The Mastoid Crevasse and 3-Dimensional Considerations in Deep Plane Neck Lifting.

Background: Advances in face and neck lifting involve release of tethering points along the superficial musculoaponeurotic system-platysma complex to freely manipulate the deep natural glide plane in the face and neck.

Objectives: The aim of this article was to determine a combination of deep plane techniques for addressing the face and neck and to elucidate, for the first time, a measurable endpoint for the gonial angle. Analysis of deep plane tethering and decussation zones was also undertaken.

Methods: Extended deep plane surgery performed in 79 patients (158 hemifaces; age, 30-75 years; 95% female), over a 3-month period, was reviewed. Patients were followed for 1 year. Measurements were performed systematically during deep plane face and neck lifting.

Results: Before intervention, the mean [standard deviation] gonial depth was 9.4 [3.6] mm on the left and 8.3 [2.7] mm on the right. The mean depth created below the gonial angle when measuring the traditional suspension to the anterior mastoid was 15.8 [3.3] mm on the left and 13.7 [2.5] mm on the right. The distance postoperatively when measuring the gonial depth after performing the crevasse technique was 23.2 [2.2] mm on the left and 22.5 [2.5] mm on the right. This represents a mean increase in the advancement of 7.4 mm on the left and 8.8 mm on the right (average, 8.1 mm) which was demonstrated to be statistically significant bilaterally (P < .0001).

Conclusions: The deep plane techniques described here aid manipulation of the deep plane and deep neck space, while also providing measurable endpoints and more effective modes of fixation by utilizing the mastoid crevasse. The use of techniques that release tension and allow redrape produce the most natural and well-balanced results.