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Page 10 of 21 Ramirez. Plast Aesthet Res 2020;7:25 I http://dx.doi.org/10.20517/2347-9264.2019.78
2/2/2010
Figure 9. The effect of the Mandibular Matrix System to enhance the lower face, neck and jaw line
2/2/2010
Figure 10. Lateral view of the same patient
Subtractive maneuvers particularly on the neck
Not everything is augmentation in facial rejuvenation. The jowls and the neck require subtraction.
Jowl fat and supra-platysma fat are removed using a small liposuction cannula, preferably under direct
visualization. The deep subplatysmal fat is removed only under direct vision. The danger of liposuction
in the deep compartment is bleeding, nerve injury or salivary fistula. Its fibrous consistency also makes
suction difficult. Fat removal is in a planimetric fashion that includes extension around salivary gland.
Isolated fat excision in between the digastric muscles is not advisable as it can lead to cobra neck deformity.
The digastric muscles are tangentially shaved or advanced medially to reduce bulk. If salivary glands are
found to be enlarged excision can be performed.
The combination of central oval endoscopic with peripheral excisional cervicofacial lift is called BEAM
(Biplanar Endoscopic Assisted Mask) facial rejuvenation [Figure 11]. The combination of BEAM facial
rejuvenation with Deep Subplatysmal Cervicoplasty is called TEAM (Triplanar Endoscopic Assisted Mask)
facial rejuvenation [Figure 12].
