After a face and neck lift six months ago, why is one of my platysmal muscles still very pronounced?

The platysma muscle changes after a neck lift.  Majority of the time it continues to be smooth if it has been sutured together under the neck.  However sometimes a part of the platysma can become hyper active a few months after surgery as it is recovering and become more pronounced.  Your options are as follows;1.  Small incision under the chin to reach the platysmal band and cutting it.2.  Botox in the platysma which is only temporary.3.  Thermirase treatment by burning the nerve that supplies that platysma.RegardsDr. J

The platysma muscle in the neck typically joins in the midline above our hyoid bone.  That is the right and the left platysma muscle attached loosely to each other in the midline.  This connection is very attenuated (weekend) as time goes on and therefore we ay perform a platysmaplasty during our Advanced Facelift operation.  Even thought we re attach these muscles to each other, then can easily separate following the procedure if we lift something heavy or do something that contracts the muscles early recovery.A few things can be done.  Sometimes botox can be used to weaken the medial portion of the muscle and soften this appearance.  If however, this is an ongoing problem, you may require a repeat platysmaplasty.  This isn't a big surgery at all, however, it is possible that it fails again.  One way or another, I think your facial plastic surgeon will be able to help solve your problem. 

You might have some scarring developing.  Check with your plastic surgeon to see if massage or steroids will help the issue.

When the patient has platysmal bands, the sequence that many plastic surgeons will use is the following:#1 identify the muscle and separate it from the surrounding tissues#2 transect the muscle to some extent to "cut the cord "#3 suture the two edges of the muscle together to unify the two halves, thereby eliminating the bands #4 pulling the muscle up from the sides around the facelift incision to further tighten and smooth itResidual bands after a neck lift usually mean some objective above was unsuccessful, be it from a suture which pulled through, or dissolved, or tissues which did not pull and tighten the way the surgeon had hoped an expected, etc.I would say at this point discuss with your surgeon potential solutions which can involve Botox, nerve ablation, a limited reopening of the incision to address an above goal, etc.Your best resource here is your operating surgeon.Best of luck!Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

I can picture what you describe, but without knowing the details of how your operation was performed I can only guess as to what might be the best explanation.It really depends on what techniques were used for the necklift part of your operation.  Persistent platysma bands (or asymmetric banding) can have a variety of causes, and there are several options available for improvement.  These range from Botox injections to temporarily weaken the muscle activity to revision platysmaplasty surgery.

Thank you for your question and for sharing your experience with us. It may be that your platysmal muscle needs additional surgical tightening or relaxing incisions to diminish the amount of platysmal show that you have.  An alternative is using Botox to relax the muscle, but this would be temporary in its effect and needs to be repeated.I would recommend visiting with your surgeon to who can help assess your concerns and develop a treatment plan with you.

To prevent banding the platysma muscle should be plicated from the chin down to the sternum. Failure to do so can cause postoperative banding.

Sometimes in spite of the best effort, banding of the plastysma is present after surgery.  A easy, though temporary, fix is to inject Botox into it.  This will relax it so it doesn't show as much.  A more permanent correction would require a repeat platysmaplasty which is not a big operation and can be done with local anesthesia.  That would allow either resuturing of the muscle or a small division of the muscle to correct your issue.  Talk with your plastic surgeon about what would be best for you.

Hard to say without before and after photos and physical exam.  Discuss further with your surgeon.   A touch up may be helpful but sometimes more surgery isn't the answer and can look unnatural.  Good luck!  Dr. Vargas

Symmetry is an ideal we all strive for, but unfortunately can never truly achieve. All patients are asymmetric to some degree without surgery, and after surgery; it is all a question of degree. Without photos or a physical exam, it is difficult to determine if this is an expected degree of asymmetry or something that needs to be 'corrected.' There are many options to treat platysma bands. All that being said, you are still early in the recovery and have a  good 6 months of continued healing. I would continue to follow up with your surgeon. Good luck!