Platysmaplasty or not in a lower facelift?

Question

In a quandary! I am going to have a lower facelift. I have consulted with two surgeons and done a fair amount of research and I am getting conflicting information regarding platysmaplasty. I am 59, this will be my first procedure and I would like to do it right! Thank you

Stephen M. Krant, MD, FACS · Answer

The two platysma bands need to be tightened in the midline to control the contour beneath the chin (submental). The lateral platysma muscle can also be tightened to give better contour.
Skin tightening alone does not control these bands. Make the right decision. Good luck!

David Hansen, MD · Answer

A neck lift (platysmaplasty) always gives a little better result when done with a lower facelift.  Be sure to get them done under local and enjoy the new  you.

Raymond E. Lee, MD · Answer

I would say in general most 59 year olds would need a platysmaplasty which is tightening the loose and separated vertical muscle bands that run from under your chin to you collarbone.  These muscle bands create the dreaded "turkey neck."  There are some exceptions but without photos the experts here can not make definitive comments.  Make sure you surgeons have done hundreds of face and neck lifts and are comfortable with these procedures.  Best of luck!

Stephen Prendiville, MD · Answer

In my experience, a platysmaplasty is invariably necessary for patients at age 59 in order to maximize quality and longevity of results.  Although there are exceptions, laterally based facelifts without an anterior platysmaplasty are usually reserved for patients in their late 40's, early 50's.  A consultation would be best in order to determine what is best for you.  Good luck!

Alejandro J. Quiroz, MD · Answer

Thank you for your question. That is and important question and I believe everybody need to ask. In my practice I always include the Platysma muscle as a part of the treatment of the lower face because I see it as a one unit but the treatment of the platysma muscle (paltysmaplasty) can vary according to the patient.

Zoran Potparic, MD · Answer

Based on this single photo and short of in person evaluation, I would suggest platysmoplasty as a part of neck/face rejuvenation. Tightening anterior bands of platysma muscle in the portion of neck (or sometimes all the way down to jugulum?) with wedge excision and similar manipulation based on case to case basis, is mandatory in the neck like yours. Once you select your surgeon you should discuss this issue again and let him do procedure that he thinks will work best for you. Good luck.

Edwin F. Williams, III, MD · Answer

Great question!  For years plastic surgeons have debated the ideal method to correct platysmal bands, and many techniques have been described.  In my opinion, using the extended deep plane technique, platysmaplasty can often be avoided.  My best recommendation would be to find an experienced surgeon who shares your vision and has before-and-after pictures that you find pleasing, and trust them to do the right thing for you.

William Portuese, MD · Answer

In our practice, a platysma plasty is a routine component of a lower face and neck lift procedure. We place sutures in the platysma bands above the hyoid bone, and when patients have severe banding like yours present in the photograph,  we transect the bands down low in the neck at the level of the cricoid.  It would also be a good idea to pretreat the bands with Botox since they are very prominent. This will  be beneficial to prevent the bands from growing back together after the transection

Robert Singer, MD · Answer

Based on your  limited photo but without an examination, the vertical bands of the neck will get a better cosmetic result with a platysmaplasty performed through a submental incision at the time of the lower facelift.
Keep in mind that following the advice from a surgeon on
this or any other website who proposes to tell you what to do without examining
you, physically feeling the tissue, assessing your desired outcome, taking a
full medical history, and discussing the pros and cons of each operative
procedure would not be in your best interest. I would suggest you find a plastic
surgeon certified by the American Board of Plastic Surgery and ideally a member
of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust
and are comfortable with. You should discuss your concerns with that surgeon in
person.

Robert Singer, MD FACS

La Jolla, California

Laxmeesh Mike Nayak, MD · Answer

Platysmaplasty means "reshaping the plastysma," usually, but not always, with sutures. Platysmaplasty is hard work, and many surgeons, including myself, sometimes go through a phase where we believe we can get a great result by pulling harder from the sides, and skipping the platysmaplasty. It looks good for several months, but not as good as if an appropriate platysmaplasty is done. Several months later, the results are even more disappointing compared to a true necklift with deep neck (subplatysmal) work plus platysmaplasty.
As for types of platysmaplasty, the Feldman true multilayer corset is most effective in long term band correction, but tends to "anchor" the face and jowls downward, making correction of the jawline and cheeks less effective in those that need it. It is also most painful, and feels most uncomfortably tight for many weeks. Other options include partial (to hyoid) or full (below cricoid) approximation of the platysma with simple, mattressed, or running +/- locking sutures, with or without partial or full transactions. Each had its purpose, and it is important for surgeons to be familiar with all to use the one that fits the patient the best at the time of surgery. I sometimes go in with one plan, and change to another based on tissue behaviour. I occasionally even excise the platysma altogether - nothing to suture! That is still a type of "platysmaplasty" ("reshaping of platysma")

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