My platysmal bands seem more prominent AFTER my lower neck lift including a platysmaplasty. What should I do? (photos)

A neck lift procedure includes tightening of the skin and also a platysmaplasty, which means repairing the platysma muscle in the midline to get rid of platysmal bands. You have prominent platysmal bands and a platysmaplasty should have been part of the operative planning for your neck lift. It doesn't look like you had one. I would discuss your concern with your surgeon. Best!
Pej Aflaki, M.D.
Johns Hopkins-trained plastic surgeon

Thank you for the  sending in your question.   If appears your platysma muscles have separated.  You would require a secondary platysmaplasty which can be done with local anesthetic. 

Any experienced facelift surgeon will appreciate that effective and long term correction of platysmal bands is difficult and often frustrating. It is difficult to know from your photos what procedure you have undergone. Some surgeons will tighten the platysma  using a lateral approach via a facelift incision. Others may use a submental incision ( small scar under the chin) to sew the muscles together in the midline. With either approach persistent bands or early recurrences can be seen.It is also the case that if aggressive liposuction of the neck has been carried out the platysmal bands can become more noticeable post surgery. However,your photos indicate that the platysmal bands are quite strong and it would seem that if you were to pursue this, the bands need to be addressed via a submental approach using a small incision under the chin by sewing the two bands together. Given that the bands are very strong it is usual to divide or transect the platysma muscle to some degree. Some surgeons advocate a partial division of the muscle and some advocate a complete transection of the muscle. I would advise discussing this with your surgeon in the context of the surgery which has already been undertaken. All the best 

Platysma bands are the inside edge of the right and left platysma muscle which are bow stringing at the angle of the neck and the under surface of the chin. Not everybody has these visible bands. They can be more prominent in someone with a center neck strains there neck muscles frequently. When we repair the bands, we are usually repairing just the upper part of the bands, that is, the area in the under surface of the chin and at the angle of the neck and the under surface of the chin. This is most commonly done with sutures and there are several techniques for this. It is normal on the lower portion of the neck for the bands to be prominent in someone with a thin neck who is straining. Botox can help soften this. There is no good surgical solution for prominent bands the lower part of the neck. This bands are persisting or appear to have returned at the first neck and under the chin, it is possible that sutures have pulled through the muscle.  This is not an infrequent finding as muscles do not hold sutures well. Often, when bands are repaired your surgeon will also partially cut the muscle to decrease the tension on the sutures. However this is not a foolproof method. Discuss your concerns with your surgeon and possible options.

I recommend getting a formal evaluation with your Doctor to go over your desired results and concerns. There are non invasive alternatives which can give improvement. These options can help give improvement: thermage/venus legacy and Kybella/Ultherapy. See an expert. Best, Dr. Emer

Thank you for your question and pictures.  There are three components to the neck which may need to be addressed with surgery.  Some patients may just need a neck lift if loose skin is their only problem.  Some patients may need this combined with neck liposuction if they have a little fat and wish to have a L shaped, contoured jawline and neck.  Some patient may need muscle tightening, also known as platysmaplasty, which will require a small incision under the chin away from direct view to gain access to the front edge of the muscles on the neck; they are sutured together with permanent stitches. The muscles of the neck are the foundations and building blocks of the neck and are fundamental to achieving a tight and toned result.  Please consult with your surgeon and see if these can be repaired.  All The Best 

  The platysma bands can be treated with Botox injections, however it is cost prohibitive, and only temporary. A platysma plasty with transection of the bands is performed during a routine face and neck lift procedure. For many examples and more information, please see the link and the video below

Hi lindsey,

Thanks for posting pictures – you did a good job illustrating the problem.

Planning to see your surgeon again is a great idea as well, I’m glad you already have that set up!

What I see in your photo is recurrence of the platysmal bands. In most cases, the platysma is sewn together like a corset. It is possible for these bands to recur even if the surgery was done well.

Your experience with Botox is accurate – a temporary fix. An additional surgery to release the bands and re-do the plication is likely your best chance at a long-term solution. There shouldn’t be any significant “damage” from another surgery, but there is no way to guarantee that the bands will go away permanently. At this point, decisions will be based most on your priorities.

I hope this helps!

 If appears your platysma muscles have separated, if indeed they were addressed.  You would require a secondary platysmaplasty which can be done with local anesthetic.  Discuss this with your surgeon as he is the only one who knows exactly what was done in your surgery.

It is possible that the platysma bands were not repaired were sewn together far enough down in the neck.  However the platysma plasty can only be performed down to about the level of the hyoid bone just above the thyroid cartilage.  Some surgeons deal with this problem by transecting the platysma muscle and a lower level.  However it is best to discuss all of this with your surgeon and follow your surgeon's advice.