Hi Dr. Yang,
I recently had a wonderful personal consultation with you and will likely seek another in a few months when I have healed further. In the meantime, I have a few follow up questions that may be of interest to others. I will post them separately based on topic.

My first question is why do you not suture the platysma along the front of the neck (you mentioned you only corset it under the chin and stop as soon as you get to the cervicomental angle), and why do other doctors prefer to continue down the neck? What are the benefits and drawbacks of both approaches? Also, what are the benefits and drawbacks of back-cutting the platysma versus not doing so and what are the reasons some surgeon prefer one approach and others prefer the other?

Thanks in advance!

Hi naturesculptor,

More surgeons perform the midline platysmaplasty with the backcut at the cervicomental angle, than surgeons who perform a "true" corset platysmaplasty, the way that Dr. Feldman performs it.

In Dr. Feldman's necklifts, it is not something that can be performed under local anesthesia, as you had your necklift performed. At the time of surgery, Dr. Feldman will decide whether or not the pre-platysmal fat, subplatysmal fat, submandibular gland and digastric muscles need to be reduced, sutured or plicated to further contour the neck, before performing the corset platysmaplasty in full. Since the surgery goes a few inches further down the front of the neck, if there are bleeding issues, the full anesthesia is really necessary to be able to control blood pressure and keep the patient "calm" (but really unaware and completely asleep). Otherwise it is a set up for a potentially a disastrous situation of trying to operate through a 3/4" incision 6 inches down the front of the neck to perform the corset and on top of that be doing it on an awake patient whose blood pressure can spike if they sense that something is not going right. If the patient bleeds, from superficial anterior jugular veins running along the front of the windpipe, the entire "pocket" will fill up with blood and will be nearly impossible to isolate the bleeding let alone tie off a vessel so many inches away from the incision. The regular midline platysmaplasty with backcuts on the platysma muscle is about 2 inches away from the submental incision, which is still manageable for sewing and tying, as well as visualization and hemostasis (stopping bleeding.)

Since the sewing together of the platysma muscle under the chin only, is still a "corset", we tend to interchangeably use the term corset platysmaplasty, with sewing the platysma muscle in the midline, as opposed to the lateral platysmaplasty. The main subtlety is whether the surgeon continues to sew the platysma further down the neck or stops and cuts notches on the front edge of the platysma muscle at the cervicomental angle. I believe that many surgeons as well as the public thinks that any sewing of the platysma in the middle is considered a corset platysmaplasty, but not necessarily the exact same way as Dr. Joel Feldman described.

I have sewn the platysma muscle past the cervicomental angle in a few patients, but in those few patients, I felt they developed a midline "band" running down the center of their neck at the cervicomental angle, and it blunted the angle more. Stopping the corset sutures at the cervicomental angle creates a sharper angle.

The main reason to perform a midline platysmaplasty is for a patient whose platysma muscle is detached and hanging down. The hanging muscle blunts the cervicomental angle. By sewing the left and right platysma muscle edges which are hanging down towards the ground helps to contour the anatomy to make a "flat" area under the chin. The skin simply lays over the newly shaped foundation. No need to overly stretch the skin, since skin tends to mirror the foundation underneath. Stretching skin without contouring the foundation will not accomplish the desired results. This is why it is common knowledge not to perform a "skin only" facelift and the SMAS foundation under the facial skin needs to be tightened for the best results.

Let's look at the anatomy of the platysma muscle:

Image Credit: http://http://antranik.org/muscles-of-the-head/

Image Credit: http://aclandanatomy.com/abstract/4010571

Notice there is a left and right platysma muscle. Notice that the left and right muscle is very close to each other under the chin. Notice how the platysma muscle separates as it approaches to the two heads of the collarbone. The midline platysmaplasty mimics the natural anatomy somewhat, since in most patient's who have hanging muscle bands the bands are clearly separated from each other, and there is no other way to make the platysma muscle lay flat to the undersurface of the chin and looks very similar to the natural anatomy. True there are no "backcuts" in the platysma in nature. True, the left and right platysma may be completely separated under the chin, but there are some people whose left and right platysma muscle fibers naturally "interlock" under the chin, and perhaps those people are the lucky ones, since not all people develop platysma muscle bands.

I think that platysma muscle "tents" or "bowstrings" through the skin because it is too "short." If the platysma muscle were longer, it may have a better chance of laying flat against our neck. I'll try to explain using a Pythagorean Triangle from 7th grade Geometry.


