Neck Lift Complication - Submental Scar Tissue Causing Platysmal Rupture. Is This Common?

If no incision was made underneath the chin, your problem is a curious one indeed.

Many patients have a separation of the platysma.  A lift that pulled the platysma apart could worsen that problem.  Fortunately it would likely be improved with a platysmal plication procedure.  There are different plication methods, so there is hope.

If your platysma was cut horizontally, this approach predisposes to showing of the glands below the jawline and hematoma formation.  It can also decrease neck bulk over time.  It can be repaired but requires both a platysmal and facelift incision to repair.

It sounds as though you have had a tough recovery, sorry to hear that.

Fortunately, most complications following neck lift surgery are rare and self-limiting. The most common adverse event following a neck lift, which is not even considered a true complication, is slight asymmetry or under correction. These issues can often be addressed during an additional procedure performed under local anesthesia in an office setting.

More serious complications include blood or fluid collection under the skin that must be drained in the operating room. Rarely, a branch of the facial nerve may be injured during a neck lift, resulting in a temporary weakness of one side of the lower face. If this occurs, facial nerve function usually returns without further intervention in three to six months.

Platysmal muscle banding, inadequate undermining, excessive trauma, persistent fat pads, blood or fluid collections, and other unforseen issues can complicate neck lifts with irregularities and subsurface scarring.  There is great potential to minimize these irregularities by judicious compression and ice packs early after surgery, also massage and thermal wraps in the later post operative period.  I have been impressed with the use of cold lasers for tissue recovery acceleration and pain control.  Unfortunately, some of these irregularities will require revisional surgery that can be safely done after 3 to 6 months after the inflammation of surgical trauma has subsided.  Work closely with your surgeon on your postoperative course to optimize your results.

Hi NoGainWithoutPain in Cambridge, MA,

As you can see, the plastic surgeons here are having difficulty answering your faclift question without photographs & based on the information provided. Platysma rupture is not a term typically used among face lift surgeons. Perhaps, you mean banding which refers to the visible edge of the platysma muscle. Neck banding is commonly seen from natural aging alone.

While a majority of healing after face lift occurs in the first few weeks, there is still some healing that occurs at 3 months. Without an incision under the chin or any direct neck procedures during your face lift, it is unlikely any muscle ruptured. Hematomas (blood clots), bruising, cellulitis, and infection are known facelift complications.

The fact that your are happy with the results in the face suggests that the neck should also improve, once  the inflammation subsides. However, speak with your face lift surgeon regarding any concerns. Best of luck.

Dr. Chaboki

It certainly is possible to have multiple different problems after face or neck lift surgery. Although small hematomas, infection and salivary gland infection are rare, you are the evidence that they can happen in one patient.

I certainly would not jump to the conclusion that this is your surgeon's fault - both of you had rather bad luck.

In terms of rupture of the platysma, I am not quite sure what you are describing. The platysma is a very pliably broad sheet of muscle. If you do not have an incision under the chin, then lifting is usually accomplished from the sides making breakage of the muscle under chin highly unlikely. I would suggest to have your facelift surgeon explain to you how he got to his diagnosis.

A platysma rupture is not a true diagnosis and I can't even imagine what that means. In some instances, plastic surgeons practice complete transection of the platysma muscle. Hematomas tend to occur in patients with hypertension or on antocoagulants.

Complications like hematoma and infection can occur - though rarely.  I'm hopeful that if it's been 3 months and most of the problems have been resolved, that you won't have any more issues that come up.  I'd recommend you stay in close communication with your plastic surgeon so he/she can monitor you and make sure you are healing well.

Dr. Cat Begovic M.D.

Without a submental (under the chin) incision, visibility is limited to the anterior/central part of the neck.  Suture repair, and surgical modification to the submental fat, and muscles in this area would be quite difficult without this incision.  This could explain some of the problems, or not.

Perhaps a second opinion might be in order.  Be sure your doctor is certified by the American Board of Plastic Surgery.

That is why we have the term unforseen events or complications. Just luck of the draw. Sorry. From MIAMI Dr. Darryl J. Blinski

If I might read into this question a bit, it seems that you are really asking, is my surgeon being honest with me?  First off, 3 months out from surgery and still having problems is quite unusual and typically would indicate a technical problem with the surgery.  While it is possible to be "unlucky", being unlucky four times in a row...

The most important part of the relationship between you and your surgeon is trust.  When this is gone, you need a new physician.  At this point, I would recommend getting an opinion from another plastic surgeon in town.  They will likely charge you for the consultation as they did not do the surgery but it will be worth it.  If they concur that the surgery was done correctly, you will have trust in your surgeon again, if not, you will be in the hands of someone that will correct whatever problem exists.