What is the usual objective of posterior/lateral platysmaplasty?

As part of necklift lateral plastysmaplasty performed (no ant. p-plasty). Looks bit strange, unnatural. Months later still some pain at diff times of day, and marked discomfort most times. Front platysmal banding more visible (in part because he also did lipo). Wondering the circumstances in which you suggest lateral p-plasty, and would you discuss with patient pre-op the discomfort, and possible change in "line" of neck? Reason for op was loose skin and bands in front. Thank you.

Doctor Answers 4

Not a fan of lateral platysmaplasty

Hi westsider,

I don't perform lateral platysmaplasties with my necklifts.  I think I may be the exception.  I do have a reason for doing this.  I rely on the anterior or corset platysmaplasty in the middle to smooth the bands and create an improved profile on the neck.  Instead of pulling on the lateral platysma on the sides to help support the necklift, I suspect that the lateral platysmaplasty may actually cause the neck to fall.  Since the neck skin is being pulled back with the lateral portion of the platysma muscle, if the suture which is holding the platysma muscle back fails or cheesewires through the tissues, then the platysma will return to its more natural position.  Along with that return or snap back of the platysma muscle is the skin which was not fully released with a lateral platysmaplasty type necklift.  

Unless the patient has a fat submental area or excess fat under their chin, I try not to perform any liposuction.  I worry that fat removal can worsen the crepiness of the skin under the chin.  Instead I try to keep a reasonable thickness of fat on the skin and if possible peel the skin and fat directly off of the platysma to keep that as thick as possible, but not double chin levels of fat (of course.)  The corset platysmaplasty is performed to tighten the front of the neck and improve the profile as much as possible.  Then the facelift is performed on the sides of the face which free the skin on the side and this skin "freeing" is connected to the skin that was freed under the chin.  Now the skin under the chin is completely free to be tightly gift wrapped under the chin and along the upper neck.  The skin is push up vertically to make sure the under chin area is as snug as possible after SMAS tightening, and the incision behind the ear, and possibly into the hairline allows for a nice skin removal in the posteriorly.

In general without placing lateral platysmaplasty sutures anchored to the back of the ear area (mastoid are) my patients do not experience any choking or noose like sensation.  In 2006, I was performing the lateral platysmaplasty, and my patients did have a temporary stiffness and nooselike sensation, which lasted 4-6 weeks.  This feeling would go away.   In one of my follow ups, one patient noted that they felt something snap, and their stiffness and noose sensation went away with that snap.  This particularly observant patient also noted that the front of the neck fell and the skin tightening in the front all came down in that same "snap."  

Had I not listened carefully to my patient's feedback, I may not have noticed this pattern.  Soon after I mainly was performing corset platysmaplasties, and at some point simply stopped with the lateral tightening.

If you look at my results, there is no 4-6 week let down and the neck stays up, even without the lateral tightening.  The bonus is that they don't feel the noose sensation or stiffness.  The main discomfort is tightness directly under the chin in the neck to chin junction.  

Please follow the link to Falling Necks, Pixies Ears and Thick Neck scars for my original web article in 2007 based on my experience with the lateral platysmaplasty.


Dr. Yang

New York Facial Plastic Surgeon
4.8 out of 5 stars 30 reviews


Platysmaplasty is a procedure usually utilized during a facelift to tighten the platysma muscle, which relaxes with aging.  In milder cases, the platysma can be elevated from underlying structures and tightened laterally.  In more severe cases, it is tightened centrally via a submental incision.  I will generally tighten the muscle both centrally and laterally in a facelift.  The discomfort you are describing sounds like inflammation around the greater auricular nerve.  Injection of dilute steroid shots and/or Botox may improve these symptoms

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 81 reviews


It is unusual to try to tighten the platysma (and, thus tighten the anterior neck) without some form of posterior pull on the muscle.  In many cases, a platysmaplasty of the anterior borders (the bands) is performed.  Discomfort can last for several months, so hopefully you are in this time frame.

John Frodel, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Objective of Posterior/Lateral Platysmaplasty

If vertical ridges are present on the front of the neck beneath the chin, these represent loose sagging downward of the edges of the 2 platysma muscles or sometimes actual downward pulling with muscular contraction.  There are 2 generally accepted methods of tightening the platysma muscles.  One involves suturing the front muscle edges together and upward which is done from an incision under the chin, frequently at the time of a face or necklift.  The other approach is to tighten the posterior (back) region of the muscle further backward behind the ear.  Most surgeons will use one or the other techniqe at the time of a lift to tighten the muscle, correct the bands, and improve the neckline.  Although it is unusual for pain to last over months, it is possible that a nerve that runs near the back border of the muscle might have been traumatized by the surgery or a stitches that are used to tighten the muscle backward behind the ear might be pressing on the nerve.  I would suggest that you discuss this thoroughly with your surgeon.

Richard G. Schwartz, MD
West Palm Beach Plastic Surgeon
5.0 out of 5 stars 24 reviews

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