Updating the concepts on neck lift and lower third of the face.

BACKGROUND: When planning a face lift, the surgeon must keep in mind that signs of aging vary depending on the patient's age, skin quality, bony structure, and muscle tone. The deformities must be evaluated individually to determine the best treatment.

METHODS: The purpose of this article is to discuss the surgical and philosophical aspects of the treatment of the lower third of the face and neck, based on the authors' experience of 40 years. A review of 1500 patients who were operated on in a private clinic and in the Hospital of the Rio de Janeiro State University was conducted to evaluate the different aspects of deformities and their treatments.

RESULTS: In the majority of patients, the authors open the neck and treat the platysma muscle. Subplatysmal fat is removed with care, only in the midline. The authors do not perform any procedures on the submandibular glands or the digastric muscles. The authors do perform superficial musculoaponeurotic system (SMAS) dissection and SMASectomy in the majority of cases, with plication only in thin patients. Many procedures have been described for facial rejuvenation. Most of them aim for a good aesthetic result with a short recovery period. In the authors' experience, the best results are accomplished in a young patient with thin skin.

CONCLUSION: Although the surgeon selects treatments for patients based on their deformities, it must be kept in mind that treatments must be selected to satisfy the patient's needs and preferences.