Dr. Kridel in Vogue Magazine, where he was
the only facial plastic surgeon noted for Texas.
Dr. Kridel voted top doc for women by H Texas Magazine.
Dr. Kridel named as a Super Doctor in Texas Monthly Magazine.
For submental contouring, the areas of liposis and important facial landmarks, including the sternocleidomastoid muscle, the hyoid bone, and the angle of the mandible, are marked in the preoperative holding area with the patient in a sitting position (Fig.19-5).
Figure 19-5 (A) Preoperative. Patient on three-fourths view with submental fullness and early jowls outlined, with the posterior earlobe and submental incisions marked. (B) Preoperative marking on base view of the mandibular angle, border of the mandible, hyoid bone, thyroid notch, area of greatest submental liposis, and area of planned feathering.
Preoperative marking is imperative because when the patient lies supine on the operative table fatty accumulations tend to shift and even disappear. Sub-mental and infralobular incision sites are also marked prior to infiltration of anesthetic solution. Patients with prominent submandibular glands should be aware that these will not be reduced in size and may appear after submental and submandibular liposculpting.
In most cervical liposuction cases, the subcutaneous tunnel dissection extends to the sternocleidomastoid laterally, and at least to the hyoid bone inferiorly. Submental fat is generally located centrally, so that dissection and suction extending to these borders serves as more of a feathering function, with the most fat aspirated in the area of greatest concern. Graduated markings should reflect the area in which the function of liposuction is to blend and not necessarily to recontour. When the jowl areas require recontouring, approach to this site may be gained from an infralobular or transnasal approach, utilizing very small-bore cannulas under lower pressure to avoid oversuctioning or neural damage.
The importance of preoperative marking is not to be understated. Careless marking may result in asymmetries and undesirable contour deformities. Similar to cervicofacial fat collections, prominent platysmal bands or hanging folds of skin must also be marked preoperatively to guide their management.