Let's look at this right triangle. If the "a" segment is the flat area under our chin, and the "b" segment is the neck portion, the over all length of "a" +"b" is longer than "c" which is the straight line route (hypotenuse) from "A" to "B".

If we think of segment "c" as the platysmal band, sewing three-four stitches together of the platysma will help to push the c segment towards the "a" segment, but with each stitch, the c segment gets stretched tighter and tighter, to a point that as the "c" is being bent in to the right angle, it can't fully get pushed into the right angle" because there is so much tension from point "A" the head of the collar bones pulling on the cervicomental angle, which will create that central band. If the "c" segment is cut at the cervicomental angle the platysma segment "c" under the chin can more easily lay against segment "a" the area under the chin. Backcutting releases the tension from the top of the collarbones to the cervicomental angle and helps create the sharper cervicomental angle.
**This last explanation is highly technical, and not explained in such layman's terms, but naturesculptor has a "tailoring" and sewing background, so I hope it makes sense specifically for her.

I'm not sure I explained that well enough in layman's terms, but that's the best I can think of right now.

Best,

Dr. Yang

Words are not enough to express my gratitude for your willingness to go into such incredible detail. I would feel lost without your insight right now. Thank you, thank you, thank you. I now realize that I had no business undergoing a necklift given the relatively minuscule problem I was attempting to correct. What I don't understand is why my doctor thought this operation was a good idea. Since you and I last spoke, I've developed the dreaded pixie ear deformity as the lateral tightening finally drags itself back to the proper position. I'm also getting banding under my chin that I never had (probably due to a combination of having all the subdermal/submental fat removed against my wishes, the failure of the corset platysmaplasty to disguise the muscle bands, and the tension placed on the platysma from remaining lateral tightening causing the muscle to angrily band out and away from the underlying structures). The result is that someone who never should have had a necklift in the first place will now need a revision of the entire operation from a more skilled doctor to correct the damage. I feel like a fool. Forgive my rambling about my personal situation. I will try to limit that in the future when writing on this forum!

The hypotenuse example helps to explain perfectly the constriction I feel at the cervicomental angle and at my collar bone. I keep telling my doctor it feels as if the muscle has been shortened on the right side and is no longer long enough to lay properly into the cervicomental angle. Instead it is pulling away from that angle, but my doctor has no answer for me. I think the lateral tightening of the platysma that was thrown into my operation without my knowledge is the culprit. Your hypotenuse example also clarifies an important benefit of backcutting the platysma. I can see how sewing the platysma all the way down the neck without backcutting could make the cervicomental angle drop undesirably. I have some further questions based on your response.

-In every platysmaplasty, do you peel the entire platysma away from the body (all the way to the outer edge) before suturing it at the midline, or do you only peel away the middle edges and leave the outer edges stuck where they are? I'm asking this because I realize lateral tightening usually resolves itself, but if for some strange reason there is residual lateral tension when you revise a patient, would you be able to release that by peeling the muscle off the body in its entirety in order to get it to immediately reattach without any lateral tension?
-Does the backcut ever grow back, and if so do you run the risk of the muscle feeling shortened as if there never had been a back cut performed during the platysmaplasty?
-In a very thin neck (and one that may now have a liposuction deformity under the chin), does a backcut ever cause visible irregularities in the way the platysma contracts when there is little to no fat under the skin to obscure the muscle? Would there be an indentation, for instance, where the muscle had been cut away... or maybe does the top edge of the backcut ever curl outward when contracting after being severed from the rest of the muscle? Would there be a large risk of strong bands forming at the outer edge of the backcut where the muscle was still continuous lengthwise? Could you simply run a horizontal cut in the muscle from inner edge to outer edge to prevent new bands from forming anywhere, or is there some reason you must leave some of the muscle intact in a continuous line from face to collar bone? If so, how do you prevent the outer area of the muscle where there is no backcut from forming bands? In a thin-necked person, do you ever corset the muscle all the way down the front of the neck to create a continuous sheet of muscle while at the same time employing the backcut to prevent the muscle from becoming too short for the neck as it is narrowed? Or do you find the thinness of the neck does not require changing your most commonly employed platysmaplasty technique?
-if a pixie ear has formed, do you sometime have to do a modified facelift to correct it, or can you usually correct it using only the necklift again (I have already read your wonderful post on correcting pixie ear deformities, so I hope I'm not asking something you feel you've already answered)? I ask this because it now feels as though all the skin in from of my tragus and earlobe is being dragged aggressively downward, and the only way I can get it to look and feel normal again is to lift that skin upward toward my side burn area. Ugh.

