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 19

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..

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 13 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 20 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 6 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
4.6 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 98 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

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!

Robert M. Tornambe, MD
New York Plastic Surgeon
5.0 out of 5 stars 24 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.