Do I need revision platysmaplasty 15 months after my lower facelift? (Photo)

Thank you for your question.  It appears from your photo that you have platysma bands but a proper assessment requires an in person examination.  I think it is reasonable to expect that a facelift would address platysmal banding on a long term basis (at least several years if not permanent).  I would suggest discussing your original goals and expectations with your surgeon.  Correction might require an incision below the chin depending on their preferred technique.  They may have taken a more conservative approach with the initial surgery to spare you this incision but looking back they may agree that more work could have been done on the platysma.  
Surgeons are often trying to deliver the results you seek with the minimum invasiveness to balance healing, swelling, visible scar.  Surgery is a form of injury to tissues and philosophically there are many judgement calls during surgery as we work to get the best result for you.  Sometimes (in retrospect) we have erred on the side of caution with less undermining, less release of tissues and less incisions.  Sometimes patients imply they want a less invasive surgery (lower facelift or neck lift versus standard facelift, breast implants without a lift, mini rather than standard tummy tuck) and this compromise in invasiveness/cost can lead to less correction than hoped for.  One of the hardest things for surgeons is trying to explain why the more extensive surgery is the better choice given a patients individual goals without sounding like we are trying to upsell the patient.  
If your original consult dealt with skin laxity and jawline contour only, then you have a nice result. If you specifically discussed platysmal banding and your desire to have that corrected, then the surgery does not appear to have succeeded in that respect and a revision is something to consider.  You may find the original surgeon is willing to do this for you at minimal to no additional cost, or you may need to seek a second opinion from a reputable board certified plastic surgeon in your area.  Again - I am basing my comments on a single static photo and a full in person exam is the only way to properly review your situation and properly discuss any further options.  Good luck and I hope things get resolved to your satisfaction.

Neck lift surgery can be somewhat unpredictable at times. My guess is that your surgeon used a lateral approach to resolve the excess skin/muscle laxity, which worked for a few months but then the platysmal bands reappeared. At this stage, you would benefit most from a submental approach +/- lateral approach with a thorough platysmaplasty to reduce the chance that the bands will return. Prolonged neuromodulator use is not a great strategy. As for cost, patient would pay for facility +/-anesthesia but not for my time.
Gary Linkov, MD
Neck Specialist
Manhattan

Some docs don't do a platysmaplasty when they do their lower facelifts. You may not have had it done before.  I always do and it makes such a big improvement. Since everyone sags and ages differently, the platysmaplasty is going to cost you 1 yr later so don't be surprised but it will be so worth it. Unfortunately, there are no guarentees in cosmetic surgery.

Thank yo for your question.  What you have in the neck is a platysma band.  The patysma band con be treated nonsurgical by injecting botox and it will help for about tree months but is not going to be perfect and need to be re-injected.  If your intention is a more permanent solution surgery is the answer and that will give  you a more permanent solution of your condition.

1. Midline platysmaplasty through submental incision2. Revision facelift with lateral pulling and tightening of platysma3. Thermitight In terms of financing it should be discussed with your surgeon as all surgeons have personalized policies on how to handle any revisions. RegardsDr. J

Thank you for sharing your question and photographs.  Unusual to have the bands recur this quickly, but it can happen even in the most skilled of hands. I typically cut the muscle responsible for these bands low in the neck to limit the chance or recurrence, while also tightening the muscle in the middle of the neck and behind the ears as much as possible. 

Platysma bands can recur even after well-performed surgery. I have used two main techniques: firstly, notching each band low down and then stitching together the bands to create a smooth 'corset'; or completely cutting through the band on each side, and pulling each muscle with strong sutures back toward the ear. I have used the second technique only for the last six months, but I suspect it will prove to be better than the corset. In any event, the surgeon does need to do something apart from simply pulling from the back, to deal with these cords. I deal with revisions as follows: I do the surgery at no charge to the patient, who does pay the clinic and anesthesia fees. I recommend you have a good talk with your surgeon. All the best.

Your platysmal bands are fairly heavy. I would normally like to see the pre op and the post op at about one month before making a comment on the adequacy of the work. If you are talking about a warranty as in a guarantee, nothing is ever guaranteed. However, I try to work with my patients. Some don’t charge patients especially if it’s less than one year. However some charge a facility fee. Some charge if it’s more than a year. It really depends on the circumstance and the doctor. It your case, it would likely need a platysmaplasty and modified lateral pulls as in a neck lift. If that were already done, your doctor might need to re-examine the case. 

Hello and thank you for your question.  The best advice you can receive is from an in-person consultation.  It really depends on much neck laxity you had prior to surgery.  Based on your photograph, you can benefit from a surgical neck lift revision.  In my practice, I would not charge one of my patients for such a revision.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.   Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.

Best wishes and good luck.


Richard G. Reish, M.D.  FACS

Harvard-trained plastic surgeon
 

In our Practice the goal  for the cheek and neck lift -is to eliminate  the neck bands completely. Even in the best hands- they may sometimes recur, but in the immediate post-op period and for years beyond they should be gone. Based on your photo- you appear to have possibly had inadequate platysma treatment - and it my opinion- will require re-entry and deep revision