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Rethinking complete platysma transection

A plastic surgeon critically looked at his own series of 150 consecutive complete platysma transection necklift patients and suggests the specialty should reconsider what the most appropriate procedure might be for correction of the anterior neck.

In a recent study, Mario Pelle Ceravolo, M.D., a plastic surgeon practicing in Rome, Italy, and colleagues studied the use of a major neck rejuvenation procedure, combining full neck undermining with complete platysma transection and midline platysma approximation.

The prospective study was conducted between 2010 and 2014, evaluating patient satisfaction and recurrence rates of anterior skin laxity and platysma bands. The researchers reviewed 138 of those patients at three months and 96 cases at one year. During those reviews, patients completed questionnaires designed to gather their input on the procedure.

They found that 100% of patients were satisfied at three months, but that dropped to 76% of patients at one year. Results, according to what the surgeons saw, began to decline at one year, when 48% of patients appeared to have anterior neck skin excess and, in 45%, the bands were recurring.

While the results from the major cosmetic procedure were satisfactory in most patients, the authors note the technique’s many downsides, including that “… it is time consuming, there is the risk of iatrogenic deformities unless it is carried out precisely, the postoperative recovery is often very long, and there is a significant failure to maintain long-term correction.”

NEXT: Alternative Approaches

 

Dr. Jacono

Alternative Approaches

Facial plastic and reconstructive surgeon Andrew Jacono, M.D., says that he has witnessed the same things in his practice with the complete platysma transection necklift.

“My way of avoiding those problems was to abandon those techniques that I was taught and to start doing a different procedure,” says Dr. Jacono, who practices in Manhattan and Long Island, New York.

According to Dr. Jacono, when surgeons do face and neck lifting surgery, the most common place to have failures is in the neck.

“The complete platysma transection necklift is one of the more aggressive procedures that has been popularized among plastic surgeons during the last two decades. The theory behind it is that if you cut from the center of the platysma in the middle of the neck, all the way across to the lateral part of the neck, you’ll deactivate the muscle so that the muscle won’t droop as much,” Dr. Jacono says. “Anybody who does a lot of face and necklifts, and that’s primarily what I do in my practice, sees that oftentimes after two years or more, the results of a necklift might not be as long as we’d like and other deformities can show up as a result of all the maneuvers we do on the muscles.”

As a result, Dr. Jacono published a paper in 2011 on his minimal access deep plane extended vertical facelift approach, which includes an extended lateral platysmal flap elevation, to prevent the need for anterior platysmal plication and platysmal myotomy.

Dr. Ceravolo also dramatically changed his approach to the surgical necklift, and his results will be published February 2017 in Plastic and Reconstructive Surgery (PRS).

Dr. Ceravolo“After many years of carrying out very aggressive procedures on the neck, I realized that very few of our patients accept to be away from social [activities] for four to eight weeks, and even [fewer] of them accept some of the risks linked to complete neck undermining ( i.e., long term skin induration, irregularities of the contour, etc.),” Dr. Ceravolo says. “For this reason, I have dramatically changed my approach to neck rejuvenation [for the last] six years. I am now using a technique, which I call Lateral Skin-platysma Displacement (LSD), which can obtain similar or even better results than the most aggressive techniques and still avoid any submental incision, anterior neck undermining and many of the risks that these maneuvers entail.”

The result of the revised approach, according to Dr. Ceravolo, is patients are more willing to undergo a procedure in which they achieve tightening of the skin laxity over the anterior neck and diminished platysma bands, in a shorter recovery time and with fewer side effects.

Disclosures: Drs. Ceravolo and Jacono report no relevant disclosures. 

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