Composite Platysmaplasty and Closed Percutaneous Platysma Myotomy: A Simple Way to Treat Deformities of the Neck Caused by Aging
Accepted 8 April 2009.
Background
Although cervical skin and platysmal laxity are more apparent at the lateral area of the neck, the reported treatments focus on performing plication on the anterior midline or releasing the muscle's lateral border and tractioning it back. Because of the ineffectiveness of such methods in solving more complex cases, surgeons have been trying more efficient procedures that are also riskier and could therefore increase the complication rate.
Objective
The author describes a simple method for treating cervical laxity using composite platysmaplasty. He also reports on the use of closed platysma myotomy to treat remaining or recurrent platsymal bands.
Methods
A vertical incision was made on the platysma, parallel to the midline, followed by the creation of a flap made of skin and platysma at the area where tone loss was more evident. When this flap was pulled back, it formed a double muscle layer that pressed on the submandibular gland, pushing it back into its original position. The tightening achieved by the fixation of the flap provided excellent definition of the mandible line. The platysma bands were approached by a method of percutaneous incision of the platysma.
Results
Between October 2005 and December 2008, 129 patients underwent surgery. Seventeen patients underwent closed percutaneous platysma myotomy in conjunction with platysmaplasty. Four patients underwent platysma myotomy to treat platysmal bands in a secondary procedure from two to eight months after the original surgery. All patients were satisfied with the aesthetic results of treatment. The only serious complications were two cases of temporary neuropraxia of the cervical branch and one hematoma with partial necrosis of retroauricular skin.
Conclusions
Composite platysmaplasty, combined with closed platysma myotomy when indicated, has a short learning curve and provides satisfactory results with a low complication rate and fast recovery. While closed platysma myotomy has been performed by the author as an independent procedure, those operations are not covered in this report and deserve a separate study. (Aesthet Surg J;29:344-355.)
Reprint requests: Raul Gonzalez, MD, 6611 Amadeu Amaral–Villa Seixas, Ribeirao Preto, São Paulo, Brazil
DISCLOSURES
The author has no disclosures with respect to the contents of this article.
1 Dr. Gonzalez is an Associate Professor of UNAERP Medicine School, Ribeirao Preto, Brazil, and is in private practice in São Paulo, Brazil. He is a member of the Brazilian Society of Plastic Surgery.
ABSTRACT