It's the plastic surgeon who will have to tuck, tighten and smooth that saggy skin under the chin.
By TOM VALEO
Published July 29, 2003
We see them all the time - middle-age people who, through good nutrition and vigorous exercise, retain the lean-muscled body of an adolescent.
One part of the body, however, refuses to participate in this deception, and ruthlessly reveals advancing age unless stopped by a plastic surgeon's scalpel.
That part of the body - the sagging, wrinkled skin beneath the chin and down the front of the throat - is known as "wattle." It's called wattle presumably because it resembles the fold of skin that hangs from the neck of a turkey. For male turkeys, the red wattle is an asset; it helps put female turkeys in the mood to mate. Humans, however, consider wattle distinctly unsexy.
What causes the human wattle?
For starters, blame skin and its loss of elasticity. Pinch a fold of skin on the back of a child's hand and watch it snap back instantly. By age 60 or so, that same fold of skin when pinched will flow like molasses back into shape. That's because collagen and elastin, two proteins that give skin its structure and elasticity, deteriorate with age, making skin resemble a rubber band that has been pulled too many times. In addition, glands secrete less oil, and blood flow to the skin diminishes. As a result, skin becomes less supple, and the shortage of oxygen causes collagen and elastin to break down faster.
Beneath the wattle, the platysma muscle thins and loses strength over time, causing it to succumb to gravity. Ah, but a muscle responds to exercise, right?
That's what some merchants would have you believe. For instance, there is the exercise ball for under the chin, and electrical stimulators to make the platysma stronger and firmer. But the platysma, which runs from the jaw bone down either side of the throat, connecting to the deltoid muscle in the chest, is unique.
"It's a muscle that serves no purpose other than to provide contour to the lower jaw and neck," says Dr. Rod J. Rohrich, chairman of the Department of Plastic Surgery at the University of Texas Southwestern Medical Center at Dallas and president-elect of the American Society of Plastic Surgeons.
The platysma does not respond to exercise the way the abdominals respond to situps or the thigh muscles respond to squats. The only way to eliminate wattle is by surgically tightening the muscle.
"Just removing excess skin and tightening what remains is not the answer," says Dr. Paul Smith, an assistant professor in the University of South Florida's department of surgery. "You must tighten the underlying muscle as well."
To eliminate wattle, plastic surgeons make an incision around the ear. They remove the slack in the platysma by pulling it back and sewing each side to the bone behind the ear. Once the muscle is taut, the skin of the neck and jaw line is draped over the platysma. The surgery takes about three to four hours and costs $5,000 to $6,000, Smith said. A surgeon in Minneapolis has developed a technique that might improve the recovery process. Dr. Joseph Gryskiewicz discovered that patients who were not candidates for a facelift benefited from liposuction to remove fat from below the chin. But liposuction irritates the inside surface of the skin, so Gryskiewicz had his patients wear a "jaw bra" that holds the skin tightly against the underlying muscle. Within a week, the patients' skin adhered to the muscle, giving it a firmer, smoother look.
Even after successful plastic surgery, the process that leads to wattle starts again, but the patient can preserve the effects of the surgery somewhat by avoiding weight gain and exercising.
Other ways to combat wattle include getting proper amounts of sleep, monitoring your alcohol intake, avoiding smoking and staying out of the sun.
- Tom Valeo is a freelancer who writes about medical and health issues. Write to Tom Valeo, c/o Seniority, the Times, P.O. Box 1121, St. Petersburg, FL 33731 or e-mail him at floridian@sptimes.com
To learn more
For more information, contact the American Society of Plastic and Reconstructive Surgeons at www.plasticsurgery.org or call toll-free 1-888-475-2784.
