Complete Platysma Transection in Neck Rejuvenation: A Critical Appraisal

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Background:The most common features of aging in the anterior neck are skin laxity and anterior platysma bands. Most neck correction techniques fail to obtain lasting correction of these despite promising early improvement. The authors use a major procedure to obtain the best results, combining full neck undermining with complete platysma transection and midline platysma approximation. Even using this technique, the authors have had concerns about the long-term results, and are aware of the lack of published studies of results using this technique.Methods:A prospective study was conducted on 150 consecutive neck-lift patients operated on by the same senior surgeon (M.P.C.) between 2010 and 2014 to evaluate patient satisfaction and recurrence rates of anterior skin laxity and platysma bands. Patients were reviewed at 3 months (138 cases) and 1 year (96 cases). At both time points, patients completed questionnaires on level of satisfaction and eventual complaints regarding their surgical treatment, and were objectively evaluated for skin excess and recurrent bands.Results:At 1 year, 76 percent of the patients were satisfied with the outcome using this technique, although satisfaction had been 100 percent at 3 months. However, only 52 percent showed no anterior neck skin excess and 55 percent had no recurrence of bands 1 year after surgery.Conclusions:Despite obtaining satisfactory results in most patients, this technique has several downsides: 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. After 25 years’ experience with these deficiencies, a reconsideration of the most appropriate procedure for correction of the anterior neck is warranted.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.

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