Why do surgeons disagree on the best treatment for platysmal bands? And why not excision? (Photos)

Im 40, fitness model, bf under 10% w/ prominent platysmal bands, lax skin- I'm ready for a necklift with a lower/full facelift. However, in every neck lift photo there's a bit of loose skin left- a "natural look" ?? I want a TIGHT neck and if the result is that my face looks 40 yrs old and my neck looks 20, I'm ok with that... Is this "Natural look" the reason why neck lift revisions are so common? I've included unfortunate photos and thank you very much for your time.

Doctor Answers 20

Platysmal Bands - Why All of the Confusion?

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Surgeons treat platysmal bands in different ways for several reasons.

  1. The most effective treatment for bands in the middle of the neck is sewing them together and possibly cutting them down low in the neck. This requires lifting the skin off of the entire neck, followed by the use of drains and a two week recovery. Many people don’t want the expense, drains, and length of recovery this requires. They opt for other and less effective ways of dealing with the bands. Short scar facelifts pull on the bands from the side without lifting the skin off of the front of the neck. No drains, less expense, shorter recovery, but in most cases a lesser result.

2. Other patients have bands on the sides of their necks, usually in patients with a low body fat. Sewing the bands together in the front of the neck does not solve that problem. Botox, however, may be of benefit.

3. As far as excision of the bands in the front of the neck, that just leaves you with bands further apart.

You asked why neck skin is sometimes a bit loose after a necklift? The answer has to do with less than excellent skin laxity. The skin is tight right after the lift, but it loosens with time. In some patients with poor skin elasticity, it may loosen very quickly. You might think that pulling the skin tighter at surgery is the answer, but that will distort the ear, produce widened scars, and in some cases lead to skin death.

If the amount of loose skin is excessive after surgery, a 2nd necklift after 6-12 months can be done and the results from this are usually longer lasting.

I hope this answers your excellent questions!

Los Angeles Plastic Surgeon
4.9 out of 5 stars 13 reviews

Neck laxity, whats the best correction?

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Hi LatoLA,

Thanks for your question and your photos. You are correct that there is no one way to fix the neck skin the best. Platysma bands are one of the most challenging things we can six in plastic surgery because it's a muscle that constantly moves. Some people sew them, some people pull them, some people paralyzed, and some cut but at the end they all have their pros and cons to each treatment. The best treatment will be based on your anatomy and what your board-certified plastic surgeon fields is the best way to address the issue. I Recommend several consultations to see what is in your best interest. A natural results can be achieved with a tight neck. I do not see any jowling which requires you to have a lower facelift. I would recommend something minimally invasive like thermiaes, and thermitight to get improved results without surgery. good luck

All the best,

Carlos Mata MD, MBA, FACS

Board certified plastic surgeon



Carlos Mata, MD, MBA, FACS
Scottsdale Plastic Surgeon
5.0 out of 5 stars 38 reviews

Why do surgeons disagree on the best treatment for platysmal bands? = because there is no best solution #necklift #playtsmabands

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Platysma band are usually corrected with neck lift. Sometimes they can be temporarily corrected with Botox treatment. Percutaneous transection of the platysma band also could improve it. 

The reason why surgeons disagree on the "best" treatment for platysma bands corrections is because there is no a single procedure that "fits all". Therefore, the "best" treatment for a patient's platysma bands (eg. fitness model)  might not be the "best" treatment for another patient (eg. old lady in the 60s)

John Mesa, MD
New York Plastic Surgeon
4.9 out of 5 stars 141 reviews

Surgeon's will agree on what is best for platysmal bands

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BUT depending on what the patient's goals are, there are a long list of things that could be done for the bands short of the neck lift/corset platysmaplasty.  You have to tell your surgeon what scars, risks, and costs you're willing to absorb to have your problem addressed.  Then a plan is customized to your anatomy and needs.  At your age, would probably just suggest Botox but then there are other effective, less invasive procedures as well.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Corset platysmaplasty done after backward pull

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there are many options for platysma bands.  I have a large number of patients who have a low amount of body fat, and have worked with excision of the bands, transection of the bands, suture fixations, and the like.  Nothing will absolutely avoid recurrence.  My best results with a great percentage of success are to do the posterior platysma pull first and the facelift (which is more detailed than this answer allows) in a backward direction, and then perform the the corset secondarily.  This is more difficult, as things are tighter, but allows a greater amount of backward pull on the neck without making the facelift appear un-natural. I also like to paralyze the bands prior to operation with botox for a "splinting" effect.

Gregory S. Keller, MD, FACS
Santa Barbara Facial Plastic Surgeon
4.9 out of 5 stars 15 reviews

Facelift Necklift Candidate

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Dear LA to LA, There are different ways to address laxity in the face and neck and platysma bands and the reasons that these differ is that each surgical plan is designed uniquely for the patient taking into consideration their facial anatomy. A consultation with in office examination will best determine a course of action that will provide you the results you are looking for. A natural looking result does not necessarily mean that you will have loose skin it means that you will not have any visible signs of the procedure (incisions) from pulling to tight or an unnatural appearance from pulling in the wrong direction. Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 218 reviews

Neck Skin and Platysmal Bands -- VASER Hi Def Liposuction/ThermiRF/ThermiTight, Venus Legacy/Thermage/Ultherapy, Botox/Dysport

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there is no cure for this but surgery, unless you want to try botox non invasively with or without thermirase. I suggest seeing an expert.  Best, Dr. Eemr.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Platysmal bands

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It isn't uncommon for some return of some laxity under the chin after a neck lift.  A deeper plain lift with complete transection of the platysmal bands would be your best choice to minimize it.  Seek out a double-boarded surgeon for a consult.  Best wishes.

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 18 reviews

Platysmal bands

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As surgeons continue to answer this question you will see a multitude of different answers with a few common themes, that is because there are multiple ways to approach this issue, and and everybody's platysmal bands are different.

Platysmal bands themselves are easy to address, from tightening to cutting them out, there are multiple effective ways approach them. The limiting factor with you is going to be your skin laxity. As we damage our skin with aging, sun exposure and environmental exposure, you can stretch it as much as you want and it will continue to relax and re-stretch no matter how tight it is draped, which has other issues with the quality of your lift. 

For this reason, I almost always combine a lift with a resurfacing procedure in patients with lax skin. This resurfacing can be an ablative, fractional laser or non-ablative, dependent on needs, but often with the downtime that you will be experiencing from your lift it is best to just pair it with an ablative fractional laser for the best results. This is the only way that you will address the major underlying limiting factor of skin quality, and for you without any subcutaneous fat to cushion the look of your underlying neck, your skin quality becomes especially important to hide any contour underneath. 

To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.

Cameron Chesnut
#realself500 Physician

Cameron Chesnut, MD, FAAD, FACMS
Spokane Dermatologic Surgeon
4.9 out of 5 stars 123 reviews

Platysmal bands

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The "natural look" is avoiding an abnormal, artificial appearance in any type of aesthetic procedure.  It does not imply a minimal improvement, or suboptimal treatment.  A tight contour in the neck is very compatible with a "natural" result.  In your case, based on your photographs, a "sub-mental" neck lift with a wedge excision of the bands, and skin tightening plus muscle plication all done through an incision in the natural crease below the chin should give you the improvement you desire.  You do not need a chin implant, which would give an "unnatural" look.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.