Goals/Purpose: Grading systems are a valuable tool in guiding aesthetic surgeons to the appropriate interventions. The anterior neck has been overlooked in the development of grading scales and classifications despite recent procedural and technological advances in neck enhancement. In the 1980's, general criteria for the appearance of the youthful neck were published. To date, no classification system has been established that accounts for the effects of age, weight and congenital aesthetic variability of the cervicomental region that is both reproducible and useful in providing the clinician with a management plan to address enhancement of the cervical region. The aesthetics of this area are dependent on the following four components: skin, fat, bone and muscle. This study aimed to develop a classification of the lower third of the face and neck that accounted for all four parameters.
Methods/Technique: Three-dimensional, standardized photographs of the cervicomental region from more than 100 subjects of various ages, ethnicities and body habitus were analyzed in order to develop a classification system that encompassed a wide spectrum of cervicomental variability. The classification system includes the validated scales for platysmal banding (Figure 1), for jaw distinction (Figure 2) and cervicomental angle scale (Figure 3) that accounts for soft tissue changes and ptosis.
Results/Complications: A five-point classification of the lower third of the face an anterior neck was developed (Figure 4) that assesses skin/soft tissues, muscle and bone when evaluating the lower one-third of the face and the anterior neck.
Conclusion: This is the first validated classification system for the cervicomental region that accounts for the aesthetic contribution of skin, fat, bone and muscle. It has the potential to serve as a powerful clinical assessment tool that will help guide treatment. This scale can now be used to produce evidence-based guidelines to select from the expanding procedural/technological advances.
