Composite platysmaplasty and closed percutaneous platysma myotomy: a simple way to treat deformities of the neck caused by aging.

BACKGROUND Although cervical skin and platysmal laxity are more apparent at the lateral area of the neck, the reported treatments focus on performing plication on the anterior midline or releasing the muscle's lateral border and tractioning it back. Because of the ineffectiveness of such methods in solving more complex cases, surgeons have been trying more efficient procedures that are also riskier and could therefore increase the complication rate. OBJECTIVE The author describes a simple method for treating cervical laxity using composite platysmaplasty. He also reports on the use of closed platysma myotomy to treat remaining or recurrent platsymal bands. METHODS A vertical incision was made on the platysma, parallel to the midline, followed by the creation of a flap made of skin and platysma at the area where tone loss was more evident. When this flap was pulled back, it formed a double muscle layer that pressed on the submandibular gland, pushing it back into its original position. The tightening achieved by the fixation of the flap provided excellent definition of the mandible line. The platysma bands were approached by a method of percutaneous incision of the platysma. RESULTS Between October 2005 and December 2008, 129 patients underwent surgery. Seventeen patients underwent closed percutaneous platysma myotomy in conjunction with platysmaplasty. Four patients underwent platysma myotomy to treat platysmal bands in a secondary procedure from two to eight months after the original surgery. All patients were satisfied with the aesthetic results of treatment. The only serious complications were two cases of temporary neuropraxia of the cervical branch and one hematoma with partial necrosis of retroauricular skin. CONCLUSIONS Composite platysmaplasty, combined with closed platysma myotomy when indicated, has a short learning curve and provides satisfactory results with a low complication rate and fast recovery. While closed platysma myotomy has been performed by the author as an independent procedure, those operations are not covered in this report and deserve a separate study.