By Alexander Zurriarrain, MD

As plastic surgeons, we know that traditional platysmaplasty improves the contours of the aging neck and jawline by eliminating sagging skin and excess fat. It can be combined with other surgical lifts, such as face and brow procedures, and when expertly performed on suitable candidates, it provides long-lasting results. Now, thanks to advanced techniques, many of these neck-lift procedures are being performed minimally invasively and, in some cases, non-surgically.

Better Cosmetic Tools

Even the tools and resources at hand for neck rejuvenations have improved. The American Society of Plastic Surgeons describes use of a thread lift, which employs “absorbable, barbed sutures” as part of a minimally invasive approach to stimulate collagen production in the neck, enhance texture of the skin, and reduce skin laxity. The sutures, where placed, help lift the neck tissues.

Also becoming more popular have been mini- or micro-neck-lifts, which usually involve limited cutting combined with liposuction or other skin-enhancement procedures. A majority of patients responding to non-scientific surveys have indicated a high degree of satisfaction with the outcomes of a micro-neck-lift.

Panoply of Nonsurgical Options

Meanwhile, the number of nonsurgical platysmaplasty options have increased in proportion to the growing numbers of patients coming to our practices at an earlier age and seeking more youthful-looking necks. These are typically patients who hope to enhance their skin tone and remove the neck folds and wrinkles, which often start to manifest even in their 30s and 40s.

At the same time, they want to avoid “going under the knife.” Nonsurgical approaches are more attractive to this population because of the shorter procedure times, quicker recovery periods, and fewer risks—all at less expense. The main drawback of these procedures is that the results achieved are relatively temporary.

In our toolboxes are injectable dermal fillers; Botox; Kybella, which is composed of deoxycholic acid capable of breaking down fat cells; fractionated ablative lasers; radiofrequency with microneedling; and even ultherapy, another form of energy treatment to encourage collagen production.

Traditional Neck-Lift Still ‘Gold Standard’

All this said, traditional surgical platysmaplasty remains the gold standard for achieving optimal, long-lasting results, especially in older patients who often have developed excessive skin sagging, neck fat deposits, and wrinkling; extensive banding of the platysma muscle; and abnormal neck contours, including an ill-defined jawline. In fact, the neck is one of the first areas to exhibit signs of aging and sun damage. The surgery can be done under general anesthesia or with intravenous sedation.

In a typical neck-lift, the surgeon will first make incisions either behind the ears or under the skin as a way to “hide” the scar. The platysma muscle is tightened and stitched together to secure it; excess skin and fat are trimmed off; and remaining skin and tissues are smoothed and repositioned to achieve a more slender, youthful neck and then anchored in place with sutures.

The surgeon might also perform liposuction or undertake further skin tightening using an energy device as part of the procedure. The neck-lift produces no tightness or inhibition of head movement and may be combined with a facelift, depending on the patient’s desired needs and the surgeon’s recommendations.

Creating ‘Feel-Good’ Images

Critical to the success of any platysmaplasty is patient selection. In general, ideal candidates have no medical condition that will impair recovery and healing, do not smoke, offer solid reasons for undergoing the cosmetic procedure, and maintain realistic expectations of the results. The goal, of course, is to enable our patients to realize a more youthful appearance by streamlining their profiles, smoothing and tightening their skin, and crafting a more defined jawline. Indeed, we want our patients to feel good about themselves.

Our Role in the Evolution

Platysmaplasty has evolved significantly, thanks to a changing—and increasingly younger—patient population, the introduction of new modalities, and advancements in plastic surgery equipment and technology. The prevalence of “selfies,” social media posts on platforms like Facebook and Instagram, and video calls, along with the idealized appearance projected by popular actors and singers, have only heightened people’s concern about their public image. Wrapping a wrinkled neck with a scarf is no longer sufficient. 

As aesthetic plastic surgeons, we owe it to our patients to achieve the best possible outcomes.

This means questioning, counseling, and assessing their specific needs before initiating any procedure, while also staying updated on the latest techniques and approaches to ensure the highest quality and longest-lasting results.

Alexander Zuriarrain, MD, FACS, is a board-certified plastic surgeon and owner of Zuri Plastic Surgery in Miami. Listen to a podcast PSP did with him here.