Overview of Platysmaplasty Facelift
Platysmaplasty is a cosmetic surgical procedure that aims to enhance the look of the neck. It’s commonly performed to restore a more youthful appearance by refining the contour of the neck from the jawline down to the chin. Typically, people between the ages of 40 and 60, who are looking to improve the definition of their jaw and neck, undergo this procedure. However, it’s not the best option for those over 60 years old who have a lot of loose skin and fat on the neck. In such cases, additional procedures like face-lifting and liposuction might be necessary.
In some instances, platysmaplasty is performed alongside a comprehensive facelift procedure (known as cervicofacial rhytidectomy), which focuses on rejuvenating the entire face – from under the lower eyelids down to the collarbone.
The surgical technique used today has developed over time, with many medical professionals contributing to its evolution. In 1928, a surgeon named Bourguet was the first to introduce a technique akin to modern platysmaplasty, where he made a cut under the chin to operate on the platysma muscle, which is prominent in the neck. Subsequenty, several techniques have been developed, including procedures using facial tissue, medical meshes, smaller incisions for the placement of supportive stitches, and plasma injections under the skin to induce skin tightening.
Anatomy and Physiology of Platysmaplasty Facelift
The neck is a complex body part made up of different layers and sections that give it shape and function. Surgeons who do cosmetic procedures on the neck need to understand its structure correctly to make it look pleasing and youthful.
The neck can be divided into three parts or ‘subunits’: the chin area, the underneath of the chin, and the front part of the neck. These parts are composed of different layers. The outermost is the skin, then the superficial fascia, which is made up of fat, a thin muscle called the platysma, veins close to the surface, lymph nodes, and nerves that are sensitive to the touch. The deepest is the deep fascia, which has three layers consisting of fibrous connective tissue.
The platysma muscle is a wide, thin muscle found at the front sides of the neck. It’s controlled by a branch of the facial nerve and helps to lower the lower lip. This muscle and a system of fibres and muscles, called the superficial musculoaponeurotic system (SMAS), divide the fat under the skin of the neck and face into two layers.
When performing a neck-lift or a surgical procedure to reduce wrinkles on the neck and face, it’s crucial for surgeons to be aware of the location and paths of the nerve branches in the neck. In particular, the marginal mandibular nerve and the cervical branch of the facial nerve that aids the platysma muscle need to be handled carefully to avoid damaging them.
A nerve called the great auricular nerve, popularly injured during a face lift, provides sensation to parts of the ear and nearby areas. It comes up from behind a muscle in the neck and goes towards the ear. During surgery, caution must be taken to avoid damaging this nerve.
Aspects of a youthful and attractive neck include a well-defined angle between the chin and neck, a prominent chin viewed from the front and side, a higher and backward position of a bone in the neck called the hyoid bone, a clearly visible lower margin of the jawline, a visible muscle in the neck, and a noticeable bulge in the neck due to thyroid cartilage.
Aging can cause various changes in the neck such as loose skin due to loss of elasticity, fat accumulation, damage from sun exposure, changes in fat distribution, and hormone-related changes. Muscles and supporting structures in the neck may become less toned and tight, leading to saggy muscles and fat under the cheeks, usually referred to as jowls. These changes ultimately lead to a less defined neck and facial structure.
Some secondary changes associated with aging like prominent wrinkles around the mouth and nose, loss of facial bone volume, and fullness under the chin can also occur. New research suggests that bands on the neck, often thought to be due to saggy skin and muscles, may actually result from increased muscle activity.
Why do People Need Platysmaplasty Facelift
Platysmaplasty is a cosmetic procedure that helps enhance the appearance of the neck, often reversing age-related changes such as saggy skin, noticeable neck muscle bands, and excessive neck fat – often referred to as a “turkey-gobbler neck.” Keep in mind that a traditional facelift, known as a cervicofacial rhytidectomy, usually addresses these neck issues most effectively. However, if you are hesitant about a full facelift, a neck-lift or platysmaplasty can be a good alternative.
Several criteria need to be checked before one can be an ideal candidate for a neck-lift. These criteria, proposed by Giampapa and Di Bernardo, include a less defined neck angle, a less distinct jawline, no looseness in the middle facial structures, minimal to moderate fat in the facial and neck area, and the desire to avoid a full facelift.
