What is the difference between tightening of the platysmal muscle behind the ear versus under the chin?

I am about to have a lower face lift, and my PS has indicated that my platysmal bands are to widely separated to allow for the usual 'corset' under the chin procedure. He plans to raise the bands and make an incision behind each ear into my hairline (these incision were already there from a previous facelift 10 years ago). Should I worry about how long the results will last? What could happen given this procedure? Thank you in advance for your help with this.

Doctor Answers 9

About Facelift Surgery

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A #facelift is a surgical procedure designed to remove the major folds and wrinkles that form on our faces with age. Gravity, sun damage, smoking, living in a dry climate, and a variety of factors contribute to the aging process of our faces. Facelift techniques vary from patient to patient to give each person a procedure tailored to produce the best possible surgical result. A facelift will smooth out major folds and #wrinkles, #tighten the tissues beneath your skin, remove #sagging and excess skin. A facelift can also reduce excess skin around the #neck and #jawline.  

There is not just one facelift procedure, but a whole range of #facelift procedures. These different techniques have been developed over the years, involving different incisions and lifting the skin to varying degrees. A facelift may also involve the tightening of certain muscles and tissues, or liposuction of areas such as the jowls or chin.

It is important to understand that facelifts are meant to remove major folds and wrinkles, not fine wrinkles. A facelift which removes every line and fold would be too aggressive and would result in an unnatural result. Fine lines and #wrinkles are better addressed by skin treatments such as chemical peels or microdermabrasion, which we also offer at our office. 
Incisions vary depending upon whether the patient is male or female, the hairstyles, hairline, age, previous surgery, and other factors. Generally, the #incision starts in the temple, in front or within the hairline. It continues in front of the ear, sometimes partially hidden within the ear. It then goes under the earlobe, behind the ear fold, and ends within the hairline or at the hairline behind the ear. The newer, shorter scar #techniques, which do not include scars in or by the hairline, can be used for most patients. Frequently another small and hidden incision is made under the chin in a natural skin fold. This allows fat removal and tightening of the platysma muscle in the neck if required.

During your #consultation, your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure will be evaluated. Based on this evaluation, your board certified plastic surgeons will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. In doing so, he or she should be sure to have a full understanding of what results you expect. If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives.

Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Neck Tightening

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Thank you for your question, your plastic surgeon will be able to assess your neck to advise which approach would be needed.  If patients platysmaplasty bands are fairly wide apart, these will need to be stitched together, giving a nice contoured smooth neck, to do this performing the surgery under the chin would be more effective, giving longer lasting results.  Alternatively, some patients may just need the SMAS muscle tighten, to give a smooth neck line, therefore targeting skin which has lost elasticity.  All The Best 


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Sewing the bands together as a platysmaplasty can bring the bands together, however your PS indicated they are too far apart for that.  Reaching out to pull them together can bring you face and neck downward and limit the upward pull of your SMAS tissues.

A lateral approach only can have great results and especially due to the widened nature of your muscle anatomy.

Treatment of the Neck in re-do Facelifts

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In re-do facelifts, it is exceedingly rare to treat the muscles centrally like is occasionally done in primary facelifts. Even in primary facelifts, sewing the muscle together centrally is only needed when there are significant central bands that are not corrected laterally, as most central bands occur from descent of the muscle from above and laterally and reestablishing the lateral ligament returns the muscle to its youthful position. If done properly where the muscle is elevated laterally, it is also unusual to need to open the full incision behind the ear. (See TodaysFacelift.com)

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Platysma muscle tightening in neck/face lift

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It will depend of individual anatomy and configuration of platysma muscle which approach surgeon would select. Most of my patients  have both anterior and posterior platysma muscle tuck. However, if clinical presentation is such that anterior muscle bands are widely separated anterior plication is not possible. In that case complete transection of platysma and posterior (behind the ear) muscle tightening is an option. You should discuss this with your surgeon in more detail since he is the only one who has a benefit of in person  evaluation. Good luck.

Zoran Potparic, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 22 reviews


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In my practice, I usually do both.  Platysmal bands are tightened under the chin as well as on the sides. This will allow for the longest possible longevity of your results.  Good luck with your procedure1

Brian K. Machida, MD, FACS
Ontario Facial Plastic Surgeon
4.1 out of 5 stars 24 reviews

What is the difference between tightening the platysma muscle behind the ear versus under the chin?

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In our practice, the platysma muscle is always tightened underneath the chin as well as behind-the-ear to allow full tightening of the muscle. Tightening it only from behind the ear is an incomplete tightening.  Tightening the platysma muscle underneath the chin allows for a significant improvement in the jawline. For more information and many examples, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Difference between tightening Platysmal muscle and the chin muscle

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Frequently, patients require both, the tightening of the platysmal muscle and the chin.  The tightening of the muscles in midline, is called platysma plasty.  This is generally indicated when patients have significant fullness in their neck.  In some younger patients, tightening from the side is adequate.  However, in older patients, generally tightening both are required for the best results.    

Hope this helps.

Dr. Philip Solomon

Philip Solomon, MD, FRCS
Toronto Facial Plastic Surgeon
4.4 out of 5 stars 118 reviews

Face Lift Platysma muscle bands

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The platysma muscle is a fan like muscle that stretches from the chin and mandible all the way to the collar bone. It fans out laterally to the ears. 

The two approaches allow access to the entire muscle. People often get two prominent (anterior), in the midline, bands that cause an aged and demarcated look. 

In my hands these bands are best treated with the submental (chin) approach. It is difficult to reach this area from behind the ear without having the incision taken into the hairline. 

With the behind the ear approach the muscle is pulled superior (up) and posterior (back). This then flattens out the entire muscle and skin. 

I prefer the combined approach. Discuss this with your surgeon and then you will be able to weigh the pro's and con's of each approach and each risk.

Hope this helps.

Best of luck,


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

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.