Neck lift with or without platysmaplasty?

Thank you for your question.

Choosing the appropriate type of neck lift and whether to have the platysma bands sutured depends on various factors that contribute to the aesthetics of the neck contour. Although I haven’t seen your photographs, I can provide some general information to help you understand the considerations involved.

In my opinion, there are three main elements that can detract from the aesthetics of the neck contour:

1. Volume: This can be situated under the skin and frequently under the platysma muscles.
2. Laxity of the Skin: Loose or sagging skin can impact the overall appearance of the neck.
3. Platysma Bands: These vertical bands can become prominent and affect the smoothness of the neck contour.

A platysmaplasty is generally used when there are visible platysma bands or when reducing volume under the platysma requires restoring the relationship of the platysma muscles.

If the contour of the neck is relatively smooth and there are no prominent platysma bands, a smaller intervention may be sufficient, and it might not be necessary to suture the platysma bands.

However, when the neck contouring requires more involved volume reduction or control of skin laxity, it is often beneficial to include suturing of the platysma bands. This can help achieve a more refined and aesthetically pleasing result by addressing both the volume and the muscle structure.

With significant neck sagging you would need a facelift / neck lift with muscle tightening (platysmaplasty). At the same time, I would recommend lasers (Fraxel, CO2, Halo, or Erbium) and microneedling RF (Fractora, Morpheus8, PiXel8, Intensif) to improve the crepey skin and wrinkles. Overall, the neck can be treated with a combination approach:

1. Microneedling and laser treatments for texture
2. Botox, Dysport, Xeomin or Jeuveau to help platysmal bands
3. Intensif, Fractora, PiXel8, or Morpheus8 microneedling RF for crepey skin and lifting
4. Injectable fillers like Belotero, Restylane Silk, Versa, and Juvederm Volbella to improve lines and folds
5. Face/neck lifting if sagging is prominent or premature, with or without platysmaplasty (muscle tightening)
6. Renuvion (J-Plasma), ThermiRF, and InMode FaceTite/AccuTite for internal tightening
7. Ultherapy and Thermage for external tightening
8. Regular Venus Legacy, Exilis Ultra, or InMode Forma treatments with facials to maintain tightness
9. PDO NovaThreads or Silhouette InstaLift cone threads for lifting and long-term collagen production

See an expert for a formal evaluation and to develop a personalized treatment plan based on your individual situation and goals. Best, Dr. Emer

Thank you for your question. Neck lifts can involve cervicoplasty, platysmaplasty, or both depending on the patient’s individual needs. While cervicoplasty can tighten skin by reducing loose skin along the jawline, platysmaplasty tightens the neck muscle bands below the skin. Cervicoplasty requires only a small incision, while platysmaplasty is a more invasive surgery. Both procedures work to target the skin along the jawline and under the chin to produce the desired results, and can be used individually or concurrently. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can assess your individual needs and help you choose one or both procedures based on your specific concerns.

Neck lift (as any other surgical procedure) needs to be planned based on the presented problem (fat deposits, deep fat, platysma muscle bands). Platysmoplasty or not, will depend of patient clinical presentation. This can be decided only on the basis of in person evaluation. Consultation with a board certified plastic surgeon, expert in neck and face lifts, is recommended. Good luck.

A necklift will always entail removing stretchy, loose skin and firming up the remaining skin. If the patient has 1 or 2 vertical ridges in the front of the neck, these represent saggy platysma muscle bands that have fallen away from their normal attachments. If present, then a platysmaplasty is performed to lift and stitch upward these muscle edges, which adds to the longevity of the new smoother neck contour. If muscle bands are present and not treated, then the smoothing that comes from just tightening skin won't last nearly as long.

There is some confusion and misunderstanding between terminology, and there is probably disagreement. As an experienced face and neck lift surgeon, I modify my approach and procedure upon the findings when I see the patient. Usually a surgeon will recommend lifting the neck via a face lift approach combined with a direct neck approach, to both suture the decussated platysma together anterior but lengthen posterior lumbar as well as remove fat if needed. Rarely in a younger patient with an isolated fatter neck Vaser or Lipo can be performed either alone or with an isolated anterior surgical approach, but this is in a small proportion of cases. En e the key is to see a plastic surgeon with the correct certification but more importantly expertise in face and neck surgery in particular.