Q: I am 47, someone thin, really good skin tone. In June, I had submentoplasty without the skin incision to remove banding. It looks a lot better than before but I still have two small bands located right at the junction of the cervicomental angle. They do not extend down my neck, they are just in the angled area, maybe about 3/4 inch long. When I clench my teeth, everything flattens out nicely. But when I am relaxed, they are visible. Should I redo the bands, skin incision, fat added? What is the best remedy? Thanks.
A: Hi Tina,
I read your description carefully, and the one unusual thing that you described was that the two little bands flatten out when you clench your teeth. This is different from what normally happens when someone already has platysmal muscle bands. If the person has very small platysmal muscle bands when they are relaxed, the bands can get thicker and longer when the person clenches their jaw/teeth. This is different from what you have described, which makes me think that botox or a revision of the corset platysmaplasty may not be the right way to go.
- A Submentoplasty is a mini-necklift, which does not require incisions around the ears to remove skin. My cut off for performing mini-necklifts is age 45, and if the patient’s skin elasticity is poor from prior sun damage, that age may be even lower. Normally once the muscle bands are flattened out using a corset platysmaplasty, or midline platysmal imbrication, which simply means that the edges of the muscle bands are sewn to each other, this should be a good method to flatten out the platysmal muscle bands which are tenting through the neck skin.
- As these muscle band stretch out the skin of the neck, the neck skin will accomodate to its new shape. If a younger patient with good skin elasticity has a submentoplasty, these two skin “imprints” from the muscle bands should flatten out on their own. However, with sun-damaged skin or skin with decreased fat support and loss of elasticity, it may maintain the imprint of the two platysmal bands.
- A mini-facelift or lower facelift alone with incisions in front and behind the ears may be necessary to remove enough skin to flatten out these pseudo neck bands. A thorough consultation with a board certified facial plastic or plastic surgeon should be done having you clench and unclench your teeth to carefully diagnose what exactly is going on. If your examination is consistent with your description, then a lower facelift procedure to go along with your submentoplasty should complete the transformation of your neck profile.
- In this age of the mini-facelifts and mini-necklifts (submentoplasty), sometimes doing too small of a procedure may result in too small of a result. Most patients who have the combination of a lower facelift along with a proper necklift usually get the best results. There is a synergy in combining the lower face and neck together, since the lower facelift can help the neck, and the necklift can help support the lower facelift result. When performed alone, sometimes it’s just not enough.