Evaluation begins with a general assessment of the patient’s overall health, facial features, and symmetry. Critical in analyzing patients presenting for rhytidectomy include those items listed in Table 10.1.
Although all factors are important, those directly related to the neck are most critical and will ultimately lead to the success of the extended sub-SMAS rhytidectomy. Together, these factors are used to grade the patient preoperatively into one of three categories: a type I face-lift patient demonstrates good skin elasticity, minimal jowling, minimal to no lipoptosis, early cheek and neck skin laxity, and minor platysmal laxity or banding (Fig. 10.1). The most common is the type II face-lift patient. This individual presents with moderate facial and neck skin ptosis, clear jowling, moderate lipoptosis, and heavier platysmal banding with an obtuse cervicomental angle (Fig. 10.2). The type III face-lift patient, including most males (Fig. 10.3), has heavy cheeks, prominent jowling with frequent prejowl grooves, loss of mandibular definition, significant platysmal bands with large amounts of lipoptosis, and absent cervicomental angle or convexity of the neck (Fig. 10.4). This grading is directly related to the expected amount of surgical work and intervention in creating a long-lasting, pleasing contour of the neck. Additionally, the underlying skeletal structure should be noted, as a low hyoid position portends difficulty creating a sharp cervicomental angle. Moreover, a chin or prejowl implant can improve the structure and overall result in select cases (Figs. 10.5 and 10.6). Lastly, the periorbital, perioral, brow, and midface should be evaluated for adjuvant procedures during rhytidectomy.