Lateral tightening or midline tightening the Platysma muscle?

90% of my neck lifts involve both the midline platysmaplasty, which is approached via an incision under the chin. Then during the facelift, an incision is made around the ears which gives access to the lateral part of the platysma, and this is always tightened.   Unless the neck laxity is minimal, I usually suggest a platysmaplasty as that allows the best long term results for facial rejuvenation. The advantage is the best neck contouring and longevity of results, the disadvantage is another incision and techincally more surgery. 

Thank you for your question;

 As to how to treat the platysma muscle , in the 

majority of the cases  we do both the lateral and 

also the middle tighten of the muscle.  In some 

cases  where the platysma bands are very 
prominent we transect  the muscle

Thank you for the question. This issue is very controversial among plastic surgeon. Many surgeons only tighten the platysma in the mid-line, while others tighten it laterally. You should discuss this with your surgeon as to which option would be best for you. He/she might even recommend both, depending on your exam. The main disadvantage of the mid-line approach is the scar under the chin.  Good luck.

The aging neck is a joy that all of us individually will endure,  as gravity and laxity takes it's toll on the neck .  As the neck anatomy varies slightly from patient to patient, all aging necks may require site specific approaches to address  targeted  issues with the neck of each patient.  Generally speaking, the best solution for the aging neck involves a two prong approach to the neck, with tightening not only laterally, but also medially in the midline-which allows for a tremendous improvement in lax muscles of the anterior neck.  Ideally this would be a permanent solution for neck issues, but as we age, the neck muscles that form bands in the anterior neck-become thin and may not be amenable to a great amount of tightening-and thus one common failure of neck lift surgery is that these anterior bands may recur...much to the chagrin of not only the patient, but also the surgeon.  We as surgeons wish that the anatomy would tolerate big, long lasting sutures in these thin muscles-but occasionally the tissues will disappoint us-thus leading to a recurrence of the initial problem.  Talk to your selected surgeon to discover what your options are for neck rejuvenation, and fingers crossed that your neck anatomy will allow a long lasting resolution of the issue.  Good luck to you !!

It will depend of the individual patient neck problem which area will need more tightening. In average face/neck lift patient with moderate to severe platysma muscle laxity and visible bands we would do both anterior and lateral platysma muscle plicaton. We do that approach in probably 80-90% of our face/neck lift patient. If only neck lift is performed tightening and manipulation of anterior portion of platysma muscle is performed.

Think about it this way...the further away from which you pull an area, the less effect there is.  So it makes sense that if the pull is just done laterally, the least amount of effect is seen in the midline.  Plus, as tissues relax (which is inevitable), the midline which has the least amount of effect from a lateral pull will regress first to looseness.  Doing both will give the maximal effect for the maximal time, and this has been true for all my cases

The neck is much more complicated than loose skin.  If there is only fat and a lax neck, then a lateral approach without an incision underneath the chin may work.
However, if there are “platysma bands”, fat beneath the platysma muscle, large digastric muscles, large submaxillary glands, these problems need to be addressed through an incision under the chin.  
I’d suggest seeing a board certified facial plastic surgeon in your area for a comprehensive consult.

When I first started doing facelifts, I always plicated the platysma centrally. Now in the last ten years I rarely do it. I find lateral SMAS elevation of the platysma gives the longest results of lift to the neck. I find removing the adipose tissue with liposuction helps loosen the neck for elevation as well. Keys to an excellent result involve positioning the neck in the right position to allow for maximum elevation, lateral fixation of the platysma and redrawing the loose skin. Good luck.. See a board certified ASAPS plastic surgeon in consultation...

The platysma is a very large muscle sheet that goes from the collarbone to the cheekbone and is the basis for modern facelifts.  A deep plane facelift suspends the platysma in the midface while both a deep plane and SMAS facelift address the platysma along the jawline and in the neck.
As you noted the platysma muscle can be advanced towards the ear (lateral tightening) or towards the midline(platymal plication).  There are 2 potential issues with midline advancement.  First it will limit how much you can pull the muscle laterally.  Second it is not easy to get things perfectly smooth (I speak from experience with over 1000 facelifts).  I prefer to start by pulling laterally and then assess if there is still laxity in the midline to determine if midline tightening is necessary.
Most importantly, one of the most common complaints on real self is neck problems - that is because we are treating a very strong dynamic muscle with pulling.  This is not going to correct everything and there will almost always be some recurrence of banding.  Better to have a realistic expectation than to get frustrated with a good result.  

Hello and thank you for your question. Depending on your neck and facial anatomy, I often plicate the platysma both centrally and laterally.  If good technique is used, this can be done with minimal scarring and can result in a natural look, not over-done look, with rejuvenation of your face and neck.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.

Best wishes and good luck.


Richard G. Reish, M.D.  FACS

Harvard-trained plastic surgeon