I Second Platysmaplasty Done and I Still Have Prominent Banding, What Can I Do?

Hi Danielle1231,

Very strong platysmal bands ( the vertical muscle bands of the neck) can be difficult to treat.  For people who are reading along, who don't understand what neck muscle bands are referring to the edge of the muscle in the neck (the platysma muscle) tents through the skin like a clotheline hidden under a bedsheet.  As you pull the clothesline tight, the bedsheet appears to have a band running through it.  In my experience, patients who have muscle bands which protrude actively while talking or making facial expressions, can have remaining muscle bands showing after a platysmaplasty.  When the patient is relaxed and not talking, or smiling, the platysmal muscle band appears flatter, and not prominent.  However, since most people are animated when having a conversation with another person, the patients who have prominent muscle bands will complain that their muscle bands are not flattened enough.

The platysmaplasty will help to tighten the platysma muscle directly under the chin, to create a longer distance from the tip of the chin to the beginning of the neck.  If the platysma muscle is simply hanging down passively the platysma muscle band can lay flat against the neck.  For patients with prominent muscle bands which actively contract, I warn them prior to the necklift that they may have some residual muscle bands showing.  In order for the muscle band not to affect the profile of the neck. I routinely make a cut into the platysma muscle band where the corset platysmaplasty stitches end.  I will cut between 1/2 -3/4" into the muscle and try to remove a small triangle of the muscle, to prevent the muscle from healing itself together.

If I perform this backcut into the edge of the platysma muscle it helps to flatten out the platysma muscle band towards the center of the neck, but if the patient's platysma muscle is extremely strong, a new band may form away from the center of the neck towards where the cut edge of the platysma muscle ends.  In essence the new edge of the platysma muscle is where the muscle is continuous from the tip of the chin to the collar bone.  Using the clothesline and bedsheet analogy, it would be like cutting the clothesline, and the bedsheet will flatten out since it is no longer tethered on the clothesline.

There are more aggressive methods of cutting the platysma muscle of 1-2", however, I have not needed to do this on my patients.  It seems to be much more aggressive modification of normal anatomy, as opposed to a 1/2-3/4" notch on the muscle edge.  Not every patient would benefit from this kind of platysma muscle transection or cutting, but perhaps you may be the exception.  

One other method, to consider is the Giampappa stitch.  I have use this in the past for patients with difficult, heavy necks.  It uses a permanent suture or thread similar to fishing line, which goes from the back of one ear to the back of the other ear.  Because this suture is permanent, it could potentially help flatten out the platysmal muscle band from actively protruding out.  I'm not sure if the GIampappa stitch is designed to treat strong platysma muscle bands, but if I had a patient with strong muscle bands, I would likely perform a longer notch on the edge of the platysma muscle and add the Giamapappa stitch for treatment of the muscle bands.  In layman's terms, it would be like wearing both a "belt and suspenders" to hold up the pants.  Each method backs up the other.

I hope this explanation helps.

Best,

Dr. Yang

It is very difficult to answer your question without seeing your pictures – you should consider posting images showing your areas of concern.  Having said that you may need additional platysmal resection or myotomy

Recurrent bands after platysmaplasty is a complication that can happen when the scar from the surgery forms around the band even after a secondary surgery. I would need to see it to determine what type of surgery can be used if any to fix this. I don't think Botox helps this problem.

Botox works in the short term, but its effects can be pretty minor.  Although we all use it for platysmal bands, keep expectations conservative.

I would suggest you look at your persistent bands from two points of view.  One is technical, in that it is likely that another surgery could help.  Surgeons by their very nature are confident in their skills, so most of them would suggest that something more aggressive or different in technique would finally conquer those bands.  Muscle back cuts, or full division, or partial resection of redundancy might all be suggested.  The best technique for you depends on what is seen in person, and what procedure works best in each surgeon's hands.

The second consideration is strictly logical.  By the description of your incisions, it sounds like your surgeon did something to your bands on two occassions.  It may in fact be that he/she did any and all of those steps outlined above, and did them correctly.  And yet that still did not work despite two attempts.  It really may be that additional surgery will just repeat history.

There is no way to know what is the "right" answer.  My suggestion to you is get a second opinion by someone with a strong facial rejuvenation experience and reputation, and realize that a third surgery if suggested might not work.  And be prepared for a conventional facelift approach/cost/recovery instead of just a touch up.

Without seeing either a photo or having a physical exam, it is very hard to give you specific information.  That said, it is unlikely that nothing else can be done.  A revision, through your same incisions, with either further platysmal tightening from the sides and under the chin, or dividing of the platysma should help.  Botox may relax the banding but is temporary.  Another opinion may be of help to you.  Be sure to see a board certified plastic surgeon.