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

either a surgical or non surgical approach.  The bands in the neck are due to muscular activity of the platysma muscle, and can be relieved by cutting the muscle or re-directing the vector pull of the muscle through sutures.  Botox or Dtsport, by interfering with the function of the muscle, can temporarily relieve the banding in the neck.  The muscle can also be excised or back cut, both of which serve to limit the pull, or banding in the neck.  The surgeon can also suture the separated edges of the muscle together across the midline in a "corset" fashion, thus re-directing the pull of the muscle and eliminating the banding effect.  In general, where multiple approaches are used to treat the same problem, no one approach is consistently superior, and the experienced surgeon will match the technique used to the specific patient and his or her needs.  Either of the approaches you mentioned, or a combination of both surgical approaches may in fact be best for you, and the best way to tell is by a consultation with an experienced cosmetic surgeon...

Hi.

1)  The goal is to have a smooth right angle under the chin.  How you achieve that is based on the anatomy. Very seldom is a significant amount of platysma removed.  In some patients, suturing together the muscles in the middle works well (the corset approach).  In others, the bands have to be divided (not removed) low in the neck to interrupt the "bowstring" effect.

2)  There often are other anatomical problems besides bands that contribute to a bad neck (fat under the platysma. hanging salivary glands, a low hyoid bone).  These are dealt with at the same time.

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.  

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.

Interesting question. With no photos posted in at rest and active contraction of the P-bands very hard to advise. Some also cut and plicate the P-bands as a combination techniques. One risk in excising a small portion of the P-bands is submandibular gland ptosis. Seek in person opinions. 

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.

Dear lady, it would have helped to see which is the degree of platysmal banding you have, and to know whether these bands are dynamic or static. Also which "work" did you have previously on the platysma?

My management of the neck usually only involves a vertical lifting of the platysma with a MACS-lift, which I designed in Belgium together with my associate Dr Tonnard. In the cases where preoperative assessment shows that vertical lifting doesn't correct the bands, an small incision under the chin is added to either remove the bands or to approximate them in the midline, however not pulled as tight as Dr Feldman's corset platysmaplasty. This usually gives a smooth neck with disappearance of the vertically visible platysmal bands.

Dynamic bands without a static component can often be treated with botox alone.

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