Hi naturesculptor,

-In every platysmaplasty, do you peel the entire platysma away from the body (all the way to the outer edge) before suturing it at the midline, or do you only peel away the middle edges and leave the outer edges stuck where they are? I'm asking this because I realize lateral tightening usually resolves itself, but if for some strange reason there is residual lateral tension when you revise a patient, would you be able to release that by peeling the muscle off the body in its entirety in order to get it to immediately reattach without any lateral tension?

I don't know if you have heard a saying, "If it ain't broke, don't try to fix it." Patients who have this procedure either have platysma bands hanging, or a blunted cervicomental angle. So, suturing the midline helps to create the definition. For the same reason, I want to keep the platysma muscle fibers linear or straight, I don't perform the lateral platysmaplasty, because I think the effects are temporary. For the same reason, I don't want to overly pull the platysma muscle fibers to the middle either, because this will cause a different distortion, so I leave the outer edges stuck where they are.

The lateral platysmaplasty is performed so skin can be removed behind the ears. If the incision behind the ears are made during a revision, and the lateral platysmaplasty is released, my concern is that once the lateral platysmaplasty tension is released, there may be a large gap of skin between the incision edges. The lateral platysmaplasty is performed to take the tension off of the skin and get the edges to line up with minimal tension on the skin. However, the patient may "feel" tension under the skin.

-Does the backcut ever grow back, and if so do you run the risk of the muscle feeling shortened as if there never had been a back cut performed during the platysmaplasty?

Sure, that's possible. If it does, a platysma band may reform in the same location as prior to surgery. When a muscle is shortens or "contracts" it can "tent" or "bowstring" through the skin, which the patient sees as a muscle band.

-In a very thin neck (and one that may now have a liposuction deformity under the chin), does a backcut ever cause visible irregularities in the way the platysma contracts when there is little to no fat under the skin to obscure the muscle? Would there be an indentation, for instance, where the muscle had been cut away... or maybe does the top edge of the backcut ever curl outward when contracting after being severed from the rest of the muscle? Would there be a large risk of strong bands forming at the outer edge of the backcut where the muscle was still continuous lengthwise? Could you simply run a horizontal cut in the muscle from inner edge to outer edge to prevent new bands from forming anywhere, or is there some reason you must leave some of the muscle intact in a continuous line from face to collar bone? If so, how do you prevent the outer area of the muscle where there is no backcut from forming bands? In a thin-necked person, do you ever corset the muscle all the way down the front of the neck to create a continuous sheet of muscle while at the same time employing the backcut to prevent the muscle from becoming too short for the neck as it is narrowed? Or do you find the thinness of the neck does not require changing your most commonly employed platysmaplasty technique?

Older patients naturally lose fat on their neck, and develop "crepey" skin as they age. I believe this happens because the overall thickness of the skin thins out. Let's use some arbitrary units to explain. If the neck skin was originally 5-6 units thick when they are children or teenagers, and don't have any crepeyness, when they are older, the skin may thin down to 2-4 units thick. If you pinch this thinner skin it will be crepey. By removing skin, it creates some "tension" on the skin and the crepeyness is less "apparent" but if the person positions their neck a certain way which takes the tension off, the crepeyness become apparent. Although necklifts is the "gold standard" it does not "restore" the younger configuration. If that were the case, then the older skin is still 5-6 units thick, but X units too much skin, so removing the X units of skin will restore the younger configuration. Instead, the skin thins and the skin removal reduces some of the crepeyness appearance.

On thin necks, the main thing that I see is that even though I performed the back cut, sometimes I still see the muscle bands reform in the original location. But I don't see visible irregularities. I feel that sewing the platysma muscle bands down the middle of the neck to form a single midline platysma band would be considered an irregularity since that is not possible in nature. The thinner the skin, the more you can see all of the structures under the skin. Just think of an older man or woman, and their necks, and the back of their hands. You can see every vein and tendon through the skin.

This is also the reason, I don't perform any liposuction on thin necks to preserve every last bit of fat in their neck. If the skin heal directly to the platysma muscle then it is possible to see the contraction of the muscle. If there is some kind of irregularity, the possibility of being visible increases. I have not seen it on my platysmaplasty patients, because I leave as much fat as possible on these thin necks.

I do see that a new band can form at the outer edge of the back cut. This new band is the remaining continuous platysma muscle fiber which was not cut. It is not visible unless that patient is actively flexing and shouldn't affect the overall profile of the cervicomental angle.