Certain particular cases assert the need for platysmaplasty. For instance, if you have very prominent neck muscle banding (more than 1.5cm deep) that can’t be fixed by tightening the side of the neck muscle, or if you need a subplatysmal lipectomy – a procedure that removes fat beneath the neck muscle – then you’ll likely need to pair that surgery with platysmaplasty. Platysmaplasty is also indicated if your neck muscles have split apart in the middle, a condition called type III platysmal decussation.
When a Person Should Avoid Platysmaplasty Facelift
While there aren’t any strict rules that always prevent surgery, some people may not be good candidates for an operation. This could include:
People who expect miracle-like changes from the surgery – these expectations might not be realistic.
Those dealing with mental health issues such as a focus on imagined appearance flaws (this is called body dysmorphic disorder), severe mental illness with loss of touch with reality (psychosis), extreme mood swings (mania), and significant long-term sadness (major depression).
Individuals who smoke heavily and can’t quit at least a month before their surgery. Smoking can affect the body’s ability to heal itself after the operation.
People who aren’t in good health overall – they might not be fit enough for an operation.
Individuals taking certain medications like isotretinoin. This drug can cause poor wound healing, making surgery riskier.
Those who have serious changes around their jawline or saggy areas on their face (the term doctors use for this is “midfacial ptosis”), which may make the surgery more difficult or the outcome less successful.
Equipment used for Platysmaplasty Facelift
The procedure called platysmaplasty, which is a type of facial plastic surgery, needs several different tools. Here’s a straightforward version of what those tools are and why they’re used:
- Long and medium length needle holders: These hold the needles that are used to sew the skin during and after surgery.
- Webster needle holder: A special needle holder useful in delicate surgeries.
- Metzenbaum scissors: These are special scissors with fine, curved, blunt tips that your surgeon uses to separate the platysma, the muscle in your neck, without causing any injury.
- Deaver retractor and Lighted retractors: These are tools that hold your skin and tissue aside to give doctors a clear view and access the working area.
- Fine Mayo or McIndoe scissors: These are types of surgical scissors used for cutting.
- Castañares scissors: These are another type of surgical scissor used in the process.
- Skin hooks: These are used to lift and hold the skin during surgery.
- Adson-Brown forceps: This is a type of tweezers used for holding and maneuvering small and delicate tissues.
- Barron knife holder: This holds the surgical knife safely during the procedure.
- Fine bipolar forceps: This tool uses electricity to cut or control bleeding in tissues.
- Monopolar electrocautery: This is a device that uses heat to stop bleeding or to cut through tissue.
- Liposuction cannulae: These are thin tubes used to remove excess fat during the surgery.
- Nerve hooks: These are used to protect the nerves during surgery.
- Tissue elevators or dissectors: These are used for lifting and separating the tissues during the procedure.
- Headlight and loupes: These are lights and magnifying lenses doctors use to see better during your surgery.
These instruments help the surgeon perform the platysmaplasty accurately and safely.
Who is needed to perform Platysmaplasty Facelift?
During a surgery, there are several key people involved to ensure everything goes smoothly. This team includes the surgeon, who leads the procedure. The surgeon’s assistant is there to help the surgeon during the operation. A scrub nurse is another important team member who helps by handing the necessary tools to the surgeon.
An anaesthetist is a doctor who specializes in giving anesthesia, which is a medicine to help you sleep and not feel any pain during the surgery. The anaesthesia technician supports the anaesthetist in preparing and giving the anesthesia.
The circulating nurse’s job is to move around the room, conducting checks and offering assistance as needed. After the surgery, a postoperative care nurse will look after you, monitoring your recovery and ensuring your comfort.
Preparing for Platysmaplasty Facelift
Before you undergo surgery, your doctor will go through a series of preparations to make sure you’re ready. These include asking about your health history, taking photos for reference, doing some blood tests, evaluating your body’s response to anesthesia, and ordering other tests based on your health history.
Your doctor will pay close attention to the signs of aging on your face, like loose skin, the thickness and elasticity of your skin, the presence of wrinkles, and your skin’s response to sunlight. They will also pinch your skin to check the quality, thickness, and the amount of fat below your skin.
Your doctor will also assess the amount of excess skin around your neck and chin area. They will check the fat under your skin in these areas, both at rest and when you contract the platysma, a muscle in your neck. They can tell where the fat is located based on how the skin pinch size changes when you contract your neck muscles. It is also necessary to estimate the amount of excess skin in the neck and the depth of the neck wrinkles both at rest and when you move.
Two weeks before your surgery, your doctor will advise you to stop taking certain medications and supplements, such as aspirin, anti-inflammatory drugs, blood thinners, and most herbal supplements, except for Arnica Montana, which may help to limit bruising after the surgery.
