Corset and Midline Platysmaplasty

A corset platysmaplasty technique is different from other neck lift techniques in that it focuses on tightening the platysma muscle under the chin where the muscle is the weakest. Midline platysmaplasty focuses on the midline neck muscles that cause a “Turkey Waddle” and tightens the muscles to improve the overall look of the neck and chin.

PLATYSMA

A platysmaplasty corrects the turkey gobbler bands in the neck and also decreases the downward pull on the face. It also slows down the aging process and gives immediate results by tightening the platysma in the middle. The procedure is connected to the superficial muscular aponeurotic system (SMAS) of the face and it descends the SMAS. Although many people assume gravity pulling the face down, it is actually the platysma muscle that is causing it to pull down.

Previously, doctors would only remove the superficial fat between the skin and the muscle to create the jawline in the neck. Doctors will now frequently go under the muscle AKA subplatysma dissection. Taking out the fat underneath the muscle, even going as far down as the digastric muscle and taking some of the belly of the digastric muscle before closing up the platysma, makes the neck as sculptured as the patient desires. The platysma muscle must be cut to be weakened. If the doctor decides to sew it together in the midline, it will have to be sewed behind the ears as a sling within the face to hold it up. After some time the strong muscle breaks whatever connections are in the center of the neck or in the back of the neck because they turn bad from longevity.

DIFFERENCES

One of the main differences between a corset and a midline platysmaplasty is that a midline just closes the muscle in the center. The corset closes the muscle at the side and pulls it in two directions to tighten it much like the corset of a female. A woman’s corset cinches in her waist a number of inches in two different directions from the front and the back. In this operation, the tightening is done in the front and the side.  That is why it is called a corset.  Both approaches are equally effective.

BEYOND MIDLINE AND CORSET

The neck operations of today are moving far beyond midline and corset platysmaplasty. They go into deeper layers to get better contouring by taking out the lower submandibular glands and going down to the digastric muscles. Going deeper is not for everybody as some people can get away with doing a superficial operation. The future is moving towards a combination of different neck lift approaches and techniques as opposed to just corset or midline. The doctor will make the proper analysis of the patient and determine how deep and how many layers the doctor has to go through for the ideal results.

IDEAL CANDIDATE

There is not a lot of difference between the candidates for either one. It just depends on how the doctor analyzes the muscles in the neck. Somebody with looser muscles would want to do a corset and somebody with tighter muscles and a little bit of a laxity would want to do the midline.

LIMITATIONS

There are not many limitations when it comes to either technique. The technique decision is greatly based on the age of the patient. A platysmaplasty is for a younger patient. If the patient is a little bit older and the face has already fallen, the doctor should do a platysmaplasty and a facelift as well. An older patient has lax skin and, if only a platysmaplasty is performed, the whole neck area above the Adam’s apple will actually be depressed with the two sides of the face hanging down. The face has to be lifted up on both sides to match the operation of the platysma.

One other limitation is how much the surgeon can actually cut down on, or lift up, the platysma. It is tightened 1-cm or 2-cm and never more than that.

RISKS

As far as hitting any structures, ordinary structures near the area where a platysmaplasty is performed are dangerous because the surgeon can hit the facial nerve. Taking out the submandibular gland can involve hitting a branch of the facial nerve causing the mouth to not elevate and go downwards on a temporary basis. Most of these nerve injuries repair themselves and it takes about eight weeks for it to come back. If the surgeon does the technique evenly and takes his time, there is not a lot of danger.

With a midline specifically, the doctor can take out part of the thyroid gland by mistake or the parathyroid glands from the middle line. The vocal chords can also be hit by accident.

RECOVERY 

After a corset or midline neck lift, doctors want the patients to wear a neck strap for three days. Some doctors put drains in when they do a neck lift that come out on the third day. Sutures come out in a week. The healing process takes one or two weeks. It is pretty painless with little to no swelling or bruising.

RESULTS 

In general, the results can last 10 or more years.  The operation is an altering of the anatomy. The face gets loose again and will have to be tightened again. As far as the platysma loosening up and hanging down, it does not do that when the platysma is cut. The results are different with each patient but it will be more aesthetically pleasing when done with a facelift.

FINAL THOUGHTS

While a corset platysmaplasty and a midline platysmaplasty are alike in many ways, the two of them are not interchangeable enough to be performed on all patients. An experienced doctor can examine a patient and determine if they are a candidate for one or both techniques based on their age as well as what needs to be done to achieve the desired results.

Written by Cosmetic Town Editorial Team - MA

Based on an exclusive interview with Richard Ellenbogen, MD in Los Angeles, CA