Can someone explain in detail how a platysma myotomy is performed? Would I be a good candidate?

Question

I had a deep plane facelift 15 months ago by a highly respected NYC plastic surgeon. I am still experiencing extreme tightness around my neck and on the sides of my face. I have had Kenalog injections, lymphatic massage and ultrasound without success. I also still have a purple bruise on my neck. I have heard of a platysma myotomy. Would I be a good candidate for that, might that help me and exactly how is that performed?

Fernando Colon, MD · Answer

It is important to make a causal diagnosis of the problem.If it is due to the platysma itself perhaps a neurotoxin suchas Botox may help relax the muscle. If this improves thesymptoms it will be diagnostic and you could continue todo the injections. A very discriminate evaluation of yourplatysma anatomy as well as the symptoms will be required.I saw a patient from another good plastic surgeon that washaving similar type of symptoms at 2 years post op. I followher with massage and conservative measures as magnesiumlactate supplements and homeopathy. Eventually the symptoms resolve. Be cautious about another operation particularly if youlike your cosmetic result. Best wishes.

Farhad Rafizadeh, MD · Answer

platysma myotomy is done at the time of the facelift to eliminate platysma bands under the chin and then the borders of the muscles are sewn together to create a sling under the chin. The platysma is then tightened with the SMAS layer on both cheeks to complete the job. The patients will feel the tightness for a month or so, but it is usually not a long term problem. You may have had some other work under the platysma that is causing you tightness. It would be impossible to give you an answer without seeing you and reading your operative report.

Jonathan Saunders, MD · Answer

wow. I have never heard of something being too tight after a year. curious as to pictures. I am not sure releasing the platysma would work because it has all healed together at this point. you live in a great location for plastic surgeons.  I would see somebody out there

Ronald J. Edelson, MD · Answer

it sounds like it would involve undoing the platysma tightening you had in your original facelift. I’m not sure if it would work because I have never performed it. I also have never had a patient complain of being too tight after a year. Best to get a few consults on possible solutions. You may well eventually find someone who has experience in the procedure and can help.

Robert Brueck, MD · Answer

Without photos it is hard to say what needs to be done.You have tried all the non-surgical things to do.At this point I don't feel a myotomy which is a cutting of the platysma muscle will help you in this regard.I would follow up with your surgeon and discuss this with him.

Can someone explain in detail how a platysma myotomy is performed? Would I be a good candidate?

Answers (5)

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