I respect the natural anatomy, and only try to perform simple elegant procedures which are effective and predictable and does not overly alter the natural anatomy. To create a continuous sheet of platysma muscle is not respecting the natural anatomy, and I feel is trying to "outsmart" the creator. If it was meant to be this way, it would naturally be like that in nature. If you overly try to alter natural anatomy (because the skin of the neck is thin?) I think it is a recipe for trouble.

-if a pixie ear has formed, do you sometime have to do a modified facelift to correct it, or can you usually correct it using only the necklift again (I have already read your wonderful post on correcting pixie ear deformities, so I hope I'm not asking something you feel you've already answered)? I ask this because it now feels as though all the skin in from of my tragus and earlobe is being dragged aggressively downward, and the only way I can get it to look and feel normal again is to lift that skin upward toward my side burn area. Ugh.

Yes, that would be the way to do it, but the amount of correction depends on what happened with the first surgery. In some cases the improvement is close to normal, while in other cases, the amount of skin removed by the first surgeon was too much and the improvement is only marginally better and not as close to normal as I would like. Even though I perform the same kind of procedure to improve the pixie ears, the improvement is less dependent on my technique, but more on how much skin and the location of the skin that was left by the first surgeon.

If you ask a master tailor to fix a overly tailored wedding gown which was "taken in" too much, and want it back to its original design, it depends on what the first tailor did to "take in" the wedding gown. If the first tailor "sewed" in a new seam, but left the extra fabric inside of the gown, then the master tailor fixing it can rip the seam and use the extra fabric inside to make the gown fit the way that it was designed. If for some reason the first tailor, not only took in the gown, but cut away much of the extra fabric on the inside of the seam, then the master tailor may not be able to release the dress as much as wanted. If so then the gown may not fit as it was intended, and may still be too tight, but maybe less tight than it was originally after the first tailoring. Not ideal, but better.

Best,

Dr. Yang

Hi Dr Yang,
Your responses are teaching me so much, and helping me to gain confidence about what needs to happen for successful results. I hope I'm not making a nuisance of myself with over-zealous questioning. By the way, I just booked a flight to visit you for an in-person consultation. I'm very much looking forward to it!
I thought of a couple more questions in the meantime. By the way, I just want you to know that it is clear to me based on communications with you and recent consultations with other doctors that a platysmaplasty should not originally have been performed on me, as it is only indicated when the muscle is hanging or when the cervicomental angle is blunted neither of which was my case. The reason for all my questions now is that I am 95% sure that I will need some sort of corset platysmaplasty during my revision to get the muscle to look normal again after the damage that was done during the first surgery. I want to be as sure as it is possible that the technique that my next doctor uses is ideal for restoration of my presurgical neckline :

-You mention that lateral platysmaplasties are done to make skin excision behind the ears as tension-free as possible. I know you do not believe lateral platysmaplasties work, as the positioning is so temporary. That makes sense to me. But now I am curious how you're able to successfully perform excision behind the ears without using the lateral platysmaplasty to reduce tension on the skin?
-Do your corset platysmaplasty patients usually experience vertical constriction of the muscle during healing (pulling from the jawline and cervicomental angle downward toward the collar bone), or does that only happen when a lateral platysmaplasty is performed? If it is normal to experience vertical constriction with a corset platysmaplasty alone, how long do you find that constriction usually lasts, as it is not only uncomfortable but creates an unpleasant appearance? What is the typical recovery like for the type of platysmaplasty you perform with the backcut?
-Have you ever seen the backcut cause the platysma under the chin to retract toward the chin and pucker or bunch up? Just curious?
-I recently consulted with a doctor who feels very strongly about the Feldman approach to corset platysmaplasty. He said he never has patients experience the muscle bowing away from the cervicomental angle following full corseting down the neck (I specifically asked him about that and how the muscle may not be long enough to lay flat without a backcut). He showed me a very elaborate pattern of stitch that not only went through the midline up and down several times but also swooped out toward outer edge of cervicomental angle. I'm curious if you're familiar specifically with the Feldman stitching pattern and was that a pattern that you have found still blunts the cervicomental angle? He also said the only period when he might see a ridge down the front of the neck is during the first few months before the corset stitches have a chance to dissolve, but that is rare in his experience and always goes away. He said the inventor of the corset platysmaplasty says "don't backcut the platysma" very emphatically. Proponents of both corset approaches seem to feel very strongly that the alternative approaches are harmful or inferior or will yield an undesireable result. It has left me feeling terribly uneasy about which approach will work best for me. Can you comment on why doctor's like Feldman would caution against employing a backcut in the platysma?

