Corset platysmaplasty and choking phobia. (Photo)

I recommend following up with your Doctor to go over your intended procedure and concerns. There are non invasive alternatives which can give improvement. These options can help with jawline contouring: implants, fat, fillers, ThermiRF, Thermage and ultherapy for skin tightening with PDO Nova threads for lifting. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Thank you for your question. You submitted a single photo focused on your neck from the front view, stating your surgeon recommends a corset platysmaplasty. You’re concerned about your choking phobia, so are wary of the perception of tightness and a choking feeling after platysmaplasty. You’re also asking if this procedure is done typically under general or local anesthesia, and if it’s safe to have this done with a nurse anesthetist as opposed to a medical doctor or an anesthesiologist.
I can share with you my personal approach in helping my patients understand the pros and cons of both the surgical approach, and the type of sedation that’s optimal. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Helping people with aging neck and improving the appearance of their neck and face are significant parts of my practice over 20 years, with continuous evolution of this very challenging area, which is reflective of the many different elements it takes to try to get the best result possible for an individual patient.
Let’s understand a little about the purpose of a corset platysmaplasty. Generally in my practice, I rarely do a corset platysmaplasty as an isolated procedure. The reason is the goal is to improve neck contour by defining the area between the chin and the neck angle, as well as the overall sharpness of the side view of the neck. However, generally at the same time, there’s laxity and sagging of the facial tissue which is often done in conjunction with a facelift. If there is a significant amount of extra skin, then it’s also done with a combination of a face and neck lifting procedure. Using that terminology, there are many ways to do all those procedures.
Specifically, there is a challenge of helping people with the platysmal bands, which is generally one of the indications of corset platysmaplasty. Whether you’re using different types of suture material and the techniques to close the platysma which is divided, various types of maneuvers to maximize the result, there is the possibility of a tight feeling. It’s very rare for someone to feel like they’re choking, but it is certainly possible to feel a tightness. You can discuss this with your doctor so they can share with you their experience in what they generally find.
One of the things to understand is even though things are done very tightly during surgery, the tissue has a natural relaxation. That means the muscles and skin stretch a bit. With time, there is an equilibrium that settles out, so things that are maybe tight in the beginning tend to stretch a little with just facial movement and tissue elasticity.
Of the things to discuss is whether or not it’s indicated to have another procedure in addition to just the corset platysmaplasty, whether it’s facelift, or face and neck lift. As a side note, if you look at the plastic surgery literature, to this day, and almost every year, there are significant numbers of journal articles about the best way to do face lifting, neck lifting, and platysmaplasty. It may not be the best ways, but new ways, which as I said earlier, is reflective of the certain limitation of working with the human body, and what is done in surgery ultimately settles out over time.
As far as general anesthesia versus local, and local with sedation, in my practice, we use  something called LITE™ anesthesia which is local anesthetic to make the area numb like a dentist, also with LITE™ intravenous sedation. We generally avoid general anesthesia. This is something that has worked out very well for me in my practice. I avoid the many risks and challenges of general anesthesia. My patients are very comfortable, and get up and walk away without having any of the side-effects after using general anesthesia. It’s really the surgeon’s preference as many surgeons prefer general anesthesia versus local and sedation, and they have their reasons, so this is something you should discuss with your doctor.
As far as a nurse anesthetist versus an anesthesiologist, again it’s important to discuss this with your surgeon. Every surgeon who has their own facility like us have their own preferences. In our practice, our operating facilities are certified by the Joint Commission, and the staff I work with who are very comfortable with me and the way I do my surgeries. I think it works both ways. A surgeon can work very comfortably with an anesthesia provider whether it’s a nurse anesthetist or anesthesiologist. So if your surgeon feels comfortable, then I it’s reasonable for you to feel comfortable. I think there shouldn't be any particular bias based on this particular qualification. I think experience is critically important, and depending on the relative risk of complications related to anesthesia, that’s also an important factor to understand. If I feel someone is not a patient I would feel comfortable with operating in my office facility, then I’ll either bring them to a surgery center or hospital, or I’ll just not do the surgery. Discuss this with your doctor since your medical history is not included in your question. I hope that was helpful, I wish you the best of luck and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.