgeon then secures the suture with a knot. In younger patients where no excess skin is evident, fibrin sealant (1cc) is applied to the area of skin and muscle with pressure being applied for three minutes. This allows the muscle and skin to adhere to the newly sculpted contour. In patients with excess skin, the surgeon may remove the excess skin from the neck region using traditional face lift incisions, located around the ear, extending into the hairline behind the ear. In these patients, the fibrin glue is applied after the removal of any excess skin. The skin incisions are then closed with sutures and/or staples.

The Trampoline Platysmaplasty works best in patients with a sagging neck line acquired from aging and/or through genetics. It is especially helpful for male patients who traditionally have more muscle in the neck area. One of the benefits of the Trampoline Platysmaplatsy is that the technique does not require the removal or cutting of glandular tissue to achieve excellent results. Therefore it results in less contour deformities resulting from neck rejuvenation surgery. It is known as a non-destructive surgical technique that adheres to surgical and anatomical principles.

The Trampoline Platysmaplasty is commonly combined with eye surgery blepharoplasty and skin resurfacing (chemical peels or lasers). It is typically performed under general anesthesia or deep twilight sleep.

The most common complication is bleeding which usually requires a return to the operating room. Less common (but graver) complications include damage to the facial nerves.

Contraindications to face lift surgery include severe concomitant medical problems. While not absolute contraindication, the risk of postoperative complications in increased in cigarette smokers and patients with hypertension and diabetes. Patients should abstain from taking aspirin or other blood thinners before surgery.