The subplatysmal supramylohyoid fat

Background: Liposuction of the neck has an established role in selected patients undergoing cervicoplasty. Some authors have suggested a role for subplatysmal fat removal. Observations in the anatomy laboratory suggested the presence of discrete regions of subplatysmal fat. This information may be useful during surgical procedures in the subplatysmal plane. Methods: Five fresh cadaver dissections were performed. There were four male specimens and one female specimen with an age range of 66 to 78 years. Sequential dissection of the cervical layers included skin, supraplatysmal fat, platysma muscle, and subplatysmal fat. Loupe magnification was used to aid dissection. Results: Subplatysmal fat is found in three compartments: central, medial, and lateral. Their relationship to the platysma and digastric muscles is consistent. The mylohyoid muscle represents the posterior boundary of these compartments. Central fat is easily distinguished from medial and lateral fat due to differences in color and appearance. These three compartments abut one another and together form the subplatysmal fat layer. Differences in thickness of these compartments were noted. Conclusions: Subplatysmal fat occurs as distinct regions. These can be identified during surgery by their relationship to the platysma, digastric, and mylohyoid muscles. Knowledge of the regional differences in appearance is a further aid in identification. Knowledge of this anatomy can facilitate dissection when performed in the subplastysmal plane.