Mid-Thirties, neck bands: would submentoplasty work? Do I have to worry abount bunching? How long will the results last? (Photo)

Hi Me_Me_Me_,

Typically the vertical muscle bands (platysmal band formed by the front edge of the platysma muscle) do not form on younger patients at rest, meaning they should not be visible unless you are actively contracting these muscles.  How can people contract the platysma muscle?  You can clench your jaw while trying to show your lower teeth by retracting the lower lip.  This should strongly contract the platysma muscle.  If you form these muscle cords from active contraction, then it makes sense to botox them to relax the muscles.

In the case of younger people who do form these vertical muscle cords early in life, there seems to be some kind of weight gain causing excess fat and possibly a double chin, then some kind of subsequent fat loss.  This could be from diet and exercise, weight loss surgery, liposuction under the chin (submental liposuction) or more recently, the non-surgical skin tightening treatments such as Thermage or Ultherapy.  These non-surgical skin tightening treatments are sold as non-surgical facelifts and non-surgical necklifts, but to my eye, it is fat reduction of the jawline and submental area.  The profile improvement is mainly due to the loss of fat, similar to liposuction of the jawline or submental area.  The skin is not hanging with liposuction of these areas, but I am not clear how much actual "skin-tightening" is achieved in comparison the skin contraction which occurs with liposuction alone.

The reason the platysma bands form, is that the platysma muscle is a thin sheet of muscle that lines the front of the neck.  When there is excess fat under the platysma muscle, the platysma muscle become irreversibly stretched.  After the weight loss, liposuction or deep non-surgical energy treatments directed deep under the skin, the fat under the platysma is reduced which causes the platysma muscle to be loose and this causes the vertical cords to form.

I noticed that you posted photo of your neck while laying flat on your back (which is also called supine).  Note that the front of your neck is smooth.  The platysma muscle is on a sliding plane which can slide over the other anatomic structures of your neck.  This is why when you lay back, the platysma muscle slides back flush to your deep neck structures, and along with the neck skin on the front of the neck.

Some surgeons will advocate a lateral necklift instead of a submentoplasty, while my general philosophy is that submentoplasty using a corset platysmaplasty consistently provides sharper profile and long term durability.  The lateral necklift involves incisions behind the ear and none under the chin.  The goal is to "grab" the outer edge of the platysma muscle and anchor the outer edge of the platysma to the tough tissue behind the ears (mastoid fascia.)  In 2006, I tried many, many times to make this technique work, but after about 3-6 months, the neck profile would return to very close to the original profile.  If there were platysmal bands, the initial improvement with the lateral necklift would also return.

Understanding why the platysma band form help make sense of why the corset platysmaplasty works.  When people develop the double chin, the fat that stretches the platysma muscle is on the front of the neck and not really stretching the fat behind the ears or very much on the sides of the neck.  Imagine a frog or toad puffing out the front of his chin.  This stretching of the front of the platysma muscle fibers with the fat under the platysma muscle will cause the fibers to come apart and make the normally tight layer of platysma fibers to be stretched and thinned out.  Pulling the thicker platysma muscle on the sides will temporarily pull back the vertical cords, but there is a slippage factor to the lateral platysmaplasty which is not talked about, but this causes the neck to "fall" and lose the profile.  

The corset platysmaplasty will identify the front edges of the platysma and sew them together and additionally tighten the platysma muscle fibers to form tighter "corset" or muscle girdle under the skin which the skin will take its shape.  When the patient is laying on their back the front of the neck looks great, but when they are standing vertically, the platysma muscle slides forward.  The platysmaplasty essentially pulls the platysma forward while the patient is laying on their back which prevents the platysma from sliding back and forth.  It "locks" the platysma in the forward position.  Then the skin under the chin is completely freed up, and slide backwards.   A compression is placed under the chin to have the skin heal in the normal position while the platysma is in the "locked forward" position.  This way, when the patient is vertical the skin cannot slide forward any more to form the platysmal bands, and does not slide back when the patient is laying on their back.  A young persons neck is smooth whether they are upright or laying on their back, which is what I am trying to achieve.

