A submental plasty is the tightening of the playtsma muscles and bands of the central aspect of the neck. This procedure improves the appearance of any loose skin and excess fat found on the neck. It is also known as submental plication.
The physician makes an incision under the chin, beneath the skin. Below the skin, there is pre-platysma fat found in front of the platysma, or muscle of the neck. The platysma basically goes from the central or the midline of the neck all the way to the lateral or outside portion of the neck, almost to the ear.
Some individuals have a platysma muscle that is connected, while it is separated in others. As people get older, that muscle becomes a relaxed and can drag towards the ground and take the skin with it. Genetic predisposition sets the stage on how early or how late people see the effects of aging. Below the platysma muscle is the subplatysmal area where there is also additional fat. If a person has quite a bit of fat below the muscle, they might want to remove the fat out of the area.
There is also a muscle called the digastric muscle underneath the chin. Individuals that have more fullness tend to shave that down. Submandibular glands are glands underneath the chin, or mandible. If people have bulging submandibular glands, one solution is partially excising the gland. Once the patient has their neck muscles tightened, the excess skin can be redistributed or removed from the back portion behind the ear.
During a full neck lift, an incision is made behind the ear staying in front of the hairline. The incision tunnels all the way to the midline of the structures mentioned above. The surgeon wants to tighten the neck in the middle because that is where people see all of the deficiencies and abnormalities such as looseness, laxity, and droopiness. If a patient has a lot of loose skin, the doctor removes that skin in the back of the ear. The scars will be too long if it is removed from the front.
When people come in because they feel they have a fatty neck, the doctor can do liposuction to directly remove the pre and subplatysmal fat. However, patients who come in because they have a band that bothers them will need a tightening of the platysma muscle. Patients that have a big gland will want to partially remove the gland. The key is partial excision of the submandibular gland and then redraping the skin by removing the excess skin from behind the ear. A patient gets the best neck lift through a combination of all the things listed above.
Most of the time, a submental plasty is not done on someone in their 20s. It is more common in the mid-40s, 50s, 60s, and beyond. Once again, the key piece is genetic predisposition. There are people that are 30 but they look 22 and people that are 30 that look 45.
Environmental exposure such as stress may also be a contributor. People that smoke, do not watch their diet, and do not exercise may be interested in the procedure. In a younger person, it is generally very simple, such as fat liposuction as the procedure of choice.
It is also very common to do a facelift to compliment the results. Someone in their mid to late 30s or 40s may only need the neck. But most of the time, someone in their 50s and 60s will also get a facelift.
It is normally a very dramatic change for the patient. There are some people that have a little bit of banding and most of their friends are not going to notice the change even though the patient notices it. It depends on how the patient looks at the start of the process.
One big limitation is the health of the patient. Another limitation is the age of the patient but that is not a strict limit. A patient that takes no medication, walks every day, exercises every day, eats healthy, does not smoke, does not drink, and is older may be a great candidate for these procedures. Someone that is 50 years old, overweight, smokes, has diabetes, drinks often, and is unhealthy may not qualify from a medical perspective.
There are really no long-term risks for this procedure. The short-term risks are the standard risks when any surgery is performed such as bleeding and infections. Another risk is nerve injuries, although this is very uncommon.
If a patient has a large, round face, the surgeon has to make sure the results are not too tight in the neck, while making the improvements proportional to the face. It is important not to overdo one area and make it look youthful while the rest of the face looks merely aged.
It is not uncommon for neck bands to reappear because those muscles are very stubborn. Up to 30% of the bands may reappear within the first year but not to the extent from where the patient started.
Weight fluctuations, gravity, and incomplete tightening of the platysma can stretch out the platysma so the bands may reoccur. This situation can sometimes be improved with Botox to help relax the muscles.
The recovery for a neck lift or a submental plication is about 10 days or less. Patients will have a small incision underneath their chin or behind their ear that heal at the same rate. The sutures for the procedure around the chin are removed around 5 days while behind the ear usually remain for a full 10 days.
During that period of time, patients can walk and do normal daily activities with the exception of high impact aerobics, weightlifting, running and any exercise that increases blood pressure and heart rate. Patients will wear a neck support garment for 10 days to two weeks to allow the skin to really tighten and the internal tissue to scar down. Patients also need to stay away from medications that thin their blood such as aspirin, Motrin, Aleve, Advil, and other supplements. Patients can expect to go back to work around 10 days to two weeks after the procedure.
Touch-ups are pretty uncommon after the procedure. On average, a face and neck lift will last 8 to 15 years. It is important to remember that after any procedure, the body and skin are still aging at the same rate prior to surgery. Some people may never need another facelift while others may need a secondary facelift many years later.
Patients should consider a board certified plastic surgeon and reconstructive surgeon to perform the above mentioned procedures. Identify who in your community is well revered and trained to perform these procures and then make an appointment for a consultation.
Written by Cosmetic Town Editorial Team - MA
Based on an exclusive interview with Dr. Philippe A. Capraro, MD in Denver, CO