Abstract
Knowing the difficulties and limitations of surgery for rejuvenating the submental area during a cervicofacial rhytidectomy, we came up with the concept of the digastric corset, which is described in this article along with the surgical importance of the platysma, digastric and mylohyoid muscles based on anatomical dissections. A study of ten cadavers was conducted to describe precisely the limits of the submental area, the mandibular edge between the two Furnas ligaments, and the hyoid bone. Each anatomical item was dissected plane by plane: the skin, platysma, digastrics muscles, and mylohyoid muscle. The sliding of each muscle relative to the others was studied, photographed, and recorded. Feldman’s corset technique was tested on two cadavers and a digastric corset was performed on eight cadavers. After suprahyoid fat lipectomy, we suture the digastric retaining ligaments to the mylohyoid muscles using a running suture, like a corset, then the platysma muscles are put aside on the median line followed by lateral platysma suspension. The different steps are presented and the results of 20 patients who underwent this procedure are presented after 1 year of follow-up. This study showed that the technique of a digastric corset anchored on the mylohyoid allows for one-step reconstruction of the floor of the mouth and a well-defined anterior cervical angle, a sign of a youthful-looking neck. This technique is indicated for difficult necks, when lateral repositioning of the platysma alone gives insufficient results.
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Acknowledgments
We thank Pr. Ephrem Salamé and the Anatomy Laboratory (Faculté de Médecine, Université de Caen, France) and Eric Thiboust (photographer, Caen). All patients gave their written consent about their participation in this study and publication of their photographs.
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Simulation of platysma suspension after digastric corset. With a strong hook placed on a key point, the surgeon is able perioperatively to test the efficacy of the digastric corset, completed by platysma suspension laterally. Staples were placed on the skin incision for demonstration (MP4 3448 kb)
Anterior belly of digastric muscle retaining ligaments. By moving the platysma we can observe the digastric muscles (subplatysmal fat is removed revealing the mylohyoid muscle between the digastrics). The digastric muscle is attached to the mylohyoid muscle, which limits its movements laterally while anteroposterior displacement is possible (MP4 10220 kb)
Anatomical principle of digastric corset. Medial traction on the digastric muscle creates a submandibular hammock (MP4 3865 kb)
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Labbé, D., Giot, JP. & Kaluzinski, E. Submental Area Rejuvenation by Digastric Corset: Anatomical Study and Clinical Application in 20 Cases. Aesth Plast Surg 37, 222–231 (2013). https://doi.org/10.1007/s00266-013-0083-7
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DOI: https://doi.org/10.1007/s00266-013-0083-7