Face pulled down after neck lift - is it possible?

  • sera
  • Perth, Western Australia
  • 4 years ago

The platysma muscle sheet rises up over the mandible & inserts near the corners of the mouth, so it seems possible that overtightening could cause this. Among other functions, the platysma is a lip depressor - it balances the smile http://www.michaelevansachs.com/newyorkplasticsurgerynyc/plasticsurgeryresearchdocs/TotalPlatysmaResection.pdf Tho this article is about crooked smiles where the platysma is NOT PULLING on one side, it does convey what may happen if there's TOO MUCH PULL. Arguably, overly tight medial plication may pull the mouth corners down & inwards, while over tightening to behind the ear lobes could create a low wide sardonic grin. Comments please from surgeons?

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Have you found a surgeon to perform a revision surgery? I have had the same unpleasant result that has altered my quality of life...if you have had success with a revision surgery please let me know...thank you
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Who did your surgery Linda?
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Dr David Palaia in Mt Kisco NY...his poor judgement and lack of skill has literally ruined the quality of my life...I thought I had adequately researched in selecting a Board Certified Surgeon but appartently not. I am in search of surgeon experienced in revision facelift. thank you
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I know how that feels, I too researched a doctor and he too messed me up......hopefully we can get the job done right next time around.....
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oh, have you thought about consulting with either Aston or Baker in NYC? I know they are 2 of the best to fix bad surgeries.....they are pioneers and probably have seen it all.........
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Thank you I will make an appt. and keep you posted...
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I have just researched each Dr on various websites and after reading some negative patient reviews I would be interested in knowing if you have had any personal experiences with either Dr...thank you
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I know people who have used both, a few that I met in the office of Baker, and a few that I know have used Aston, and one especially had problems prior, he did a wonderful job......
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I am glad, you will be in good hands with either one of the two......
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kelsey1 I would like your email address if you dont mind......i would like to speak with you privately.
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Very interesting question/observation. I am a revision case, searching for a qualified doctor for neck revision. I am being more careful the second time around. I've viewed HUNDREDS of before and after photos. One thing that I can't understand is why with most of these facelifts, the corners of the mouth do not improve to a more upward position. In fact, some event look worse - more down turned after the "lift". It may be the platysma pull down (tightening) that you asked about. Anyway, as an experienced veteran, this is a serious consideration - excellent question. Many doctors will tell you not to worry about the "technical" aspect. I recently consulted with a doctor who does a different platysma technique. He does not pull and tie the bands together, but instead releases them and removes a very small portion. Not endorsing this method, but it sure sounds interesting.
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Dear annonymous8, Thats a good question. I posted this so that surgeons might answer that question. Sadly, as you can see, I'm still waiting for a response! What has happened to you? Is your face pulled down after surgery?
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Addition: I found the following articles which support that it is possible for the face to be affected and possibly pulled down neck tightening and look forward to discussion by surgeons in this subject because it seems rather important for those who claim to have been so affected: Defining the Facial Extent of the Platysma Muscle - A Review of 71 Consecutive Face-lifts. Anil R. Shah, MD; David Rosenberg, MD Arch Facial Plast Surg. 2009;11(6):405-408 http://www.shahfacialplastics.com/defining-the-facial-extend.html This article holds that the platysma muscle sheet extends (on average) nearly 4cm up over the sides of the mandible and into the skin of the cheeks, and was actually found to be LOWER in the face in patients undergoing REVISION face-lifts, suggesting the neck tightening component of the facelift caused this. The article also states: The platysma muscle is a thin sheet­like muscle that originates on the fascia of the deltoid and pectoral regions and runs superiorly and medially, inserting on the the mandible, the skin of the cheek, the com­missure of the mouth, and the orbicu­laris oris muscle. The only bony inser­tion of the muscle lies on the anterior (front) third of the mandible. When the platysma muscle tenses, it lifts the neck out (accen­tuating platysmal bands) and LOWERS THE EYELIDS AND MIDFACE (accentuating the ma­lar and nasolabial folds) and the man­dible (making the neck shorter and wider). Clini­cally, the actions created by the platysma clearly demonstrate a SIGNIFICANT FACIAL COMPONENT (caps added by me) The Aging Neck - Grand Rounds, Dept of Otolaryngology UTMB, Carl Schreiner, MD & Byron Bailey, MD. October 8, 1997 http://www.otohns.net/default.asp?id=14026 states: "If the platysma is tightened by changing the direction of its fibers, the change in vector forces may effect other muscles. For example, if the platysma is pulled posteriorly... the fibers inserting on the risorius can result in an abnormal smile." Since the platysma is CONTINUOUS with the Risorius muscle and Depressor Anguli Oris, and inserts into the Obicularis Oris muscle (all mouth/lip muscles) it makes sense that the mouth and lips can be affected, depending on the unique anatomy of the patient and which fibres are pulled in what direction and at what tension. So too, since the platysma inserts into the skin of the cheek (quite high) it makes sense that this area could end up pulled down also by excessive tightening. Furthermore, since the platysma inserts into the modiolus http://en.wikipedia.org/wiki/File:Modiolus_(face).PNG, which is an area of the corner of the mouth where many facial muscle interdigitate (intermesh), including muscles that attach in turn to the muscle around the eye (Obicularis Oculi), it makes sense that over-tightening of the platysma may lower not only the corners of the mouth and midface, but exert a downward pull on the eyelids too. Please can some knowledgeable surgeons add some input to this discussion. Its horrible to be told 'Oh that's not possible' when its real and its happening and you've just been left like that for all eternity. If there is a real unrecognised complication here, it needs to be identified and surgical avoidance/resolution found.
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can this be corrected?
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You have described exactly what has happened to me...
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