Can the platysmaplasty be done without the mid face lift, or should they be done together? (photo)

I have gone to 2 PS to ask about a neck lift, and both focused on my face, suggesting a MACS and if I needed the muscles in the neck tightened, they could that too. Can the platysmaplasty be done without the mid face lift, or should they be done together? And can it be done under local anesthesia? Thanks for listening

Doctor Answers 15

A platysmaplasty can be performed under local anesthesia, and without a mid-facelift, but only for the right candidate

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Hi Lagertha,

A MACS lift is a type of mini-facelift and a modification of the original mini-facelift called the S-lift. The S-lift has a limited incision behind the ear and a longer incision in front of your ear, curving under the sideburn, in front of the ear, then under the earlobe for a couple of centimeters. This is shaped like an S, thus the name S-lift.
For patients who are having a necklift only, the incisions are behind the ear and a 1/2"-1" incision under the chin depending on the surgeon's comfort level on keeping the incision small. I suspect that an S-lift type incision may not do enough to help remove skin for the necklift.

A mid-facelift is not the same as a mini-facelift.  The term midfacelift is actually a term used for a type of cheeklift which is performed endoscopically with an incision in the temple and additional incisions inside the mouth to release the entire cheek off of the cheekbone and reposition it in a higher position.  With as smooth as your cheeks and smile lines are I don't think an endoscopic midfacelift is warranted.   

An extended MACS lift can lift the cheeks a bit, but it is not in the same class as an endoscopic midfacelift.   A MACS lift alone would be considered a mini-facelift, and an extended MACS lift extends the incision in front of the hairline of the sideburn/temple in order to lift the cheek somewhat.  Since there are no obvious signs of upper cheek sagging, I'm not sure if the incision in front of the hairline will provide enough of an improvement to warrant the extended incision. 

The vertical platysmal banding is the main reason for performing a corset platysmaplasty. I have tried depending on the SMAS tightening to treat the which did not work. Any initial improvement in the vertical bands with the tends to fade in about 3-4 months on average with a face tightening alone without using the corset platysmaplasty.

For patients over 45 years old, a lower facelift and a necklift will provide the best results. Why? The incision behind the ear helps to tailor out the excess skin on the neck itself. The incision for the facelift will help smooth out the excess skin which may be excess or hanging under the chin. Without the facelift incision, excess skin under the chin may result in pleating or bunching of skin after the platysmaplasty, because there is no place for it to be tailored out.

Your face looks very smooth, with no obvious smile lines and smooth high cheeks. The lower facelift will help with your mild jowling (sagging of the jawline). Other than that, the facelift will unlikely show much difference on a before and after photo other than the smoother jawline.

As far as the local anesthesia question, I offer a procedure which is called a Necklift plus which is essentially a necklift with a mini-facelift to help tailor out the skin under the chin with the mini-facelift incision. This procedure is a full corset platysmaplasty under local anesthesia, but the lower facelift portion of the procedure is only a mini-facelift with SMAS tightening. I do offer a modified deep-plane sub-SMAS facelift with platysmaplasty, but I can only do that in the Surgery Center with IV sedation or full general anesthesia for the comfort of the patient in the Deep plane portion of the procedure. I am able to perform the corset platysmaplasty through a 1/2" incision under the chin, and with the retractor, and the elasticity of the skin the incision can stretch to about 3/4", which is enough of a keyhole to perform the surgery well.

Of note, to ensure realistic expectations for patients who are seeking face and necklifts, the main goal is to lift and tighten the deeper layers (SMAS and platysma) to create a firm foundation. The skin portion of the procedure is to tailor out any excess skin so none of this skin is "hanging" or "sagging" off of the face and neck. The skin is not "drum tight," but only enough to not let the skin hang. This gives a nice natural result which is not showing any tension lines or windblown look. A face and necklift is a high satisfaction procedure, but cannot make an older neck actually become a younger neck. The skin quality has not changed, any sun damage and other accumulated aging does not get reversed by tightening the foundation and tailoring out excess skin. If the surgeon tries to removed too much skin, new problems can occur, such as a pixie ears, or thicken scars.

Good luck on your face and neck improvement journey.


