September/October 2001 • Volume 21 • Number 5
Serial Notching of the Platysma Bands
Ziya Saylan, MD; Dusseldorf, Germany
Abstract Background: Traditional procedures for the reduction of platysma bands can result in scarring and hardening of tissue in the submental region.
Objective: A technique for serial notching of the platysma bands is described that is more effective and causes fewer complications than the traditional submental and midline approaches.
Methods: The platysma bands are marked for incision; optimal results require multiple incisions with a distance of 3 to 4 cm between each incision. The muscle band is dissected and undermined, and notching is performed with an electrocautery. Suturing is necessary only if severe skin laxity is present; otherwise, Steri-strips for 3 to 4 days are sufficient. In most cases, submental lipoplasty is also necessary.
Results: A series of 51 procedures performed over 14 months produced satisfactory results with no major complications.
Conclusions: Serial notching is a good adjuvant to a neck lift or lower-face procedures, particularly in older patients. (Aesthetic Surg J 2001;21:412-417.)
The platysma bands may be visible in patients after submental lipoplasty. Previously, surgeons have performed a lower-face lift or lipoplasty of the neck in combination with platysma plication or suturing, both of which may result in scarring and hardening.
The midline approach in reduction of the platysma bands can lead to complications, including infections, scar formation, hardening, hematoma, and a temporary “leather neck” appearance. If a lateral approach is preferred, such as posterior neck lift, S-lift, or lower-face lift, the bands may persist after surgery and require separate treatment. In our patients, traditional midline suturing was not completely satisfactory, and a revision and scar correction was necessary in most cases. Some patients reported persistent hardened tissue in the submental region after the platysmaplasty.1,2 The neck sling described by Giampapa and Di Bernardo3 uses Gore-Tex, which can cause foreign body reactions such as hardening and inflammation. Patients also complained of feelings of strangulation and prolonged healing time.
Especially in older patients, serial notching of the platysma with or without a neck lift can produce satisfactory results.
Dr. Peter W. McKinney1 classified the platysma bands into 4 types, according to their appearance and treatment:
Type I: Bands that are barely visible in the neck and treated without midline work.
Type II: Moderately visible bands that need only midline suturing of the platysma muscle.
Type III: Bands visible only with forced contraction that require resection of redundant edges of the muscle and midline suturing.
Type IV: Dominant bands visible without any forced contraction that need a lateral pull as well as midline work.
In May 2000, Dr. Robert Ersek described the transection of platysma bands that have become visible after submental lipoplasty (oral communication). After using this technique several times in postlipoplasty patients, I introduced it as a single or adjuvant technique in patients requiring primary treatment of the neck. We have called this operation a “serial notching of the platysma bands” (Figure 1), which can be performed alone or in combination with a lower-face lift, posterior neck lift, and submental lipoplasty.
This technique is an appropriate alternative to a face lift for younger patients who seek improvement of the platysma bands. It is also an alternative for elderly patients (type IV face lift patients, after the classification of Dr. Daniel Baker4). In these two patient groups, serial notching of the platysma bands can be more effective and cause fewer complications than suturing the muscle. It also is an alternative for those patients of any age who reject major surgery.
Patients were requested to lean their heads backward to expose the platysma bands. Incisional markings were made, with a distance of 3 to 4 cm between each incision (Figure 2).
After washing the skin with providone-iodine, local anesthesia was injected. If lipoplasty was planned, an additional infiltration with a classical tumescent solution was necessary. After injecting local anesthesia (1% lidocaine with 1:10,000 adrenaline), 1 mL to each incision site, an incision of 1 to 1.5 cm horizontal to the platysma band was made with a #15 blade. Multiple incisions were necessary for optimal results. With the use of a small mosquito clamp, the muscle band was undermined and dissected on both sides (Figure 3, A) and delivered out of the wound with the help of the instrument.
The notching was done with a Colorado needle (Colorado Biomedical Inc., Evergreen, CO), with a blended cut and coagulation setting. This was repeated along the length of the muscle (Figure 3, B, and Figure 4).
Skin suturing was not always necessary but was advisable if severe skin laxity was present. If skin laxity was minimal, we obtained much better results with Steri-strips (3M, Rochester, MN) applied for 3 to 4 days than with suturing. The incisions were closed with sterile plasters. After 5 to 6 days, the platysma bands were no longer visible even when contracted; only some skin redness remained. Patients were able to cover their necks and participate in social activities 1 day after surgery and to return to work after 5 to 7 days.
The most common advantages of the serial notching technique are as follows:
It is performed with local anesthesia.
No large submental incisions for platysmal band plication are necessary.
The duration of surgery is no longer than 20 minutes.
There is less possibility of hematoma.
The recovery period is quick (5 to 7 days) compared with that for a neck or lower-face lift (14 to 21 days).
The cost is significantly lower, compared with a neck lift or lower-face lift.
It can be combined easily with a neck lift or lower-face lift if necessary.
The technique is an excellent option for the male patient who wants a clean neck and jaw contour without a lower-face lift. It is also a good alternative to secondary rhytidectomies for treatment of only the platysma bands.
Disadvantages include the following:
There is a possibility of visible scar tissue at the anterior neck.
If fewer incisions are made, the remainder of the retracted muscle between 2 incisions can be visible and palpable under the skin.
The technique does not improve skin laxity.
A depression at the incision site may occur if markedly hypertrophic muscle is cut.
Serial notching of the platysma will eliminate platysma bands, particularly in older patients, when performed alone or as an adjuvant to a neck lift or surgery of the lower face. No special and expensive instruments are required, the recovery time is short, sutures can be removed after a few days, scarring is minimal, and no major swelling or bruising of the neck occurs. If multiple and serial incisions and notching are performed, no depressions or retracted muscles will be palpable or visible.