Facelift: Assessment of Total Platysma Muscle Transection to Prevent the Recurrence of Platysmal Bands

Abstract

Introduction: Determining which facelift technique yields the most effective long-term rejuvenation results and ensures optimal stability over time remains a significant question in cosmetic surgery: Does the most invasive surgery lead to the best long-term outcomes? This study aims to evaluate the authors' approach using total platysma muscle transection to prevent platysma band recurrence, and to provide anatomical observations supporting and justifying their procedure.

Material and methods: A preliminary study in anatomical basic sciences was conducted to establish the rationale for our method. A prospective single-blind study was conducted, involving eighty patients seeking facial rejuvenation with platysmal band correction. They underwent face and neck-lift procedures with total platysma transection by the same surgeon between May 2013 and May 2016. Cosmetic outcomes were assessed using the Face and Neck-Lift Objective Photo-Numerical Assessment Scale. Scores by three blind evaluators before surgery, at 1 and 5 years postoperatively, were compared using a matched T Test (p < 0.05).

Results: The preliminary anatomical study revealed a consistent anastomotic system between the cervical branch of the facial nerve and the branches of the cervical plexus. Incomplete platysma section during a facelift might contribute to platysma band recurrence. The clinical study demonstrated satisfactory outcomes, with significant overall appearance improvement (p < 0.00001) and no platysma band recurrence. Complication rate was low.

Conclusion: The authors' technique achieved satisfactory long-term results with minimal complications. However, due to the lengthy operating time and steep learning curve, it should be reserved for highly motivated patients.

Level of evidence ii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Facelift; Platysma muscles transection; Platysma myotomy; Rejuvenation surgery; SMAS flap; The Face- and Neck-Lift Objective Photo-Numerical Assessment Scale.

Fig. 1

Anatomical findings in fresh cadaver dissections. Ten consecutive cadaveric face and neck dissection (20 hemi-necks and faces) of the superficial musculo-aponeurotic system (SMAS) and platysma areas were carried out to study the innervation of the platysma muscle. Dissections were performed using a facelift approach. The skin and the SMAS were raised very cautiously to reveal the underlying nerves. Innervation of the platysma muscle is shown: The platysma muscle is innervated by the cervical branch of the facial nerve that is connected to the nerves arising from the cervical plexus. A constant anastomotic system between the cervical branch of the facial nerve and the branches of the cervical plexus may be responsible of the platysmal bands recurrence after a facelift procedure, when a complete section of the platysma is not carried out. 1. Marginal mandibular branch of the facial nerve. 2. Cervical branches of the facial nerve. 3. Branches of the cervical plexus. Arrow: Anastomoses between the cervical branch of the facial nerve and branches of the cervical plexus

Fig. 2

Total platysmal transection. Three cm (1.2 inches) were maintained between the edges of the transected platysma to avoid the recurrence of the platysmal bands

Fig. 3

Face and neck-lift. A SMAS flap is raised and dissected above the entire parotid region starting from the pre-auricular incision. The SMAS and platysma muscle are raised after making a 2 cm (0.79 inches) incision below the earlobe to allow traction with a horizontal vector and a vertical vector. The lower head of the platysma muscle is then pulled following a retro-mastoidal horizontal vector and anchored to the mastoidal aponeurosis, and the superior head is pulled on a vertical vector and anchored to the pre-auricular aponeurosis through Vicryl® 2/0 sutures

Fig. 4

Frontal and lateral photographs of a 56-year-old woman who presented with midline bands, jowls, and skin laxity. She underwent a face and neck-lift along with SMAS flap repositioning, total platysma transection and nanofat injections of the perioral wrinkles. Her preoperative (a, b) and 6 years postoperative (c, d) photographs are shown. Improvements in contour of mandible and platysmal bands reduction are shown

Fig. 5

Frontal and lateral photographs of a 67-year-old woman who presented with midline bands, jowls, and a very pronounced skin laxity in the neck region. She underwent a face and neck-lift, SMAS flap repositioning, total platysma transection, neck liposuction. Her preoperative (a, b) and 5 years postoperative (c, d) photographs are shown. Improvements in contour of neck mandible and mid-face are shown

Fig. 6

Frontal and lateral photographs of a 63-year-old man who presented with midline bands, jowls, and moderate skin laxity. He underwent a face and neck-lift along with SMAS flap repositioning, total platysma transection, direct brow lift, upper and lower blepharoplasty. His preoperative (a, b) and 6 years postoperative (c, d) photographs are shown. Improvements in contour of mandible and neck are shown

Fig. 7

Pre-operative aspect of a 65-year-old woman. She underwent a face and neck-lift along with SMAS flap repositioning, total platysma transection and nanofat injections of the perioral wrinkles and of the malar region. Her preoperative (a) and 5 years postoperative (b) photographs are shown. Post-operative platysmal bands reduction can be appreciated

Fig. 8

Initial appearance of a 63-year-old woman displaying prominent midline bands prior to treatment. The patient underwent a face and neck-lift procedure involving complete platysma transection. Depicted are her preoperative (a) and postoperative at 6 years (b) photographs. Evident in the images is the reduction of post-operative platysmal bands