Serial Notching of the Platysma Bands, Updated

Abstract

Introduction: A traditional platysmaplasty almost always results in hardening and scarring at the submental region. In an attempt to avoid these complications, the author has developed a technique for serially notching the platysma bands. Materials and Methods: Patients demonstrate their platysma bands so that they can be marked with a distance of 3–4 cm between every incision. After injecting local anesthesia with epinephrine 1 mL to each incision site, a stab incision is made with a number 11 blade horizontal to the platysma band. Multiple incisions are necessary for a better result. The skin must be pinched together with the muscle between the thumb and index finger. The notching is done with an electrocautery and needle and repeated at the sites marked along the muscle. The wounds are covered with sterile dressings. Results: Serial notching of platysma bands was performed on 102 patients (10 men [9.8%] and 92 women [90.2%]). Only 5 hematomas (5%) were observed. Apart from the cases of hematoma, the other 97 cases were satisfactory (98%). In 78 cases (76.5%), the doctors also performed an S-lift or a facelift and witnessed better results. In most of the cases (80 cases, 81%), a submental liposuction was also necessary. Discussion: This technique alone, or combined with liposuction of the neck and with surgeries of the mid to lower face such as posterior necklift, S-lift, short scar facelift, or a conventional facelift, will eliminate platysma bands, especially in older patients. Since using this technique, we have not been required to perform platysma plication (platysmaplasty). This kind of notching of the platysmal bands is mainly done with liposuction. No special and expensive instruments are required, recovery time is very short, scarring is minimal and the sutures can be removed after a few days. If multiple and serial incisions and notching are done, no depressions and retracted muscles will be palpable or visible. It causes no major swelling and bruising of the neck. Also, only 1 case of hematoma was observed and there were no other complications. This technique is a very good adjuvant to a neck or lower facelift in older patients and in some younger patients Type I, II, and III).