Is anterior digastric muscle resection/spot submental lipo safe? (Photos)

Question

9 months after full face/neck lift platysmaplasty/lipo, doctor suggests digastric muscle resection/spot submental lipo. I'm 54 years old. Under chin looks tight down center with bulges on each side/loose skin. Bulges are not firm at all. I think he pulled the skin tight since the scars behind my ears and neck have widened and could feel tugging/pulling for first several months. Do you agree I need spot lipo and Anterior Digastric muscle resection? He says it’s a quick 20 min procedure. Is this safe? Will it solve the problem/loose skin? How to know for sure the problem is with those muscles? If it doesn’t work what’s next?

P. Daniel Ward, MD · Answer

Thanks for your question. I think that a submental approach to your problem is likely to give the best results. However, I do not like the idea of resecting the digastric muscles. I think that a better improvement can be obtained by further tightening of the platysma muscles. I recommend a corset platysmaplasty with removal of excess lateral fat. I would be careful not to excise fat deep to the platysma muscle, which I think might exacerbate the problem.

Farhan Taghizadeh, MD · Answer

Residual neck laxity with continued excess volume and platysmal relaxation can be addressed both surgically or non-surgically.1. Non surgical: In our practice, three technologies can help with residual neck laxity and volume excess. These include using neurotoxin (botox, xeomin, dysport) to weaken the platysma, Kybella injections to melt fat, and radiofrequency treatments to tighten skin and train the neck to sit in a better position. Most practices should be able to offer you some non surgical options to try.2. Surgical: While spot liposuction with laser technology OR digastric resection sounds like good options, in our experience the outcomes are very tenuous at best. The best options in these cases are to wait a year, find a qualified physician, and undergo some type of revision procedure to get a better pull, reset the platysma muscle and then more definitively address the excess volume.Hope this helps.

Ronald J. Edelson, MD · Answer

Further lipo may be of some benefit.  I would probably do direct excision of excess fat through a submental incision.  I would not perform resection of the anterior digastric.  It is unlikely to do anything and places a nerve in the area at unreasonable injury risk.

Robert W. Kessler, MD, FACS · Answer

Thank you for your question and the photos.Anterior digastric muscle resection is a safe operation and can improve the neck contour in the right individuals.The second question is the more difficult one to answer.Your surgeon is clearly willing to work with you and has the advantage of knowing your anatomy first hand.  I do not believe large digastrics are the entire solution to your neck contour. There is more fullness in the neck than a large digastric will create. There is most likely remaining fat to be contoured as well as the possibility of large salivary glands in the area. Despite the widening incisions behind the ear the skin below the neck remains somewhat loose.Good luck and I hope this was helpful

Steve Laverson, MD, FACS · Answer

Excellent question, common problem, no quick answer, and NOT a 20 min procedure, at least in my hands.  Those paramedian bulges may be due to fat beneath loose skin folds or uneven fat resection, "sub-platysmal" fat, contraction of platysmal bands even after platysmaplasty, bulky anterior bellies of digastric, submandibular glands, a combination of the above, or something else. Neck anatomy is complex, variable, and dynamic, i.e. changing with your position and often in motion.    Only your surgeon knows exactly what was done, and he/she has a plan to improve it.

George Sanders, MD · Answer

Thanks for your question. Your situation is not unusual in that many patients who have a well done necklift will have some degree of return of skin looseness in the neck area within a year. A retightening of the skin usually yields a nice improvement, and I think you would benefit from that. As far as excess fat and bulging digastric muscles, diagnosis without examining you is difficult. You may also have some degree of bulging of your submandibular salivary glands that is contributing to your situation, as well as banding of your platysma muscle. If I were you, I would trust your surgeon who is quite familiar with your anatomy and direct your questions toward him. What he is proposing is reasonable if his diagnosis is correct.

William Portuese, MD · Answer

A thorough examination of the neck is required to make a determination about what is causing the bulges. This could be fat, digastric muscle, or platysma muscle. Resection of a portion of the digastric muscle is rather straightforward to perform and should not cause any issues when it is hypertrophied.  Submental liposuction can accomplish removal of fatty deposits in that location.   There could also be fatty deposits underneath the platysma muscle as well. None of this will address loose skin. A lower face and neck lift is required to tighten loose facial and neck skin.

Arian Mowlavi, MD, FACS (license on probation) · Answer

In general I am not a fan of cutting any muscle; what it looks like form your photos is that you have some residual skin redundancy which is best corrected with Renuvion J plasma skin tightening which will avoid more invasive procedure.

Val Lambros, MD, FACS (retired) · Answer

the procedure is safe itself but the issue is whether or not it is the right procedure. I wouldn't second guess your doc since he has actually examined you....but this look like primarily skin to me. The question is how much of the protrusion is submandibular gland. If it is a significant issue, removing digastrics will make it  worse.

Is anterior digastric muscle resection/spot submental lipo safe? (Photos)

Answers (9)

More Facelift Revision Questions

Why can't a facelift be reversed?

When can I work out and smoke marijuana after minor facelift revision?

Lumps and irregularities under my chin 8 months after neck lift and SMAS. (Photos)

For how many weeks should I wear the compression headband after revision face lift? 3 weeks p.o.

What is the type of facelift to use for thin face? Will it improvement to make difference?

Who is the best (preferably in Europe) plastic surgeon for revision facelift: scar and pixie ear correction? (Photo)

WE SEND PRETTY
EMAILS