For the best results, some skin removal me optimize the tightness of the skin under the chin and neck.  This may involve incisions behind the ears only, which would be called a necklift (submentoplasty plus incisions behind the ear to remove some skin.  In this case, the skin under the chin as well as behind the ears is freed up.  The platysma muscle is sutured forward using the corset platysmaplasty, locking it in place under the chin, while the "looser" skin under the chin and neck is slid backwards behind the ears, which helps to further offset the original skin and platysma.  If we picked a spot at the angle of the jaw, platysma muscle may be pulled forward 1/2" while the skin is advanced backwards 1/2" but this results in a full 1" of change is location of the skin.  This locking in method helps prevent the foward and backward sliding of the stretched platysma.

For older patients with significant loose skin "hanging down" directly under their chin in addition to platysma bands or possibly a turkey wattle, will benefit from a lower facelift in addition to the submentoplasty and necklift incision behind the ears.  The incisions for a lower facelift goes in front of the ears and in order to tailor out loose skin under the chin, it makes sense to pull the skin vertically upwards in front of the ears to help work the excess loose skin under the chin.

In general, face and necklifts will last 5-10 years depending on a variety of factors, age, sun exposure, the patients weight status, and whether they are gaining weight and/or losing weight.  Gaining weight will again stretch out some of the platysma muscle fibers to form a new double chin, and weight loss could in theory reform these muscle bands.  If your weight is very stable and you watch sun exposure, and since you are younger, then the submentoplasty should last on the longer end of the 5-10 years.

From a preventative standpoint, the platysma muscle can be tightened, but if the skin is "too stretched out" then skin removal to get the optimal result may become necessary.  A submentoplasty on a younger patient while their skin is still able to contract, may be able to help avoid the necklift incisions behind the ears or if the patient lets the cords really stretch the skin out under the chin, then the facelift incision in front of the ears may become unavoidable to rejuvenate the neck.

I hope this makes some sense.  Good luck on your neck rejuvenation journey.

Best,

Dr. Yang

P.S. There is a new feature on Realself, which is the "Follow" button. It is similar to the "Like" button on Facebook. If you like my response or any of the doctor responses while you research on Realself, you should "Follow" them. You will get email updates, when the doctors you follow post any new answers to questions, post new photos, or have any new reviews.

From your photos it appears that you have platysma neck bands. If that is the case and not just loose skin, then submentoplasty with platysma muscle tightening would be a very good option for you. This is often done in the office through a small incision just below the chin.

Hi there,


I have some questions for you: 
1. Have you had anything done before to the area?  ie lipo, or mesotherapy? From your pix it looks as though there may have been some previous fat removal. This may have left irregularity and deep scar. 
2. Have you had a significant weight loss?

To answer your query, it's all about the skin, its elasticity, and having a smooth and thin layer of fat under the skin.  At your age, it is possible to do a submentoplasty where the platysma is centrally plicated to correct the bands, with or without a lower transverse platysma division.
But the overlying skin must be elastic enough to redrape smoothly, and some subcutaneous fat must be present to allow a smooth gliding or mobile layer over the muscle.  IF this is not present, a posterior or lateral neck lift may also be necessary for a good result.

It is definitely worthwhile for you to seek consultation with excellent plastic surgeons in your area. It is very likely this can be corrected surgically, and I don't think it can be done non surgically.

All the very best

Howard Webster

 It is important to know whether or not these neck bands are present at rest, or with animation.  Botox is a excellent way to get started but it appears that that has failed. If there are present at rest, then a  platysma plasty procedure can help. This would involve suturing the platysmal bands together from the hyoid bone to the chin. Transection of the bands down at the level of the cricoid would help prevent them from re-occurring. Bunching of the bands is not an issue when properly performed.

Thanks for the question. Neck bands can be troubling and I understand your concerns with their appearance. There is no one clear solution to the banding and therefore you will find a number of surgeons adopting different approaches. You mentioned that you had tried botox on one occasion. As a first step you should clarify the dose that was used and perhaps try a second round of injections at a higher dose to see if the results are satisfactory. Surgery is a more definitive way to deal with the bands but recurrence can be an issue. Your options include (1) an anterior approach with an incision under the chin, platysmal plication and ligation if required (2) a posterior (facelift incision) approach with elevation and resuspension of the platysma or (3) a combination of the above two. Given your age the final decision will be based on your surgeons preferences, your expectations and balancing the benefits and negatives with each approach. Good luck
Regards
Dr Guy Watts

Based on your photos a neck lift procedure done with one incision beneath the chin may be great for you.  Please speak to a board certified plastic surgeon about your concerns to get the best options for you. Best of luck to you..