You have persistent bands at this point. Would need to know exactly what was done to the plastysma to decide what the best next step would be. If you had a plastymaplasty twice and it didn't hold, then may need to excise the bands instead. Best to get another opinion to confirm.
You are correct in that the platysmal bands were not addressed adequately. In your case, you will need yet another revision to create some relaxing incisions in the platysmal muscle and plicating the upper portion of the muscle as well. I would wait a minimum of six mos from your last surg to let the tissues heal. You may also need a revision of the face lift to tighten the posterior aspect of the platysma muscle at the same time.A second opinion in person would also be beneficial.
Thank you for the photographs. The platysmal banding remains in your neck. They may not have been optimally dissected free and joined with stitches, or the stitches may have cut through the muscle like a string through cheese, Either way, the banding has persisted. Another consultation with a plastic surgeon who has extensive experience in facial aesthetic surgery would be helpful. To better address this area, you may need more aggressive maneuvers for the muscle--horizontal sectioning of the muscle with tighter joining in the middle using multiple layers of stitches or removal of some of the muscle fibers that are pulling away from the other layers of the neck. Best wishes for an eventual beautiful result!
Looks like you might have residual plastysmal bands. I cannot give much advice here as I was not present at your consultations or surgery. However, you may want to seek a consultation with an experienced facial surgeon who might suggest a more aggressive approach (assuming this was not done) to address these issues.
I am truly sorry about your disappointment.
We do not know what was done and what you and your doctor had agreed on, expectation-wise.
It might be best to get a second opinion or to do a more complex procedure with both an anterior neck approach, plicating the bands anteriorly, transecting them inferiorly and doing a SMAS 2-layer lift around the ears.
Best of luck,
Dr. Marc DuPere, Toronto Aesthetic Plastic Surgeon
From your photos it appears that whatever treatment you received to your platysma muscle was unsuccessful. I would consider either Botox injections to the platysmal bands (often dramatically successful though temporary) or seeking a 2nd opinion and having the platysmal bands cut and a resuspension of your platysma laterally. Many doctors suture the muscle in the midline and this is an equally effective procedure.
Jon A. Perlman, M.D., FACS
Certified, American Board of Plastic Surgery
ABC-TV Extreme Makeover Plastic Surgeon
Beverly Hills, California
From the photograph it looks as though the platysma muscles have not been anchored in the midline. This creates banding that will require surgical revision.
Its unfortunate that you still have significant platysmal bands after two procedures. You do need another procedure to address your concerns. You should speak to your surgeon and find out what they feel happened and why they believe after two procedures you still have this problem. You should also see a few other surgeons in consultation. Its easy to be critical of a less than ideal outcome and it is possible that your surgery had surgical challenges. Looking at your photos it appears as if it would be straightforward to significantly improve the bands.
Sorry about your disappointing experience. You need to visit a facelift specialist who can correct your neck. This result is not acceptable after two surgeries. I will be happy to help you.
In my opinion- the primary goal of the facelift in a patient like you- is to achieve a smooth-90 degree angle neck. The bands should be gone and remain gone for a reasonable amount of time. However, there are some cases where band recurrence does occur sooner than anticipated. If however, they were never gone- then I question the success of the procedures you have had. I would seek a second opinion ASAP.