Does everyone experience some degree of choking feeling after a facelift with platysmaplasty tightening?

Question

I went for a facelift consult and was advised I was a candidate. I explained to the doctor I am very claustrophobic and had anxiety when something was tight around my neck. I do not think I could handle the choking feeling that comes with neck lift. She advised my only other option was to have lipo to the neck with facetite. If you only have mild laxity, and only require minimal tightening, will I still experience the choking sensation? I attached a photo of my neck.

Stephen H. Fink, DO, FAOCO · Answer

Hello, 
Thank you for the photos.  My face lift procedure usually includes a platysmaplasty to help obtain the best definition of the neck profile. This causes temporary tightness under the chin but the long term results are worth it in my opinion. Whether I do that part or not,  the dressing combined with some swelling can be uncomfortably firm the first night, but I don't usually hear that it causes choking. Usually it is a relieved when the dressing comes off the next day and then a thinner elastic support garment is  worn for a week.  Perhaps a short term course of some anti-anxiety medication could help but is not routinely advised when you are taking narcotic pain medication. I usually use a compression dressing followed  a support garment after liposuction as well, so I don't know if that will be much better. The results are certainly will not be the same either.

Richard G. Schwartz, MD · Answer

Your photo shows extra skin, fat, and probably loose muscles in the front of your neck.  You also have lower jowl bulges near the jawline.  Either a full facelift, or a lower cheek and necklift would smooth out and better define your neck, jawline, and lower cheeks, creating a more youthful look.  The muscle tightening in the neck creates a "snug" feeling for a week or two.  No one has actually described it as a choking feeling to me.  If your surgeon planned to place "suspension" sutures along the upper neck just below the jaw to add more  long term support, in my past experience, that can create a longer term tighter feeling that could feel like choking for some people, although it eventually does loosen over several weeks.

Jill Hessler, MD · Answer

I would say very few patients feel a true choking sensation after a facelift and platysmaplasty. There is a definite tight feeling of the neck but very few people in my experience feel like they are choking. The area of the lower face and neck can certainly feel tight and numb at the same time which can be an odd feeling. I find this is a short term concern and generally resolves within a few days to weeks for my patients.

Jeffrey Joseph, MD, FACS · Answer

In my practice, with the photo you provided, I would proceed with a lower facelift, including liposuction and platysmaplasty.  However, it really depends on what you’d like to see as an. end result.  Considering the costs, time to recover, and risks, the true measure of success are the results. I’d recommend the facelift!

Vasileios Vasilakis, MD, FACS · Answer

Thank you for your question. Based on your photographs, liposuction and Facetite (or another skin tightening technology) will not provide satisfactory improvement. Tightening of the muscles of your neck can be performed in a way that the pressure is not right over the center of the neck and airway. Also, the tightening itself can be moderate in order to reduce the pressure after surgery. A combination of these approaches, in addition to the right analgesic regimen, as well as close monitoring after surgery, can truly make a difference and allow you to have a full face and neck lift despite your claustrophobia. I wish you the best of luck. Vasileios Vasilakis, MD. Fellowship-trained plastic surgeon.

Brian K. Machida, MD, FACS · Answer

It looks like you have a midline neck band.  Your best result should incorporate a platysmaplasty.  There is an option to decrease discomfort post operatively with Exparel, which is a long term local anesthetic.  Plus exparel decreases the need for post operative pain medication.  We have done many clautrophobic patients in this fashion without a problem and they also get the optimal treatment for their condition.

John L. Burns Jr., MD · Answer

Your facelift can be done without a corset platysmaplasty,  Simply removing the excess neck skin would give you significant improvement.

Bruce K. Smith, MD · Answer

Not everyone feels that they are choking after a face and neck lift. When aggressive tightening of the platysma muscle is required, some people will complain of uncomfortable tightness in the neck for a short period of time. There is a technique for tightening the playsma muscle which uses a suture under the skin (popularized by Dr. Giampapa) which causes a choking sensation for a few days in a high percentage of patients, but only a few plastic surgeons use this technique now. You appear to be an excellent candidate for face and neck lift. I would not let your claustrophobia discourage you from having this surgery.

Patrick Flaharty, MD FAACS · Answer

Based on your photograph and concerns I would recommend a lower face and neck lift from the posterior approach and neck liposuction. This would avoid the anterior tightening of the platysma muscle which might make your anterior neck feel tight postoperatively. This posterior approach lower face and neck lift combined with liposuction works great for most patients with excellent, long lasting results. You will experience some tightness of the posterior neck and around the ears but this limits the tightness of the anterior neck beneath the chin while still achieving excellent results. Consulting with a surgeon experienced in this face and neck lift technique would be a great way to learn more about this option.

William Portuese, MD · Answer

Most patients do feel like they have a tight chinstrap underneath their neck for the first few weeks after a face and neck lift with a platysma plasty procedure. If you're severely claustrophobic, then you can simply skip the platysma plasty itself in the front of the neck.

Does everyone experience some degree of choking feeling after a facelift with platysmaplasty tightening?

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