Thank you for your question. You are asking a very good question about why there are so
many conflicting opinions on surgeons’ preferences on how to treat platysmal bands and you go
through basically the laundry list of typical approaches from anterior platysmaplasty, corset
platysmaplasty, back cuts, pulling of the platysma. And you are wondering why is there
such a variation. Well, if you get down to it, whether it is
face lifting, neck lifting and all of the different aspects of these procedures, there
is no perfect solution and that is why there are varying opinions. I think as a specialist
and a little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon. I’ve been practicing for over 20 years and I offer
the full range of face and neck lifting solutions in my practice. And I have done all those
procedures because one of the greatest frustrations for surgeon is that if someone looks great
after surgery and you are really happy and then a year later they have recurrent platysmal
bands, you wonder how could that possibly have happened given whatever technique you
are doing you work so hard to do.
The reality is that platysmal bands will sometimes respond very well to different methods and
so every surgeon feels like whatever they are doing has probably worked out well for
them in terms of the consistency and predictability but I can tell you when being in practice
for this long and seeing a lot of my senior surgeons change their approaches where they
were so passionate, so dogmatic about the very best way to treat these bands only to
say five years later that they have evolved to something else. There is constant evolution
in what we do. And I would say that in the modern approach to face lifting, neck lifting
surgery in my practice where our goal is to do these procedures with the quickest recovery,
with the lowest risk and the highest level of predictability, I think that my approach
is reflective of what are the needs of the modern patient. What I mean by that is that
sometimes it takes a dual approach. Sometimes you have to do not only the surgery but also
address volume correction, skin quality, treat the platysmal bands maybe with a neurotoxin
like Botox™. Essentially, we need to do everything we can to maximize the outcomes
but certainly face lifting, neck lifting surgery is still very successful at dealing with a
lot of these issues.
The reason why you’re dealing with these conflicting opinions is that every surgeon
comes to their procedure with a different perspective. In my opinion, in the way I approach
these issues because I do all those procedures, I look at the platysma. I look under the neck
and I look at the platysma and I make a decision as to whether or not I think that the platysmaplasty
will be successful, whether a back cut release and lateral pull of the platysma would be
successful. I make a lot of decisions based on what I see intraoperatively. A lot of times,
doctors like to promote certain techniques as being the best way to do something and
that’s something to differentiate themselves but I would state that majority, I would say
of my colleagues who have experience and who are honest about what they do will say that
they don’t do everything the same way but do things as per what they see during surgery.
There could be a plan but that plan has to be flexible.
So I think you have to talk to your doctor, find the surgeon that you feel comfortable
with and get a realistic understanding of what to expect. You know if there was one
best way to do something, we’d all be doing exactly the same way. So it really is about
what we can expect and what can we do if there is a need for enhancement whether there is
a need for something else to further augment and maximize the result. This is where we
are very fortunate in the time we live in that we can offer so many additional procedures
that are less invasive that can complement and enhance and maximize the results for our
patients.
So I hope that was helpful, I wish you the best of luck and thank you for your question!