Wanted the platysma sewn together, but surgeon doesn't do it anymore. Opinions?

Question

I'm having a facelift/necklift and wanted the platysma sewn toghether to get rid of the bands.But my surgeon said he doesn't do that anymore, due to the fact that they oftèn come back, and that he deals with it in some other way in the extended smas lift teqnique he uses.He said more and more surgeons stop doing it, but he was vague on how he does and if what he does is a more longlasting method. So is there another way or even superior way to deal with the neck bands.?

David Samimi, MD · Answer

Thanks for your question Kajsa, it is a great one and one that reminds me of the saying "There's more than one way to skin a cat". There are two schools of thought on the platysmaplasty. One, the one you are expecting is to have those bands directly sewn together with the idea this will directly address the issue. Many surgeons would agree on this approach. However many, like the one you consulted with get great results in some patients by doing a release of the superficial facial muscles (SMAS) and elevate laterally and vertically to suspend and tighten the bands without opening the neck. Benefits here is less risk of neck scar or irregularity and a theoretic better lift of the jowels and lower face because the platysma is not being pulled downward at the midline, rather only vertically up. If the surgeon you consultated wiht is truly doing an extended smas deep plane lift, you can simulate how this will look on you without the platysmaplasty by by putting 4 fingers on either sides in the middle of your cheek and elevating. If your neck bands are gone, there is a good chance you will do well with the extended smas lift alone. In the end I feel you should ask this surgeon for before and afters, ideally greater than 1 year out on necks that resembles yours, AND get another opinion from a surgeon who does recommend the midline platysmaplasty. This should give you the info to make the best decision for you. Hope this helps!

Thomas A. Mustoe, MD, FACS · Answer

Unfortunately there is no completely predictable solution for platysma bands.  Seeing the platysma in the midline with or without partial or full trransection of the platysma does not always work, and can cause other deformities occasionally that are not ideal.  Through a lateral approach it is possible to get a major improvement but there is no ideal solution.  Choose your surgeon carefully, ask to see before and after pictures and look for an honest discussion that doesn’t over promise.

George Volpe, MD · Answer

Platysmal bands, the bane of plastic surgeons. Unfortunately, in the world of PlasticSurgery, we have not found the perfect 100% reproducible way to correct platysmal bands. The various techniques do suffer from recurrence rates. The muscle bands represent the medial borders of the platysma muscle on the right and left side. The edge of the muscle that some of us have start to bowstring across the chin neck angle causing the bands. Many plastic surgeons use the technique of sowing the muscle bands together under the chin. We have also tried numerous other techniques including partially or completely cutting the muscle. Other techniques include using cross threads in other words pulling the medial band on the right more to the left and anchoring a stitch way over near the ear. One reason for the recurrence rate is that the muscle does not have a good covering on it that securely anchors stitches. Stitches that dissolve quickly do not allow enough time for the muscle bands to heal together and stitches that are stronger and last longer can pull through the muscle. Although many patients have good results with platysmal repair, one should go into facelift surgery if one has the muscle bands understanding that there is a recurrence rate and that it may happen to them. If this is not discussed beforehand at consultation, it may lead to unhappy results. It is the responsibility of your surgeon to explain details of the procedure if you do not understand. You should also ask good questions such as what is the recurrence rate of the bands in that surgeons experience and hopefully the surgeon will be honest enough to answer that. If you're not comfortable, it may be time to seek a second opinion.

Georgios Orfaniotis MD, FRCS(Plast) · Answer

If you have concerns about prominent vertical platysma bands then the best way to correct them is via a submental (under the chin) incision.Through this approach the central part of the platysma is identified and plicated, a procedure also known as platysmaplasty.This also gives access to perform a "deep neck contouring ", which includes removing any excess sub-platysma fat, which cannot be removed with liposuction, tighten the digastric muscles, and very rarely remove part of the submandibular glands. Platysma bands may be corrected via facelift only but only temporarily. No doubt this procedure carries a risk of recurrence but doing nothing is definitely not going to resolve the issue. Best wishes

Richard Baxter, MD · Answer

There is no single best method to deal with platysma bands in the neck. Regardless of which technique is used, there some degree of recurrence happens even with the best surgeons. Personally I still do plastysmaplasty (sewing the bands together) but usually divide them partially as well. If they are not particularly active then I don't open the neck except for fat reduction. Proving which method lasts longest is next to impossible.

Stephen Prendiville, MD · Answer

Although platysmal bands can return after a facelift, the majority opinion on the issue is to perform a platysmaplasty when indicated (sewing platysmal bands together); I certainly do and my patients are very happy for it.  I recommend that you see a Facial Plastic Surgeon who focuses on facial rejuvenation.

Ronald J. Edelson, MD · Answer

Your surgeon is correct that platysma bands can recur. But I disagree that most surgeons have given up on this procedure. Most plastic surgeons make it a part of their standard facelift. If not done the facelift can pull the bands further apart

Wanted the platysma sewn together, but surgeon doesn't do it anymore. Opinions?

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