Cervicoplasty & Platysmaplasty

A cervicoplasty is a plastic surgery procedure that addresses the neck area and usually includes some form of platysmaplasty.

A platysmaplasty is part of a cervicoplasty and it essentially takes the platysma muscle and tightens it. The surgeon usually does a combination of things such as excising bands and sewing them together to recontour the neck when the platysma muscle is lax. Cervicoplasty does that as well as some additional things like skin tightening and possible fat removal.

EXAMINING THE PATIENT

The cervical, or basically cervix in this case, is actually the Latin term for neck. When a surgeon is talking about cervicoplasty, he is talking about reshaping, recontouring and rejuvenating the neck. The platysmaplasty refers to one aspect of it.

In the end, it is really semantics because the doctor evaluates the patient in a way where it cannot be broken down. The doctor has to determine what the issues are with the patient. Do they have laxity to the skin? Do they have a redundant amount of skin? Do they have extra or unwanted subcutaneous fat? Do they have subplatysmal fat on the under surface of the muscle that needs to be removed?  Is the platysma muscle itself lax? Does it need to be tightened? Are there bands to the platysma that need to be divided?

There are many reasons why a neck can look aged. When it comes to a cervicoplasty, the surgeon might be correcting several of those things or all of those things. The surgeon is basically doing what the patient needs and attaches the cervical procedure to the diagnosis.

PLATYSMAPLASTY ONLY

There are some occasions where the surgeon will only do a platysmaplasty on patients that do not have a lot of subcutaneous fat or subplatysmal fats. The surgeon may just go in and tighten up the muscles through a small, submental incision.

TYPES OF PATIENTS 

The typical patient is somebody that is starting to see the physical signs of aging in their face and neck.

However, there can be a wide range of patients. There can be younger patients that have a pretty good skin tone and do not necessarily have a lax or saggy or loose platysma muscle, just extra fatty tissue. Surgeons can get rid of the fatty tissue that is in the neck via liposuction and give the patient a recontoured neck since the skin will bounce back.

OTHER OPTIONS 

As mentioned above, there can be patients that have a problem as simple as some redundant subcutaneous fatty tissue that can be handled with a small surgical procedure such as liposuction. There are medical treatments, such as Kybella, where the surgeon injects medications to dissolve the fat. There are a couple of energy based devices that can shrink and kill fat cells like BodyFX and ThermiRF.  There is also CoolSculpting which freezes the fat cells and the body gets rid of them.

There are patients with a combination of things such as laxity to the skin, wrinkles in the skin, a loose or lax platysma, or a sagging of the face itself. If somebody’s face is sagging, it is creating more loose skin in the neck and pushing that skin downward. The treatment in this case is more of a facelift.

SUBMENTAL NECK LIFT 

A submental neck lift is where the surgeon makes a small incision underneath the chin so he can do liposuction of the undersurface of the skin and directly excise fat that resides under the platysma muscle. The doctor can address the platysma muscle itself by sewing it together or dividing some of the platysma bands. The surgeon will not be able to take out skin through that small incision. The doctor is relying on the skin to contract into its new position. If there is a lot of extra skin or the skin quality is not good, the surgeon will have to make additional incisions. Doing a dissection that is typically around the ears lifts the skin up off the neck and lower face and retracts that skin up and tightens the neck that way.

LIMITATIONS

In terms of limitations, there is no textbook limitation on how much skin can be removed. The surgeon has to excise the right amount per patient which is basically enough to rejuvenate the neck and not so much that the incisions cannot be closed.

RISKS

The potential risks of any surgery include unwanted scarring, infection, postoperative bleeding, and fluid collections underneath the area of surgery known as a seroma. There can be a situation where the circulation to the skin is undermined enough that it causes skin death. There can also be some nerve damage. There is definitely going to be some temporary or permanent loss of sensation in spots which is more of a side effect than a risk.

There can also be damage to a motor nerve which is typically the cervical branch of the facial nerve. An injury to that can cause a funny frown or smile because the cervical branch of the facial nerve enervates the platysma muscle and enervates some of the lip depressors. Actually, the platysma muscle is one of the lip depressors. Injuring that nerve and/or muscle will cause a person to have a difficult time frowning on the side of the face where the nerve is injured. It should heal as time passes as long as it was not injured to the point where it was divided.

SCARRING

There will be scars if the patient has skin loss. There might not be scars if the skin survives and there is no problem with the circulation to the skin or burns from an energy-based device to tighten the skin.

There is often an incision that is made underneath the chin. Most of the time, that scar heals well with a very fine line. There are times where it heals in a thickened fashion and is more noticeable. If the cervicoplasty includes incisions around the ears because of tightening up the platysma and excising skin laterally on the outside, there is going to be incisions there. It is important when performing a procedure like this to keep the tension on the repair in the right spot so that the patient does not get a thick scar that is visible to the general public.

There is the potential of an ugly scar called a pixie ear where that scar is created around and underneath the earlobe. It pulls down almost like an elf or a pixie and is not aesthetically pleasing.

The surgeon tries to avoid these things by not overly excising the skin and making sure that the tension is off of the skin when doing the repair. The goal is to reshape the neck and put the incisions in places where the scars are not seen and they heal in a very thin fashion that is hardly visible.

RESULTS

The results are essentially permanent. Most patients come in with some related signs of aging. If they have nothing done to their neck, those signs and symptoms are going to continue to progress and worsen. A procedure like this can rejuvenate the neck and set the clock back 5 to 15 years. Patients will always look better than they would have if they had not done the procedure.

The aging process continues so there is going to be some recurrence of the signs that got them there in the first place. There are lots of things that can speed up or slow down the aging process. Maintaining a steady weight, staying out of the sun, and not smoking are a few of the ways a patient can maintain long lasting results.

FINAL THOUGHTS

Cervicoplasty and platysmaplasty are not “one time cures all” procedures. The patient has to be a participant in their own care. They need to listen to their doctor and follow their advice about proper skin care products. There are small steps along the way both before the procedure, and after the procedure, to maintain firm looking skin.

Written by Cosmetic Town Editorial Team- MA

Based on an exclusive interview with Michael Epstein, MD in Northbrook, IL