Optins to treat platysma.
This may be a matter of extent of platysma laxity. If there is minimal platysmal bands a lateral pull may be all that is need to give a good sling affect in the neck and smooth and rejuvenate the neck. As the banding gets more pronounced, the lateral pull will not be able to contour the platysma correctly and a small incision under the chin is needed to unify the edges of the platysma so the contour of the neck is correct. This midline plication does not add much time to the surgery and can easily be accomplished. This is a routine part of nearly all my facelifts unless there is minimal platysmal banding..
You would probably be shocked to know how many crazy variations of lifting and tightening the neck have been tried over the past 30-40 years!
I am one who more often performs a midline platysmaplasty. Actually that's usually combined with suspension at the lateral platysma as well, but there are times when just a lateral pull is all that is needed.
Some people think a midline platysmaplasty impairs the degree of lift and suspension you can get laterally. I and many other feel that this is not too problematic and the sling support effect of the midline platysmaplasty is very helpful in the majority of cases.
The best technique can often be determined by a careful in person examination, but your surgeon needs to be able to adjust to various findings during the operation and customize the technique to work best for your specific anatomy.
Your question is one pondered by plastic surgeons for many years. This is always a hot topic at meetings. There is no good answer unfortunately. I've always thought that it doesn't make sense that the platysma would separate during the aging process. Therfore it doesn't make sense to try and reverse this by sewing it together. I think the key to improvement in the neck is vertical lifting. Sometimes platysmaplasy may still be needed simply because it is too loose to tighten completely by pulling laterally. Even though it may be non-anatomic, platysmaplasy can help acieve the ultimate goal of tightening the muscle against the underlying neck structure to improve the external contour.
Most patients with significant neck laxity would benefit from anterior and posterior platysma tightening. This gives an optimal improvement, but at the cost of an under the chin incision and extra OR time and other costs. I like to open the neck to approach sub platysma fat and to redrape the skin. Published studies show that at 10 years post procedures, patients who had platysmaplasties had better results. For the patient who really needs an operation, minimal approaches often give minimal results. That said, there is a population of patients getting an early facelift who have good necks and do not need the open approach.
A Horne'ts Nest! How to treat the neck
You have asked a question that cosmetic surgeons ask all the time. There is not "right" answer. We all do it different and we all have different results. I myself do both midline and pull from the back. If you understand the anatomy and function of the platysma, you realize that you need to treat both the front and back, otherwise over time, you will start to get undesirable changes.
its a tough topic to write here, but there are some articles. I posted a general article below that may give some background.
Face and neck lifting is a very personal art, personal for the surgeon's philosophy and personal according to your anatomy. That said, I almost always do an submental, anterior, plastysmaplasty if the there are redundant platysma bands. I think it gives a better sling affect. This applies for me to most mini lifts too. The experienced surgeon is constantly evaluating his or her results. From that process over 30 years, this is how I feel about the procedure. In a full lower facelift, I do the platysmaplasty first and then undermine over the rest of the neck.
If the patient has prominent bands of the platysma muscle in the front of the neck than the anterior platysma plasty is essential. However, if the patient does not have any banding on the front then pulling it on the side called lateral platysmplasty is all you need.
Often both techniques are needed to get the best results. Results look very natural and should be customized. It's best to see an experienced surgeon who regularly does facelift a.
Facelifts should be customized
Everyone's face is different. Therefore, there is not a single treatment that is best for all patients. Platysmal bands can sometimes be treated with lifting laterally, yet other times, they need to be treated directly with a platysmaplasty. I'd recommend seeing a specialist in aging face surgery and trust their recommendations. I usually discuss a few options with my patients but ultimately I will recommend one as the "best" option.
Andrew Campbell, M.D.
Facial Plastic Specialist
Quintessa Aesthetic Centers
Platysmaplasty and Facelift
I usually vary my technique to patient's needs. Thick bands that are separated in the neck require midline tightening and release inferiority. Sometimes mild banding can be treated quite effectively with lateral pull, usually done in Mini-facelift. Be sure to consult with a board certified plastic surgeon. Good luck!