Had a platysmaplasty 1.5 years ago, and a revision 1 year after. Still have a lot of sagging skin and uneven (Photo)

Hello, hope you are well. Thank you for posting your information and photos. I presume you want to know the best course of action. The most effective way of managing the excess skin is a surgical neck lift with incisions concealed behind the ears. I will also pre-emptively advise you that radiofrequency, plasma, and other energy-based devices will not work.

Best,
Dr. Tower

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars.

Best,
Dr. Karamanoukian
Realself100 Surgeon

The platysma muscle is a rectangular muscle that extends from above the jaw line down over the clavicle. The front edge forms the band in the front of the neck, and often times there are several other bands extending towards the back. Fortunately this muscle is an evolutionary remnant, and does not turn the heard. Unfortunately some of the fibers can move the lower lip. Every surgeon has seen the bands come back despite suturing them together or excising them. It is important when you exercise to have good form, if you are doing sit ups or lifting weights and pulling on the neck, guess what you are strengthening the playsma muscle. Botox is a great treatment to relax the bands. If you have an element of loose skin you could think about facetight, to help shrink the skin.

Thank you for your inquiry and for sharing your photographs.

In general, I have noticed that the skin laxity situated in the upper part of the neck, just under the chin, is better addressed through a vertical vector of tension rather than an oblique one. This corresponds to the vector of change achieved with a deep plane facelift more than with a neck lift.

The platysmaplasty may have suitably addressed the platysma bands, but skin laxity is a different issue. This is one element you may want to consider.

The platysmaplasty is commonly done in combination with a neck lift. If the neck skin is not lifted and the platysmaplasty is done to tighten the muscle the skin will "tent" up. You can try a "face roller' on the skin but probably won't work. You should ask your Plastic Surgeon for their recommendation.

It appears you need a third full open neck lift to remove the excess skin in that area. Best of virtual consult with. Expect fees to be $10,000 plus.