Neck Lift: Better to Cut over Active Platysma Band, or Tie Bands Together? Under the Chin?

Management of platysmal bands during open neck plasty may be approached several ways.  Described techniques include midline suturing of the edges (corset, popularized by Dr. Joel Feldman), Z-plasty, transverse myotomy or myotomies (Dr. Bruce Connell), and others.  Use of Botox described (closed), and T-Z direct excision described by Biggs and by Gradinger.  Probably other methods as well.  Dr. William Little recently presented a series of facelifts without specific management of the neck at all.  No need to excise it, and this risks marginal mandibular nerve injury.  Complete excision unreasonable because the muscle crosses the mandibular margin superiorly and extends over a wide transverse expanse in the supraclavicular area beyond normally undermined anterior triangle skin.  Tightening the platysma in the midline below the chin has no appreciable effect on perioral dynamics.  The risks of removing a "very small" portion of the platysma depend on which portion and how small.  Certainly, neck skin surface contour irregularity may result, and injury to underlying structures.

The type of necklift incision will depend upon your gender, your hairline and preferred hairstyles, any scars from previous surgeries, and a variety of other factors.  As a general rule, a #necklift #incision starts right in front of or within the hairline on the temple, follows the curve of the front of the ear, travels underneath the earlobe, and ends at the hairline behind the ear.  There are also shorter #scar techniques preferred by many patients, which do not have incisions in the hairline.  Some patients who wish to have liposuction or tightening of their neck will need an additional incision under their #chin, which can be hidden in a natural skin fold.Local anesthetic is usually used in combination with #intravenous #anesthesia during a necklift operation, allowing you to sleep peacefully through the procedure. Though general anesthesia may be requested, it is not necessary in most cases.  A necklift and any additional procedures you may add are #outpatient procedures usually performed in a surgery center. In some cases, your surgeon may advise you to stay in a post-op care facility for a single night. 
It is important to be realistic with your desired results. Necklifts are designed to remove only deep grooves and #wrinkles, not fine ones. Smoothing out every tiny line in your face would leave you with an eerie, unnatural, and undesirable result. The goal should be to make your necklift look as natural as possible, simply turning back the clock a few years.  

The answer is that it depends.  Each neck has its only unique anatomy and  require one, two, or all of the techniques that you mentioned

Removing part of the platysma is never indicated.  In my practice it is not extremely common to manipulate the platysma any more than I do in my routine SMAS-platysma suspension laterally.  When it is indicated I prefer to tighten further at midline in a corset type manner and transcet th pltysma low to elevate the cerico mental angle,  excision of the medial edges may only be necessary to reduce bulk in cases of extreme laxity but cutting parts of bands out would likely result in contour deformity and unnecessary risk.

 

All the best,

 

Rian A. Maercks M.D.

Removing a part of the platysma bands and suturing the remainder with a back cut is the usual treatment of this problem. Since your's is a revision this may be different and without seeing you or a photo one can't give an accurate answer.