Thank you for your question.
You submitted your question with a single photo focused on your neck from the front
view. And you’re stating in your question that your surgeon recommends a corset platysmaplasty
and you’re concerned about a choking phobia or the perception of tightness and a choking
feeling after platysmaplasty. You’re also asking whether or not this procedure is done
typically under general or local anesthesia as well as a question about whether it’s
safe to have this done with a nurse anesthetist as opposed to a medical doctor or an anesthesiologist.
Well, certainly I can share with you my personal approach in helping my patients understand
the pros and cons of both the surgical approach as well as the type of sedation that’s optimal.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island
for over 20 years. Helping people with aging neck and improve the appearance of their neck
and face has been a significant part of my practice over the duration of 20 years with
continuous evolution of this very challenging area which is reflective of the many different
elements that it takes to try to get the best result possible for an individual patient.
So to begin with, let’s understand a little bit about what the purpose is of a corset
platysmaplasty. Now in my practice, generally speaking, rarely do a corset platysmaplasty
as an isolated procedure. And the reason is that the goal is to certainly improve neck
contour by defining the area between the chin and the neck angle as well as the overall
sharpness of the side view of the neck. However, generally speaking, at the same time, there’s
laxity and sagging of the facial tissue which is often done in conjunction with a facelift.
And if there is a significant amount of extra skin, then it’s also done with a combination
of a face and neck lifting procedure. So in terms of using those particular words and
terminology, there are many ways to do all those procedures.
Now specifically, one of the challenges of helping people with the platysmal bands which
is generally one of the indications of corset platysmaplasty is that whether you’re using
different types of suture material and the techniques in which you close the platysma
that is divided and various types of maneuvers to maximize the result, there is the possibility
of a tight feeling. I would say that it’s very rare for someone to feel like they’re
choking but it is certainly possible to feel a tightness. You can certainly discuss this
with your doctor. They can share with you their experience in what they generally find.
I think that one of the things to at least understand is that even though things are
done very tightly during surgery, the tissue has a natural relaxation. And what that means
of course is that the muscles stretch a little bit, the skin stretches a little bit. And
so with time, there is an equilibrium that ultimately settles out. So things that are
maybe tight in the beginning tend to stretch a little bit with just facial movement and
tissue elasticity.
And of the things to also discuss is of course whether or not it’s indicated to have another
procedure in addition to just the corset platysmaplasty whether it’s facelift or face and neck lift.
Just as a side note, if you look at the plastic surgery literature, to this day, almost every
year, there are significant numbers of journal articles about the best way to do face lifting,
neck lifting and platysmaplasty. I shouldn't say best ways but new approaches which again,
as I said earlier, reflective of the certain limitation of working with the human body
and what you do in surgery ultimately settles out over the course of time.
Now as far as something is done under general anesthesia versus local versus local with
sedation, in my practice, we do something called LITE™ anesthesia which is basically
local anesthetic which means making the area numb with local anesthetic like you would
like a dentist. And you also get LITE™ intravenous sedation. We generally avoid general anesthesia.
This is something that has worked out very well for me in my practice in the way we do
things. I avoid essentially the many risks and challenges of general anesthesia. My patients
are very comfortable and get up and walk away without having any of the usual or often side-effects
after using general anesthesia. So it’s really the surgeon’s preference. Many surgeons
prefer general anesthesia versus local and sedation and they have their reasons and this
is something that you should discuss with your doctor.
Now as far as a nurse anesthetist versus an anesthesiologist, I think again it’s important
for you to discuss this with your surgeon. I think that every surgeon who has like what
we have in our practice, we have our own facility, we’re certified by the Joint Commission,
the staff that I work with is very comfortable with me and the way I do my surgeries. I think
it works both ways. A surgeon can work very comfortably with an anesthesia provider whether
it’s a nurse anesthetist or anesthesiologist. And so if your surgeon feels comfortable then
I think it’s reasonable for you to feel comfortable and I think that there shouldn't
be any particular bias based on this particular qualification. I think experience is critically
important and depending on the relative risk of complications related to anesthesia, that’s
also an important factor to understand. So if I feel someone is not a patient that I
would feel comfortable with doing it in my office facility then I’ll either bring them
to a surgery center or hospital or I’ll just not do the surgery. So discuss this with
your doctor since your medical history is not part of your question.
So I hope that was helpful, I wish you the best of luck and thank you for your question.