Dr. Yang

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New York Facial Plastic Surgeon
4.8 out of 5 stars 35 reviews

Plastysmaplasty and necklift

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A plastysmaplasty can be performed with out a mid face lift in the lower neck however  in my experience, they are best done together to create balance and harmony to efface the nasal labial fold and correct the jowl. Best wishes.

Platsmaplasty and necklift

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One  can tighten the anterior playsma alone but would not be recommended if there is any skin laxity in the neck. This could create a new deformity.. If there is some skin laxity as well as platysma laxity then a platysmaplasty and neck lift might be the answer.. Only a consultation and exam can tell for sure what your best options are...

G. Wesley Price, MD
Chevy Chase Plastic Surgeon
4.8 out of 5 stars 10 reviews

Platysmaplasty is most often done alone and under local.

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Platysmaplasty is such a nice easy procedure to undergo under local anesthesia with minimal downtime for roughly $5500. Liposuction of the jawline/neck is always done with the platysmaplasty as part of the procedure to give the best results. Sincerely, David Hansen,MD

David Hansen, MD
Beverly Hills Dermatologic Surgeon
4.7 out of 5 stars 46 reviews

Neck lift

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Certainly a neck lift or platysmaplasty can be done separately by simply changing the vector and amount of tightening if that's all you desire .From the one photo it looks like some early jowls may be starting so doing a little lower facelift at the same time might not be a bad idea , but not mandatory.

Robert Savage, MD (retired)
Wellesley Plastic Surgeon

Platysma plasty with a neck lift or a face/neck lift

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In our practice, we performe a platysma-plasty on all neck lift and face/neck lift patients. If there is excess skin present in the neck, then a face/neck lift will need to be performed. If the skin tone is fine, then a neck lift can be performed. For many examples of both procedures,please see the link below.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Necklift with Platysmaplasty is an Option.

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Thank you for your question.  It is definitely possible to perform a platysmaplasty and necklift independent of a facelift.  Some patients are primarily concerned about loose neck and skin muscles.  In an appropriately counseled patient this procedure can be very gratifying for both patient and doctor.  Consult with another surgeon if you feel that your concerns are not being heard or addressed. Best wishes.

Neck improvement

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Dear Lagertha,
   Thanks for submitting your picture. This is a partial face picture, however your face looks fine to me. What is apparent is the followings :  Small jowls , skin laxity of the neck with fat deposits and platysma bands. All that can be improved dramatically with liposuction of the neck and jowls and platysmorraphy. I do not recommend to do it under local anesthesia because cosmetic surgery should be a pleasant experience to the patient as much as possible . Also, the surgeons can do a much better job when he is not being concerned or disturbed by the discomfort of the patient. Consult only with experienced board certified plastic surgeons who perforn surgery in accredited surgery center for your safety. Most importantly, ask the surgeon to show you before and after pictures to make sure that you like the results.
                      Best of luck,
                                         Dr Widder

Neck rejuvenation can be done without addressing the face

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A platysmaplasty (tightening of the loose neck muscles) can be done as a stand alone procedure.  It does not have to be done with a facelift.  If the neck is your only concern then that is all you should do.  A platysmaplasty is a little difficult for the patient to do under local anesthesia and I prefer to do these in the operating room with anesthesia.

Jason E. Leedy, MD
Cleveland Plastic Surgeon
5.0 out of 5 stars 148 reviews

Facelift and Necklift under local anaesthetic

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Thank you for your question.  Platysmaplasty can be performed on its own for the right candidate.  Patients with tighter skin and not as much skin laxity. I would typically advise most of my patients to combine Facelift and Neck Rejuvenation, as their biggest concerns being their jowls and neck, therefore giving continuity and a well defined contoured appearance.  
I have pioneered my Concept Facelift, which targets the SMAS muscle and skin, therefore giving the same longevity as a traditional facelift, however is performed under local anaesthetic.  This ensures a significantly reduced recovery period, with minimum swelling and bruising, therefore patients returning to their daily routines within 5-7 days. 
Please make sure you find a reputable and qualified plastic surgeon who can assess you properly to give you a realistic idea of what outcome you can achieve.
All The Best 

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