How to fix deformed platysma bands? (photos)

Question

I'm a 27 year old trans woman looking at removing my platysma bands as they are disproportionately shaped. They create an unflattering and unfeminine neck structure. I dont want to tighten or relax them, but actually remove them. I have some laxity and minimal submental fat. What procedure will achieve this?

Michele A. Shermak, MD · Answer

Hello and thank you for this nuanced question!
Neck contour is the result of chin projection, fat under the chin and the underlying structures including the platysma muscle. The platysma is a thin sheet of muscle under the fat that can separate in the midline and this is seen with weight loss, aging, and as the result of genetics.
In your case, I do think fat reduction would be helpful in optimizing your neck contour. The fat you carry in the neck is asymmetrical and blunting your neck angle. Platysma banding can be dealt with at that time, and this is a necklift. The bands are not removed, as they are part of the overall muscle - the bands are the more thickened central areas of the muscles that are symmetrical and look most aesthetic without space between the 2 sides. The bands may be sutured together in the midline in conjunction with fat removal, and then the lower part of the band is cut to break the band. Removing the muscle band will remove too much volume and will create an overly thinned, scarred look which will be really hard to correct.
I wish you the best of luck! Happy new year!

Jason Emer, MD · Answer

your anatomy really needs chin/jaw implant and neck liposuction with neck lifting to get an improved contour. you do not need your platysmal bands removed.
 
if you want a dramatic change necklift/facelift, Implants and fillers will give you that on the neck and jawline contouring and tightening of the neck contour . noninvasive may  improve the area and slow down the aging process with  facetite or renuvion as an office procedure with liposuction or without downtime PDO or instalift threads, morpheus or pixel8 deep microneedling RF , and botox/dysport/xeomin to stop muscle movement of the platysma bands and fillers for jawline contouring and chin.  We also use diluated fillers or sculptra on the neck to improve collagen production like belotero and hyperdilute radiesse .
 
start at home dermarolling to tighten you r skin, see emeragecismetics where we do free skincare consults daily and recommend emerageskin roller with anteageMD ampules daily ( see link).  Peels like cosmelan or enlighten give more dramatic at home results in 7-10 days, for less downtime you can do EMERAGE SKIN AERIFY every 2 weeks overnight and get tightening and improvement in lines and discoloration. 
 
With significant neck sagging you would need a neck/face lift with muscle tightening (platysmaplasty). at the same time lasers (fraxel,  co2 or halo) or microneedling RF (fractora, morpheus, pixel8 ) can be performed to improve the crepe skin or wrinkles and combined together for best outcomes.  
 
 You need a formal consultation, as the neck can be treated with a combination approach:
1. micro needling and MNRF and lasers for texture
2. botox, disport or xeomin to help platysmal bands and chin crepiness 
3. intensif , fractora , morpheus, pixel8 MN RF for crepe skin and lifting and tightening 
4. fillers like belotero, restylane silk, juvederm volbella , and hyperdilute radiesse  to improve lines and folds and collagen production 
5. neck/face lifting if sagging is prominent or early starting +/- platysmaplasty (muscle tightening)
6. J plasma/Renuvion, thermiRF, inmode facetite for internal tightening with liposuction 
7. ultherapy and thermage for external tightening
8. regular radiofrequency facials like Venus legacy, exilis ultra, or inmode forma treatments with facials to maintain tightness (recommend twice monthly) 
9. PDO novathreads or silhouette instalift cone threads for lifting and long-term collagen production
 
See an expert for a full evaluation and treatment plan based on your individual situation and goals.
Best, Dr. Emer

George Yang, MD · Answer

Hi, I see what you did with your pictures. The first photo your face and neck is relaxed, and the submental contour appears more symmetric. In the latter two photos you are clenching to activate your platysma muscles. This causes your right platysma muscle to protrude more than your left one. It also makes your submental fat appear to bulge more on the right than the left. Yet when you are relaxed, the submental fat does not look as much as in the clenching photos, which indicates that your subcutaneous, submental fat is not as much as it appears in the latter two photos.
Your assessment of some laxity and minimal submental fat appears to be a reasonable assessment. I suspect that you have "Subplatysmal fat" which is a more fibrous fat which is not as easily liposuctioned as subcutaneous fat, which is more buttery and easy to suction. When performing a corset platysmaplasty, the submental fat is examined. Usually people with blunted chin-neck angle AKA Cervicomental Angle (google image that term), have a small wad of subplatysmal fat which is preventing the platysma and skin from hugging the deeper anatomy to give a more defined cervicomental angle. A significant amount of this deeper fat can be manually shaved down to create a nicer profile. However, after the subplatsmal fat contouring if the two platysmal bands are sutured together, this can leave an empty spot in the center and have 2 separate platysmal bands hanging from both sides which is an older look. For this reason, with the submentoplasty, I try to rejoin the left and right platysmal bands after the subplatysmal fat reduction to close the space where the fat was removed, using the corst platysmaplasty technique. For patients under 35 years old, I am okay with allowing the younger skin to naturally contract, as we might do with submental liposuction. The only difference is that instead of only reducing subcutaneous fat, we are manipulating the platysma and deeper subplatysmal fat +/- some conservative subcutaneous liposuction.Radiofrequency technology is unlikely to tighten the platysma, or reach the subplatysmal fat. Hope that helps. Best, Dr. Yang

Brian K. Machida, MD, FACS · Answer

You seem to have asymmetric fullness in the right submental area.  It is not a deformed platysmal band. I might be missing some information in your history, like how long has it been this way and was there any previous surgery.   You need an examination to determine the depth of this fullness.  If it feels like its above the platysma, it could represent a lipoma.  If it's below the platysma, it could represent enlarged salivary glands, or enlarged lymph nodes with a myriad of etiologies, some of which may be serious.  Before jumping into liposuction, thermitight, or necklift, its best to have this looked at first.  If you've already done due diligence, then that's great.  If this is a postsurgical problem, the solution is usually a bit more complicated than liposuction and thermitight.

Tanveer Janjua, MD · Answer

Chin Liposuction and Thermitight
Chin liposuction helps reduce the bulge under the chin and can be done for the whole neck. Once the fat is removed the skin can become loose and saggy in some cases. It can be avoided by combining it with Thermitight which is a radiofrequency heat delivered under the skin to tighten it. Both chin liposuction and Thermitight can be done at the same time. The recovery is fast and it can be done under local anesthesia.
Click on the video link below
Regards
Dr. J

Zoran Potparic, MD · Answer

It would be very difficult to decide how much of anterior neck fulness is due to a superficial and deep fat and how much of that are platysma muscle bands, without in person evaluation. It is also a possibility that you have a mass of unknown origin? With all of this said, you seem to be a candidate for anterior neck lift. In person consultation with a board certified plastic surgeon is recommended. Good luck.

How to fix deformed platysma bands? (photos)

Answers (6)

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