The submental fat compartment of the neck.
ABSTRACT The anatomic understanding of the superficial compartments of the head and neck are evolving. Recently, studies have shown that the superficial fat is sequestered into separate "compartments"; however, the superficial anatomy of the submental region of the neck has yet to be defined, and improved understanding of this area may lead to advances in our ability to rejuvenate the neck. This cadaveric investigation revealed that there is one superficial fat compartment in the submental region. The anterior boundary of this compartment, previously without name, has been labeled the "submental septum." The posterior boundary of the submental fat compartment is created by a septum that arises from the platysma at a point superficial to the hyoid. Because this area is over the hyoid, it has been named the "suprahyoid septum." The lateral septal boundaries have been labeled the "digastric septae."
Full-textDOI: · Available from: Anthony Echo, Jul 04, 2015
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ABSTRACT: Even before physicians began to inject botulinum toxin A (BTXA) for the treatment of facial dynamic lines, we were already aware of the possibility of treating the platysma band and the transversal lines of the neck. There were few doctors claiming good results, but there were still questions about why, when, how, and in whom how to inject BTXA, as well as questions about the clinical results and complications of course. Now that we have being treating the lines of the neck through the platysmal bands for some time, with great emphasis at the contouring of the jaw line for the global facial rejuvenation, we can discuss treatment of the platysma muscle and analyze its dynamics, identification, and limits, and also have a better idea of how to manage the injection of BTXA in this area with good results. This article analyzes the pattern of a series of platysma muscle treatment to determine if there is a model that could be followed for the contouring of the face and neck by comparing the current knowledge about the behavior, position, and results of the BTXA injection sites based on the initial idea of treating the platysmal bands and the transversal cervical lines of the neck. We randomly selected 40 patients from our private clinic treated between 2006 and 2011 who had have botulinum toxin injections for the recontouring of the face to analyze if there was a pattern of injection to follow as a model for the treatment of the platysma. They were all female, as there were no males that had had any treatment for this indication in our files. These patients had received at least two treatments, resulting in a total of 90 treatments for the neck during 15 months, with the total dose injected per session varying from 10 to 70 units. We have made a retrospective evaluation of the pre- and post-treatment pictures, checking the effective clinical results after the treatment and making sure that the patient was included in the discussion. There was not any exact model of points, distribution, quantity, and constant pattern for the treatment of the platysma muscle for the contouring of the face. There were differences between the patients and in the same patient (e.g., different pattern from the right side and the left side). The clear knowledge of the muscular distribution through its dynamic action to work as a mimetic muscle that might change the facial lower contour is the key aspect for this treatment.06/2012; 1(2). DOI:10.1007/s13671-012-0013-y
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ABSTRACT: A better understanding of volume distribution between the superficial (subcutaneous) and deep (subplatysmal) planes of the neck may be useful when deciding on the best course of management for patients presenting for cervical contouring. The authors investigate the normal distribution of fat in the superficial and deep planes of the neck in a cadaver model, to determine the proportion of the submandibular gland that contributes to submental fullness. Fat in the superficial and deep neck planes of 29 adult cadavers was dissected and weighed. The submandibular glands were also dissected and the cervical portion of each gland was shaved off, weighed, and compared to the weight of the whole gland. The mean weight of superficial fat collected from the specimens was 15.0 g in males (n = 14; range, 2.2-35.7 g) and 14.3 g in females (n = 15; range, 1.6-37.3 g); the mean weight of subplatysmal fat was 5.5 g in males (range, 1.3-15.2 g) and 3.7 g in females (range, 0.6-15.1 g). Mean weight was not statistically significantly different between the sexes, nor between the 2 racial/ethnic groups (Caucasian, n = 14; Southeast Asian, n = 15). Approximately 40% of the submandibular gland was found to lie inferior to the lower border of the mandible in the specimens examined. The authors found no anatomical evidence of submandibular gland ptosis, even in the oldest specimens. The study provides a comprehensive analysis of the distribution of adipose tissue in the superficial and deep planes of the neck, as well as the contribution of the submandibular glands to submental volume. This objective evaluation of neck volume may help guide clinicians in the surgical planning process and provide a foundation for designing new cervicofacial rejuvenation techniques.Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 08/2012; 32(6):685-91. DOI:10.1177/1090820X12452554 · 2.03 Impact Factor
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ABSTRACT: Unwanted submental fat (SMF) is aesthetically unappealing, but methods of reduction are either invasive or lack evidence for their use. An injectable approach with ATX-101 (deoxycholic acid) is under investigation. To evaluate the efficacy and safety of ATX-101 for the reduction of unwanted SMF. In this double-blind, placebo-controlled, phase III study, 363 patients with moderate/severe SMF were randomized to receive ATX-101 (1 or 2 mg cm(-2) ) or placebo injections into their SMF at ≤4 treatment sessions ~28 days apart, with a 12-week follow-up. The co-primary efficacy endpoints were the proportions of treatment responders (patients with ≥1 point improvement in SMF on the 5-point Clinician-Reported Submental Fat Rating Scale [CR-SMFRS]) and patients satisfied with their face and chin appearance on the Subject Self-Rating Scale (SSRS). Secondary endpoints included skin laxity, calliper measurements and patient-reported outcomes. Adverse events were monitored. Significantly more ATX-101 recipients met the primary endpoint criteria versus placebo: on the clinician scale, 59.2% and 65.3% of patients treated with ATX-101 1 and 2 mg cm(-2) , respectively, were treatment responders versus 23.0% for placebo (CR-SMFRS; P<0.001); on the patient scale, 53.3% and 66.1%, respectively, versus 28.7%, were satisfied with their face/chin appearance (SSRS; P<0.001). Calliper measurements showed a significant reduction in SMF (P<0.001), skin laxity was not worsened and patients reported improvements in the severity and psychological impact of SMF with ATX-101 versus placebo. Most adverse events were transient and associated with the treatment area. ATX-101 was effective and well tolerated for non-surgical SMF reduction. This article is protected by copyright. All rights reserved.British Journal of Dermatology 10/2013; 170(2). DOI:10.1111/bjd.12695 · 4.10 Impact Factor