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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 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?

Comments (5)

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 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 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, 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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