Is an isolated platysmaplasty an option??

Question

I have a small amount of submental fat and a vertical band. There is some skin laxity but I think part of the bulk is due to platysmal banding but also digastric muscle +\- submandibular glands. I am happy to have a submental incision and even small post auricular. I do have some very early jowling and loss of cheek volume, however I am not keen on having a face lift. Any visible scarring infront of the ears would be unacceptable to me. would a chin only incision work? I am 40 years old.

George Bitar, MD · Answer

I would recommend a suture suspension neck lift.  This would require a submental incision and small post auricular incisions.  Any submental fat could be excised or contoured.  The platysma could be plicated and a suture suspension could be performed to reestablish the cervicomental angle.  Some skin could then be removed through the incision behind the ear.  I would recommend a formal consultation.  Best of luck!

Howard Webster, MBBS (Hons), FRACS · Answer

Hi there,Your questions are excellent.  There is an isolated platysmaplasty and submental fat excision procedure which works very well, for the right candidate.The issue is neck skin laxity and jowls.Looking at your pictures, the submental skin is too loose for an isolated platysmaplasty.  I don't think that your submental appearance is due to an anterior platysma band, unfortunately.So, I think an anterior platysmaplasty plus a posterior neck lift would be necessary in your position.There is some good news.  Although you would require a pre auricular incision, a short, post tragal incision should be expected to be simply not visible post operatively, once healed.  This can be shown to you during consultations, where close up images of contemporary pre auricular incision patterns and real examples can be demonstrated.Overall, you have a lovely face, and you're young.  If a minimal or limited procedure would achieve the result required for your submental region, then that would be ideal. However, I don't think you're a candidate for that simply due to the submental skin laxity which I would expect to persist after an isolated platysmaplasty.Images of both types of procedure and results would normally be shown during the consultation period.All the very bestHoward WebsterPlastic Surgeon

Jason J. Hall, MD, FACS · Answer

From the photos you submitted, you don't need an operation right now.  Start with Kybella - a non-surgical treatment for small areas of excess fat under the chin.  You appear to be a good candidate for this treatment to resolve your problem without surgery.

Matthew Hansen, MBBS, FRACS (retired) · Answer

Thankyou for your question and the images. You have a good strong jawline and a nice neck that is just beginning to loosen a bit. I don't think it is a platysma band as if it was it would usually worsen with smiling not improve. Nor do I think that either your submadibular glands nor your digastric muscles are contributing much to the problem. There is virtually no excess fat either. The issue is some mild looseness and descent of the skin and SMAS and the only reliable way to make a substantial improvement would be a lifting procedure. This would require pre and postauricular scars and I understand why that is of concern to you. Nobody wants visible scars or distortion following face and necklifting but a well performed lift should result in no visible scarring. The key to achieving this is meticulous technique focused on lifting at or below the SMAS/platysma plane and tension free closure of the skin . Older techniques of lifting often resulted in obvious scarring and even more obvious distortions of the tragus and earlobe due to the attempt to pull the face and neck up by tightening the skin as much as possible. Tight skin is not youthful or healthy, it just looks weird and the resulting scars were often stretched and poor. The aim of face and necklifting should be to restore the facial shape and neck contour and normal youthful skin tone. Pre-auricular scars placed carefully in anatomical junction zones and around landmarks such as the tragus with careful contouring of the skin flap to restore contours such as the pre-tragal hollow should be very difficult for anyone to see when they have matured (including the surgeon who put them there!).

Is an isolated platysmaplasty an option??

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