What is the difference between a submentoplasty and platysmaplasty? Would filler be enough to resolve sad mouth area? (photos)

I am 66 and had a successful facelift 20 years ago. Now I have sad face and loose neck and confused about what is best procedure for me. I am convinced of Natural Fill (using Aqua Lipo) after seeing a picture of a women on RS who still looks beautiful after one year. Do the doctor's think that one of those procedures plus fat transfer will be sufficient to bring back a more youthful look? I can't afford to do yearly fillers which are temporary fixes in my experience.

Doctor Answers 9

What is the difference between a submentoplasty and platysmaplasty? Would filler be enough to resolve sad mouth area?

Based on your photos I think a secondary face and neck lift with platysmaplasty will more likely give you the best result. In the end it will require less visits, effort and save you money. Six months after surgery, combined laser resurfacing can help superficial wrinkles and skin tone.

What is the difference between a submentoplasty and platysmaplasty?

Hi Chellamia

The difference is more semantics.  Both procedures involve treating the neck area, with a platymaplsty involving suturing of the platyma muscle.  A submentoplasty can also include the treatment of the same muscles.  Based on your photos, fillers may be a temporizing measure that may not give you the results you are seeking.  You may benefit most from another lower facelift with fat grafting to the areas around your mouth.  I have included some before and after photos of lower facelift patients.  I would recommend consulting with an board certified plastic surgeon who is experienced in performing this procedure.  Inquire about their experience and look at their results.  Best of luck to you in your search.

Sonny O, MD
Mount Pleasant Plastic Surgeon
4.2 out of 5 stars 13 reviews

Choices, choices

Platysmaplasty is tightening of the neck muscles.   Not sure about the other term, as it is not commonly used.   Fat transfer would be of benefit, but not completely correct the skin laxity of the neck and mouth.  You would do best with a secondary facelift with fat transfer.

George Bitar, MD
Fairfax Plastic Surgeon
4.7 out of 5 stars 49 reviews

Best Procedure for Facial Aging

After reviewing your photos, I feel that the best option for you would be a revision face and necklift, fat grafting to your midface and fractionated CO2 laser to improve your skin quality.  This will give you a natural appearance, longevity to the results and it will address ALL of the issues you may have.  I recommend seeking out a Board-Certified Plastic Surgeon who will accurately examine your face and neck, discuss the options and formulate a plan tailored to your specific needs.  Best wishes!

I recommend Sculptra

Thank you for posting a photo. My suggestion is to consult with your doctor about Sculptra; this facial filler will instantly restore lost volume. Sculptra will restore a more youthful, natural look and last up to two years.

Bruce E. Katz, MD
New York Dermatologic Surgeon
3.8 out of 5 stars 17 reviews

Facial aging continues years after a facelift, so I explain the options to enhance volume and improve neck definition

Hi Chellamia,

Facial aging is an ongoing process and there’s continuous loss of bone, muscle and fat. You can have procedures that have a long-term benefit that can last a while. Regardless of what procedure you do, facial aging will not stop.

If your objective is to improve the chin area also known as the submentum, submentoplasty or Z-plasty and platysmaplasty are all procedures that describe ways to improve the neck angle. On the other hand, a typical neck lift involves an incision behind the ear and some parts in front of the ear, then lifting the skin and the platysma. It also tightens it to get improvement of the angle. Submentoplasty or Z-plasty and platysmaplasty may not be as effective as a necklift. Z-plasty involves removal of skin and changing the vectors of tension so that you don’t get a straight scar that can widen. The skin can be challenging. I’ve gotten fantastic results, but also did the same procedure and gotten thickened scars. So there’s a risk involved with that procedure. I’ve been able to help those patients using a method of helping scars called platelet-rich plasma (PRP) and extracellular matrix (ECM) and was able to revise that scar. A submentoplasty can also involve work done without the Z-plasty. A submentoplasty goes underneath the chin to work the muscular layer and the other type of muscles called the digastric muscles.

The other procedure called a platysmaplasty is working on a muscle called the platysma. It is indicated particularly when there are platysma bands - two neck bands that tend to be in the center. I do a small opening, go inside and tighten the muscle of the platysma and do some other work to get the neck angle to improve.

To be able make a recommendation that is right for you, you need a physical examination. From the photo, it looks like you have little extra skin, but in the absence of a physical examination, it’s hard to make a recommendation. You should at least understand the distinction is between those two procedures.

You described something called an Aqua Lipo which is basically a different way to take fat out, but it’s still essentially fat grafting. This is taking fat from one place and putting it in another place and hoping that the volume of fat will hold. Every doctor who does this can tell you between 30-70% of the fat can get absorbed by the body. I always tell my patients who are considering fat transfer that they’ll need at least two procedures. I can place as much fat as I need to, but that fat has to survive. We do all kinds of things such as the use of platelet-rich plasma and other modalities to try to maximize the survival, but when you separate tissue from a blood supply and put it somewhere else, there is going to be variability in the tissue taking.

When you cannot afford to spend a certain amount to maintain your appearance, it can certainly be frustrating. Aesthetics are an area where you can spend a lot of money. I usually tell patients that whatever stage of your life you are in, you need to allocate a certain amount of budget. You might be better served with spending less on a regular basis to get the benefits that you desire rather than spending on surgery which has the implication that it will last longer. Yes, the facelifts can benefit anywhere from 10-20 years, but they are very variable.

I think that you have to learn more about this and you have to be honest with how much you can afford. Meet with doctors who can be honest with you about the outcome, and whether or not you’ll be satisfied. I always tell my patients who come for consultations that I’d rather not do a procedure for you than do a procedure where you’re paying less, getting less of an actual procedure, and not being happy with the results. It’s all about communication and being able to set expectations. I hope that was helpful, I wish you the best of luck, and thank you for your question.

This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 60 reviews

Non Surgical Face Lift

Thank you for your question about non surgical facelift.

At age 66, a likely option would be full facelift with moderately aggressive fat transfer to fill in your volume loss.

The platysma work can be done at the time of facelift.

The submentoplasty is limited to under the chin and will likely fall short of what you want.

To be sure what is right for you, see two or more licensed and board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have these treatments.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 149 reviews

What is the difference between a submentoplasty and platysmaplasty? Would filler be enough to resolve sad mouth area?

Submental plasty is the removal of excess fat and skin under the chin. Platysmaplasty is the tightening of the platysma bands of the thin muscle under the chin. Either can be done or both together. My over the internet opinion is a secondary full face/neck lift with fat grafting+ aPRP+AFSC injections... 

sub-mental plasty/ platysma plasty are components of a facelift

A platysma plasty is a component of a submental-plasty and both are performed during a lower Facelift procedure. The neck component of the lower facelift involves tightening the platysma muscle in 3 locations, tightening loose facial and neck skin, and  removing fatty deposits above and below the  platysma muscle.  For many examples, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 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.