What type of sutures do you use for a platysmaplasty? Permanent/dissolving? Mono/braided? Any specific reason for your choices?

Each surgeon has her/his own preference for approximating the platysma. Monofilament permanent suture should be fine. I personally use PDS, and have seen no problems from its use in the neck, requiring its removal.

You obviously have read about sutures or you are in the medical field. The use of sutures for this procedure is an issue of choice and opinion. In fact, there is no evidence suggesting one works over the other. You can make arguments for and against all them. For a perminant suture, you have risks of injections, granulomas and overtime the suture, if too tight can eventually pull through the muscle. Also, what if its painfull? It doesn't dissolve. Temporary sutures have a risk of breaking too early or your body having a negative reaction.In the end, to me, sutures are the least of the concern with a neck lift. You can do the most amazing job and use poor sutures and the odds are it'll look great.  Also, for a neck lift there are different areas where you place sutures, some behind the ear and some in the middle portion of the neck. the ones behind the ear are under more tension so you need to be carefull back here. My thought, is that there are steps in a neck lift that are more important than the suturing. The major concern in neck lifts are platysmal banding (which is when you can see the lines in the front part of the neck) and failure of the surgery. If you release the platysma properly the odds are your results will be great. 

I use a non absorbable braided suture. I like the way it holds the edges of the platysma together long term. I also like the way it  holds during the procedure as the muse is brought together from below the chin down to the lower neck..  Long acting temporary sutures likely would give similar results.   

You could pole ten surgeons and get ten answers here. Many surgeons  use a permanent monofilament suture in a buried fashion without problems. The longevity is likely greater with this type of suture. There are no large population, long-term studies showing negative results. A fibrous reaction or a suture working its way out are easy fixes. Some doctors use absorbable sutures. These can also cause a fibrous reaction in some patients.If your surgeon has experience with thousands of successful results, you can likely trust that the method used for you will be appropriate.

They all work and will have a low risk of infection due to the highly vascularized facial region. I do not know of any scientific paper that is concerned with infection in the facelift population due to a particular suture. I know docs who use silk suture for over 30 years and no problems for their platysma and SMAS work. Good Luck!

grace60, there is no one that can give you the correct answer. I have tried permanent monofilament, absorbent monofilaments that are long lasting and braided permanent sutures over the past 25 years. As of now I prefer the braided permanent sutures; I think they hold the best over time and the extrusion rate is minimal. Good luck! 

In our practice, we used braided permanent sutures which seem to hold the active platysma muscle bands together better than absorbable stitches. We have only seen couple small stitch abscesses which are are self-limiting and easily removed  in  the last 20 years. For many examples of a platysma-plasty performed during a neck lift and face neck lift, please see the link below

I have been away for a late summer break, and it is interesting to read the answers that have already been posted. All of them have value, but here are my thoughts.While it is true that both permanent and resorbable/dissolving can be and are used, and that both braided and mono, similarly, are acceptable alternatives, there are a few things that influence my thinking.First, the platsyma in many, not all patients, doesn't have a lot of strength, especially in the central neck. Back in the area below the angle of the jaw, the overlying fascia gives it more, and its continuity with the upper SMAS makes suturing under some tension a more realistic matter.This is important, because anywhere sutures are placed with tension, they will gradually cut through the tissues, just as a wire cuts through cheese or in the old days, blocks of ice were cut.This means the use of permanent sutures in many locations is of doubtful benefit. There is a race between the healing with strength of the wound, and the breakdown of absorbable sutures and loss of their strength or the pull-through of permanent sutures. We hope the healing  has progressed enough before the other factors kick in.As a result, tension is one the most important factors in determining success or failure, and just pulling the muscle together  isn't a recipe for success.When I do a midline platysmal repair, I usually use two layers of braided absorbable, and try to mobilize the muscle enough to repair it with very modest tension. I make transfers, low relaxing incisions ( myotomies) to prevent shortening the vertical dimension and "bowstringing" of the muscle which blunts rather than emphasizes the neck to jaw angle.In fact, many of us have stopped doing routine midline platsymaplasty because regardless of the suture material or specific surgical technique, recurrent platysmal bands occur with disappointing frequency, even in the best of hands. Furthermore, significant improvement can be achieved with careful SMAS/ platysmal elevation and mobilization from behind, sometimes with "closed myotomies" or division of the bands as an adjunct.

I personally use PDS to put the muscle and skin together. This is a monofilament absorbable suture. Because it is monofilament, it, theoretically, should have less chance of infection, though there is no data to support this.It has an advantage over permanent sutures since it dissolves, but it takes 6-9 months to do so. This means that, like permanent sutures, it holds the tissues until the body has built enough strong scar to not need sutures any more. All other absorbable sutures disappear before the scar has any strength, thus allowing the skin scar to widen or the muscle to stretch apart.