Before the surgery begins, while you’re standing, your doctor will mark important areas on your neck. They’ll ask you to smile and move your neck so they can accurately assess and mark these areas. These can include incision lines, fatty areas in the neck, wrinkles in the neck, the borders of your jawline, and others.
After you’re put to sleep with general anesthesia, they will clean your skin and cover you with a sterile drape. Then, a numbing solution with a small dose of adrenaline will be injected into the areas marked on your skin, and they’ll use at least 100ml of this solution to numb the entirety of your neck.
How is Platysmaplasty Facelift performed
Over the past five decades, a number of neck-lifting or platysmaplasty procedures have been developed to help make the neck area appear younger. This procedure is often combined with a method called submental liposuction and a full-face lift when necessary. Other procedures that might be done at the same time include fat reduction techniques, submandibular gland reduction, and a procedure on the digastric muscles under the chin.
Platysmaplasty involves various techniques that are chosen based on each patient’s needs, including midline platysmaplasty, corset platysmaplasty, various suture techniques, lateral platysmapexy, transverse platysma myotomy, and partial platysma myectomy.
There are two types of platysmaplasty: anterior (medial) and lateral.
1. The anterior platysmaplasty is the most commonly used and involves surgically refining the muscles in the midline of the neck from the chin to the thyroid cartilage (the largest cartilage in the larynx). The surgeon makes an incision under the skin, separates the muscle in the midline, trims the muscles, and stitches them together. This technique is not ideal for treating excess fat under the muscle, prominent glands, or hard muscle bands.
2. Lateral platysmapexy is performed when there is minimal horizontal excess of the platysma muscle. This procedure involves stitching the platysma muscle to specific areas to achieve a smooth neck contour.
Other notable procedures include corset platysmaplasty, hammock platysmaplasty, pursestring platysmaplasty, suture sling platysmaplasty, transverse platysma myotomy, and partial platysma myectomy. These procedures share the same goal – to rejuvenate the aging neck by tackling wrinkles, sagging skin and fat.
In the end, the best technique will depend on the patient’s unique anatomical characteristics and aesthetic preferences.
Possible Complications of Platysmaplasty Facelift
There are potential issues that can happen soon after, or a long time after, plastysmaplasty, which is a type of neck lift surgery.
Some of the early problems that might occur include blood collection under the skin (hematoma), fluid collection under the skin (seroma), wound infection, and injury to certain nerves, such as the marginal mandibular nerve, cervical branch nerve, and great auricular nerve. This can affect facial movements and sensation. Other possible complications include issues with the saliva glands, causing a build-up of saliva under the skin (sialocele), or even open connections between the skin surface and the salivary glands (salivary fistulas).
Later on, people might notice a few other issues like uneven shape or contour of the skin, removal of too much or too little fat, overcorrection during surgery, visible neck muscle (platysmal) bands, and the look of a too-thin neck (overskeletalization).
Doctors manage these complications in different ways. Small hematomas can be drained in the doctor’s office, but large, rapidly growing hematomas need immediate surgery to prevent blockage of the airway and death of the skin flap. In most cases, injuries to the marginal mandibular nerve or the cervical branch of the facial nerve get better on their own. These nerves control certain movements of the lower lip and corners of the mouth. Temporary solutions might include injections of botulinum toxin (Botox) to help balance facial movement.
The most common nerve injury during a neck lift is to the great auricular nerve. This can cause numbness around the ear, and, in some cases, a painful lump (neuroma) might form. If this happens, more surgery might be needed to remove the neuroma. Often, feeling will come back, but some patients might continue to have reduced sensation (hypesthesia).
Persistent neck muscle bands and uneven skin contour can often be fixed with nonsurgical treatments like Botox or surgical re-adjustment and smoothing of the skin.
What Else Should I Know About Platysmaplasty Facelift?
Platymaplasty is a type of cosmetic surgery that’s designed to enhance the look of the neck. It’s typically chosen by people aged 40 to 60 who want to reduce unsightly neck bands, jowls, and fat, but don’t want to undergo a full face-lift. The aim of this surgery is to give you a smoother, more attractive neck with a well-defined jawline.
For even better results and a longer-lasting effect, doctors often combine platymaplasty with other techniques. These include submental liposuction (removing fat from under the chin), sub-platysmal fat excision (removing fat located below the platysma muscle in the neck), and submandibular gland and digastric muscle excision (removing part of the salivary glands and a muscle in the lower jaw area).
