title: The utility of ultrasound in the evaluation of submental fullness in aging necks.
abstract: OBJECTIVE
  To evaluate the submental region of the aging neck with high-frequency ultrasound and to assess the relative contribution of its various components to the appearance of age-related soft-tissue ptosis.
  
  
  METHODS
  Ten patients with submental soft-tissue excess were recruited from the senior author's (G.S.K.) private practice. The subcutaneous fat compartment, the subplatysmal fat compartment, and the anterior bellies of the digastric muscles were imaged with high-frequency ultrasound and measured in the cephalocaudal dimension. Pseudoherniation of subplatysmal fat, judged in relation to the inferior surface of the digastric muscles, was also assessed from acquired images.
  
  
  RESULTS
  A clear delineation of submental anatomy was obtained with ultrasound in all patients (N = 10, 100%). Hypertrophied digastric muscles (n = 1, 10%) and excessive subplatysmal fat (n = 5, 50%) adversely contributed to the appearance of submental fullness in 6 patients (60%). These findings would not have been predicted with the same degree of accuracy from the physical examination alone.
  
  
  CONCLUSIONS
  High-frequency ultrasound provides useful imaging of the submental region and its components. Deeply situated subplatysmal fat and anterior bellies of the digastric muscles, both of which may be difficult to assess on physical examination, can be readily evaluated with ultrasound. When sufficiently enlarged and ptotic, deep tissues of the submental space necessitate an open submentoplasty to restore a youthful neck contour. Preoperative ultrasonography can assist with anatomical imaging of the submental space and help in planning a targeted operative intervention in patients with submental soft-tissue excess.
authors.affiliation: Department of Otolaryngology, Division of Facial Plastic Surgery, New York Eye & Ear Infirmary, New York, New York 10003, USA. gmashkevich@nyee.edu
authors.forename: Grigoriy
authors.initials: G
authors.lastname: Mashkevich
authors.forename: Jeff
authors.initials: J
authors.lastname: Wang
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Rawnsley
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Keller
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D009334:Neck Muscles / Q000000981:diagnostic imaging* / Q000601:surgery; D010808:Physical Examination / Q000379:methods; D011300:Preoperative Care / Q000379:methods*; D011336:Probability; D012060:Rejuvenation; D012494:Sampling Studies; D015595:Skin Aging / Q000502:physiology; D013518:Surgery, Plastic / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography / Q000706:statistics & numerical data