Can these neck bands after 2 SMAS facelifts and platysmaplasty ever be gone? (Photos)

Question

I've had two Facelifts and Platysmaplasty, one year apart. First was a complete failure. 2nd went to a new surgeon and had a complete re-do. Its been 4 months from the 2nd surgery, face and jaw line turned out fabulous, but my neck bands have returned, after the 1st month, the doctor said was too early to tell, but now at 4 months they are still there. How do I approach my doctor about this and is there a fix or am I just destined to always have these aging bands? I do not want Botox.

Farhan Taghizadeh, MD · Answer

Persistent neck banding post facelift and platysmalplasty can be very frustrating and here is how we handle it:1. We use radiogrequency immediately on the skin to get the skin to tighten. Often there is little separation between the muscle and the dermis in thin skinned individuals, and getting the skin to tighten will help reset the muscle more laterally. Here weakening the muscle a but with the Botox can help get a better long term result. 2. There is a technology called I Guide where you can selectively cut the bands through the skin as an office based procedure. Often in these cases the back cuts during the surgery may not have been done, leading to persistent banding.3. Unfortunately in my experience, many of these cases end in revision. We are happy to consult with you regarding this issue.

Gianfranco Frojo, MD · Answer

There are potential solutions for this issue. This is one of the most common recurring issues after necklift surgery. One option would be due performing a revision necklift. Another option would be to perform Morpheus with fat grafting. You need a VERY confident and experienced board-certified plastic surgeon with extensive experience in the face/neck. Ideally this surgeon completed 6 years of integrated plastic surgery training followed by a 1 year aesthetic fellowship endorsed by the Aesthetic Society.

Gurkan Kayabasoglu, MD · Answer

Hello,Platysmal bands can be very challenging post and preoperatively, your issue can be corrected with a small procedure that is involving resuturing the bands together in the midline of your neck. However, you need to give yourself  to heal properly. You need to find a professional facial plastic surgeon to fix it properly and not to suffer from same issue again. In the right hands you can achiave long term result.

Zoran Potparic, MD · Answer

Unfortunately in skinny necks like yours platysma muscle bands are relatively frequent postoperative problem. Since it is too early to see final result of your recent surgery this deformity may be treated with Botox. It will paralyze visible muscle bands and diminish current "deformity" possibly create better healing by eliminating muscle activity and pull? It would be wise to wait at least 1 year or longer before doing anything new. Patience.  Good luck.

Edward J. Gross, MD · Answer

The key to correction of platysmal banding is identification preoperatively.  These areas can then be marked and a proper corset platysma plasty performed in surgery via a submental or under the chin incision.  Over the years, I have become more aggressive in management of the neck and correcting platysmal bands is both highly satisfying for the patient and rewarding for the surgeon.  I would seek out a surgeon who has experience in correcting this condition and has photographs to support it.  Botox will only temporarily mitigate the problem and laser treatments or Ultherapy have minimal impact and are therefore not recommended in our practice. Best,

Alejandro J. Quiroz, MD · Answer

Thank you for your question. I am sorry about your disappointment after surgery. Fist able the SMAS facelift will not treat those bands the platismaplasty will but there are different techniques to correct the bands and I believe you need a transection combined with middle suture of the muscle and to my experience is the most reliable procedure.

Michael P. Morrissette, DDS, FACS · Answer

You likely have a thin platysma muscle and very little subcutaneous fat. In some cases, it is necessary to "double" suture the platysma in the midline. In addition, this will produce some excess skin so a behind the ear incision may be necessary to remove this excess skin. This would be considered minor revision work. Since you are happy with your second surgeon, discuss your concerns with him.

Elizabeth Whitaker, MD, FACS · Answer

Hello GoldenMimi, Thank you for your question and sharing your images and concerns.  If you have a thin, attenuated platysma muscle it is possible the suture line did not hold up well.  You may benefit from a revision of the platysma, but your surgeon will likely recommend you wait until you are 6-12 months out from the last procedure.  Let your surgeon know your concerns.  I hope this helps.All my best!  Dr. Elizabeth

Ravi Dahiya, MD · Answer

I have performed over 6,000 facelifts over the past 15 years and one of the things that I have learned most clearly is that platysmal bands can be very stubborn. This has led me to become more and more aggressive with how I manage the muscle. I now resect (cut away) a much larger segment of the muscle than I ever did before because I have seen this exact problem in the past. The good new is that this type of procedure can be done easily in the office with local anesthesia.

Cain R. Linville, MD, FACS · Answer

I'm not sure how a platysmaplasty was done, and unfortunately everyone seems to have a different terminology for something that is fairly straightforward.  The classic platysmaplasty, as described by Feldman, is a corset playsmaplasty done from the chin to the sternal notch, that pulls the edges of the platysma together and holds them there, forever.  If done properly, it should be smooth and should prevent any more banding.  So, I'm sorry for your result.  I would say that no matter what, you need to wait a few more months to let the scarring resolve, and then it looks like you'll need another platysmaplasty.  Likely that can be done via an "under-chin" incision so it's not too noticeable.

Can these neck bands after 2 SMAS facelifts and platysmaplasty ever be gone? (Photos)

Answers (12)

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