This review is devoted to the issue of age-related changes of the lower third of the face and modern methods of their correction. In addition to historical milestones in development of platysmaplasty, the authors present complex approach to rejuvenation of the lower third of the face and neck. According to literature data, modern plastic surgeons should be confident in several methods of correction of face and neck aging, as well as combination with minimally invasive technologies. Cosmetology and plastic surgery should complement each other for favorable long-term results. This article systematizes knowledge in facial and neck rejuvenation that sets the vector for individual approach based on anatomical features and type of the face.

The pursuit of youth and attractiveness is a fundamental desire in contemporary society. For many individuals, the appearance of visible signs of aging, such as skin laxity, gravitational changes in facial and neck soft tissues, and loss of harmonious proportions, can be psychologically distressing. The choice of effective methods for addressing these changes depends on their specific characteristics, the patient’s anatomical features, and the type of facial aging. The introduction of 3D imaging to determine the hyoid bone level, the volume of soft tissue structures in the cervico-mental area, ptosis of subplatysmal structures, and the volume of submandibular glands, in addition to ultrasound study of the submental projection at the preoperative stage, are key for making the best decisions regarding preoperative planning. This case report aims to illustrate how modern imaging techniques are a fundamental part of the preoperative assessment of the mid and lower third of the face to ensure the most favorable aesthetic outcomes for each patient.

The quest for surgical advancements regarding the enhancement of the submental and cervicofacial regions has witnessed a remarkable upsurge in recent years. Informed patients are actively seeking sophisticated plastic surgery techniques to achieve comprehensive rejuvenation in these specific areas. Common complaints expressed by these patients include sagging of the jawline, the emergence of deep perioral wrinkles, and the formation of “marionette lines” within the lower third of the face. Furthermore, the manifestation of age-related signs, including neck laxity, submental adipose accumulation, “witch’s chin” deformity, and weakened platysma musculature, are common within this anatomical region. This literature review aims to summarize recent technical improvements, historical evolution, indications, postoperative care, and challenges for facial rejuvenation of the lower third of the face and neck. The application of minimally invasive procedures as part of a comprehensive approach for an aging face will also be discussed. In this article, an extensive search of the available literature was conducted using leading databases, including PubMed and MEDLINE, with the keywords “neck lift”, “platysmaplasty”, “facial rejuvenation”, “medial platysmaplasty”, “lateral platysmaplasty”, “neck rejuvenation”, and “cervicofacial rejuvenation”.

Objective: In this study, we analyzed the existing chin augmentation methods and evaluated the effectiveness of using a subplatysmal fat autograft for augmenting insufficient chin projection. Materials and Methods: From January 2017 to December 2023, we studied 170 patients at the Department of Plastic Surgery, Sechenov First Moscow State Medical University, who presented with insufficient chin projection, localized fat deposits in the cervico-mental area, and age-related changes in the lower third of the face. The patients were divided into two groups: Group 1 (n = 93) consisted of patients who underwent chin augmentation using implants (Silastic, Medpor); Group 2 (n = 77) included patients who underwent medial platysmaplasty and chin augmentation using a fat autograft (subplatysmal autograft). Results: Chin augmentation was performed on all the patients with varying degrees of insufficient chin projection. The mean age was 36.5 ± 2 years. The average follow-up period was 18.9 months (range: 2–45 months). For chin augmentation using implants (Silastic, Medpor), +chin projection increases were observed as follows: 1.1–1.2 cm at 3 months, 0.9–2.3 cm at 6 months, and 0.8–1.7 cm at 12 months. The complications in this group included inflammatory processes in 7 (8%) patients, hematomas in 6 (6%) patients, and contour asymmetry in 13 (14%) patients. In the group that underwent chin augmentation with a subplatysmal fat autograft, the chin projection increased by 0.8–1.2 cm at 3 months, 0.7–1.3 cm at 6 months, and 0.6–1.9 cm at 12 months. The mean age was 38.3 ± 7 years, with an average follow-up of 18.3 months (range: 2–43 months). No infectious–inflammatory complications were observed. Aesthetic complications were noted in 14 (18%) patients. Conclusions: Among the existing methods for chin augmentation, many still consider osseous genioplasty to give more predictable results. However, its traumatic nature and lengthy rehabilitation period prompt surgeons to seek effective yet less invasive alternatives. When selecting a minimally invasive method for chin augmentation, preference is given to fat injections (lipofilling) and intraoperative use of autologous fat grafts. Augmentation using subplatysmal autologous fat grafts is a minimally invasive, safe, predictable, and long-lasting method for chin correction.

Objective. To evaluate the effectiveness of fat autografts for cervicomental rejuvenation procedures and chin augmentation. Material and methods. The study included 70 male and female patients aged 35-65 years with age-related changes in the lower third of the face, localized fat deposits in cervicomental area and insufficient chin projection between 2020 and 2024. All patients were divided into three groups: the 1st group (n=30) — medial platysmaplasty and chin augmentation with subplatysmal fat autograft; the 2nd group (n=15) — removal of Bichat’s fat and chin augmentation with fat autograft using Bichat’s fat pad; the 3rd group (n=25) — medial platysmaplasty and chin contouring with lipofilling. Results. Patients with various age-related changes in the lower third of the face and insufficient chin projection underwent cervicomental rejuvenation and chin augmentation. In case of chin augmentation with subplatysmal fat autograft, chin prominence increased by 0.6±0.2 cm after 3 months, 0.5±0.3 cm after 6 months and 0.4±0.2 cm after 12 months. In chin augmentation using Bichat’s fat pad autograft, chin projection increased by 0.5±0.2, 0.4±0.2 and 0.3±0.4 cm, respectively. In chin contouring with lipofilling, chin projection increased by 0.6±0.4, 0.4±0.2 and 0.2±0.1 cm, respectively. In the 1st group, 2 (3%) patients had uneven chin contours. There were no infectious-inflammatory complications. Conclusion. Autologous fat injections (lipofilling and fat autografts) are preferable for chin augmentation. Augmentation with subplatysmal fat autografts is a minimally invasive, safe, predictable, and long-term method for chin augmentation.

Objective. To improve the efficiency and outcomes of surgical correction of body contour deformities using original technique of aesthetic lower body lift. Material and methods. In 2020—2024, we observed 30 patients with buttock ptosis, excess skin and fat in the back, waist and abdomen, as well as anatomical defects of anterior abdominal wall. Mean age was 37.7±4.3 years (range 30—45), mean body mass index — 27.8±1.17 kg/m². In the first group, patients underwent lower body lift procedure without de-epidermized flaps, in the second group — the same procedure with de-epidermized flaps. Patient satisfaction after lower body lift was assessed using the BODY-Q questionnaire. Results. Mean follow-up period was 24±10 months (6—42 months). Body contour correction was performed for buttock ptosis, excess skin and fat in the back, waist, and abdomen, as well as diastasis recti. The incidence of aesthetic complications was 12%. Complications occurred only in the first group: 1 (3%) patient experienced scar line disruption; 2 (6%) patients — insufficient soft tissue volume within postoperative scars; 1 (3%) patient — recurrent buttock ptosis. Conclusion. Lower body lift is effective for buttock ptosis, excess skin and fat in the back, waist, and abdomen, as well as diastasis recti. The advanced lower body lift technique demonstrated high efficacy in long-term period.