Why do some surgeons not believe in performing anterior platysmaplasties, and just pull the platysma laterally (posterior)?
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Doctor Answers 20
Optins to treat platysma.
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.
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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.
A Horne'ts Nest! How to treat the neck
its a tough topic to write here, but there are some articles. I posted a general article below that may give some background.
Anterior platysma plasty
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