Does the platysma muscle always need tightening? How do you gauge when to do a neck lift or only a lower face lift? (Photo)

In 30 % of my patients, I add a platysmaplasty (tightening of the platysma in the midline) on top of a lateral repositioning. I do this when the midline of the neck is very loose and/or when fat has accumulated between the platysma muscles. The surgery and the recovery are a bit longer than with a lateral modified deep plane face lift, but the result on the neck is worth it. There are a few exemples of patients with platysmaplasty in my before and after photo section. 

I do a platysmaplasty neck tightening on every lower face/neck lift i do and i do them all under local with a little iv sedation for complete comfort and ease. I call them the advanced mini face/neck lifts and the results are totally natural looking and very dramatic.  Hiding the incisions is what I'm noted for as well.

There is no strong scientific answer to your question because the best technique very much depends on the aesthetic outcome preferred by the patient. In your situation, there are no strong platysma muscle bands which would be a significant indication for direct work.

You can get some reasonable orientation regarding your expectations from surgery with a relatively simple test:

If you lie down completely flat and look in the mirror to examine the neck you may find that the contour of the neck is very good or that it has a degree of volume excess which you may like to clear.

If the contour of the neck is very good when you lie down, it increases the likelihood of a good result from a simple lower facelift intervention. There is still a small risk that in the effort of improving the neck too much tension may be applied on the skin which can be followed by the distortion of the earlobes.

If the contour of the neck is slightly full when you lie down, contouring under the chin will be necessary if you want to achieve more definition.

For the placement of the scar round the front of the ear, most of the time the key factor is the attention to detail of the surgeon. It is possible to achieve good results with a variety of placements the scar.