Why do some surgeons not believe in performing anterior platysmaplasties, and just pull the platysma laterally (posterior)?

I'm very confused by the different answers given by surgeons regarding treatment of the fac. Some say it's best to just treat loose platysma by making incisions behind the ears & pulling laterally - to me this seems that it would just pull the bands further apart at the front of the neck. But stitching together the platysma at the front (corset-style) seems quite unnatural. To do both seems like the pull is in 2 different directions and wouldn't hold. Also some say to cut the bands - why?

Doctor Answers 20

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..


Boston Plastic Surgeon
5.0 out of 5 stars 91 reviews

Platysmaplasty techniques

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.

David W. Rodwell III, MD
Charleston Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

Excellent question

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.  

Matthew Bridges, MD
Richmond Facial Plastic Surgeon
5.0 out of 5 stars 21 reviews

Doctors may change techniques with platysmaplasty during surgery, or through evolution - experience is most important factor

Thank you for your question. You are asking a very good question about why there are so many conflicting opinions on surgeons’ preferences on how to treat platysmal bands, and you go through the laundry list of typical approaches from anterior platysmaplasty, corset platysmaplasty, back cuts, pulling of the platysma, so you ask why there is such a variation. If you get down to it, whether it is face lifting, neck lifting, the different aspects of these procedures, there is no perfect solution, which is why there are varying opinions.

As a specialist, let me give you a bit of background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been practicing for over 20 years, and offer the full range of face and neck lifting solutions in my practice. I have done all the procedures you mentioned because one of the greatest frustrations for surgeon is when someone looks great after surgery and you are really happy, but a year later they have recurrent platysmal bands. You wonder how could that possibly have happened given whatever technique you worked hard to do.

The reality is platysmal bands will sometimes respond very well to different methods. Every surgeon feels their technique worked out well for them in consistency and predictability. However, I can tell you after being in practice for this long, I see a lot of senior surgeons so passionate and dogmatic about the very best way to treat these bands, only to say five years later they have evolved to something else. There is constant evolution in what we do, so in the modern approach to face and neck lifting surgery in my practice, our goal is to do these procedures with the quickest recovery, the lowest risk, and most predictability. I think my approach is reflective of the needs of the modern patient, meaning it sometimes takes a dual approach. Often you do not only the surgery, but also address volume correction, skin quality, or even treat the platysmal bands with a neurotoxin like Botox™. We need to do everything we can to maximize the outcomes, but certainly face lifting, neck lifting surgery is still very successful at dealing with a lot of these issues.

The reason you’re dealing with these conflicting opinions is every surgeon comes to their procedure with a different perspective. The way I approach these issues with experience with all those procedures, I look at the platysma, under the neck, then I make a decision as to whether or not the platysmaplasty will be successful. I also determine if back cut release and lateral pull of the platysma would be successful. I make a lot of decisions based on what I see intraoperatively. Often, doctors like to promote certain techniques as being the best way to do something to differentiate themselves from other doctors. However, would say the majority of my colleagues with experience and honesty don’t do every surgery the same way, but will adjust to what they see during surgery. There could be a plan prior to surgery, but it has to be flexible.

I think you have to talk to your doctor, find the surgeon you feel comfortable with, and get a realistic understanding of what to expect. If there was one best way to do something, we’d all be doing it exactly the same way. It really is about what we can expect, and what can we do if there is a need for enhancement, and if there is a need to further augment and maximize the result. We are very fortunate to be in a time where we can offer many additional procedures that are less invasive, but can complement, enhance, and maximize the results for our patients. I hope that was helpful, I wish you the best of luck and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 66 reviews

Platysmaplasty

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.

Mark D. Wigod, MD
Boise Plastic Surgeon
5.0 out of 5 stars 7 reviews

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. 

Dr Bonaparte

James Bonaparte, MD, MSc, FRCSC
Ottawa Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Platysmaplasty

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. 

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon
4.5 out of 5 stars 25 reviews

Anterior platysma plasty

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.

Regards

Dr. J

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 104 reviews

Both techniques

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.

Brian K. Machida, MD, FACS
Ontario Facial Plastic Surgeon
4.1 out of 5 stars 22 reviews

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

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.