Also, I have some thoughts that I want to share with anyone who may read this who is under 40 (or under 50 for that matter) and considering anti-aging surgeries. I felt I had done my research. I asked very technical questions of my doctor prior to undergoing my procedure. I read research papers I'd found on the web published by various surgeons as well as multiple posts on this site and other sites regarding complications and so on. The mistake I made was not formally consulting with multiple surgeons prior to submitting myself to a necklift and not reading more posts specifically about complications of young people undergoing lifting procedures. Since the surgeon I chose had my trust, once he agreed with me that a necklift was appropriate for me, I never questioned whether it was the right procedure to treat the tiny issue I was having. I only questioned the various types of necklifts available and which was most effective. As it turns out, I have learned that a necklift was entirely inappropriate for me. The doctor I chose knew that I was happy with the angle from my chin to my neck (which was sharp and flat prior to surgery) and that my only concern was a very tiny gather of skin that would appear at the top of my neck when I turned my head from side to side. I thought it was happening because I am thin and have a thin neck with no fat on it, so why not tighten the skin a little to stop the aging before it has a chance to become noticeable? I thought I was being proactive and terribly smart! And I was unfortunately misguided by my doctor about the validity of this approach. He told me that I would respond better to the surgery because of my youth and that it would be easier to obtain a pleasant result with such a minimal change desired. What he did not tell me was the following: very slight loose skin in a young, thin neck is not effectively treated by a necklift particularly because younger people are at a greater risk for widened scars and pulled earlobes due to the stronger elasticity of their skin. So tightening a little can backfire a lot. I did not know this. If I had, I would not be in the unfortunate position in which I now find myself. In addition, I had a surgeon who took (well-intentioned) extra liberties during my surgery that have made a mess of my neck and lower face. I only signed up for a corset platysmaplasty (as a preventative measure for future muscle bands) with a small amount of skin tightening behind the ears meant only to address the tiny gather at the top of my neck. But my surgeon (with good intentions) threw in skin-undermining along my jaw and muscle repositioning there as well as lateral platysma tightening... all of which not only did I not need, but these extra maneuvers made me look much worse. For 3 months I had trouble swallowing due to the poorly performed platysmaplasty. I have a puckering and bunching of platysma and skin under my chin which has destroyed my previously flat jawline, and I have a pulled earlobe and thick scars in front of and behind my ears that look dreadful. The saddest thing in my case is that I would never have signed up for this procedure if only I had known how inappropriate it was. I just did not find the doctor who was willing to explain that to me, and instead found a doctor who applauded my willingness to dive in. I know he did not intend to do harm to me, but I still should not have trusted his judgement. Now I have no choice but to pour an exhausting amount of energy and crippling amount of money into trying to get my neck and lower face as close to how they looked before surgery.... all of which could have cost me nothing and left me with no scars if I had simply been advised that this surgery was not appropriate for my situation. If you are young and considering any sort of lifting procedure, I hope you will be luckier in whose advice/expertise you trust than I was. Do yourself a huge favor and be skeptical of any doctor who does not warn you of the perils of subjecting young tissues to these types of procedures.

Hi naturesculptor,

-You mention that lateral platysmaplasties are done to make skin excision behind the ears as tension-free as possible. I know you do not believe lateral platysmaplasties work, as the positioning is so temporary. That makes sense to me. But now I am curious how you're able to successfully perform excision behind the ears without using the lateral platysmaplasty to reduce tension on the skin?

After the platysmaplasty, the skin is released from under the chin and behind the ears. The neck skin separated from the platysma, so that I can "walk the excess skin" behind the ears and trim the apparent excess. Since the lateral platysma is already separated (in my operations) from the neck skin, if I perform a lateral platysmaplasty I only imagine the platysma getting pulled in an unnatural direction behind the ears, yet the skin was already separated from the lateral platysma, so it is not really helping me to take tension off of the skin behind the ears. In order to use the lateral platysmaplasty to "really" take tension off of the skin behind the ears (at least during the operation) is to raise a limited flap of skin behind the ears and expose the back portion of platysma, yet, leave the submental skin mostly intact. The lateral pull of the platysma will carry the skin

-Do your corset platysmaplasty patients usually experience vertical constriction of the muscle during healing (pulling from the jawline and cervicomental angle downward toward the collar bone), or does that only happen when a lateral platysmaplasty is performed? If it is normal to experience vertical constriction with a corset platysmaplasty alone, how long do you find that constriction usually lasts, as it is not only uncomfortable but creates an unpleasant appearance? What is the typical recovery like for the type of platysmaplasty you perform with the backcut?
-Have you ever seen the backcut cause the platysma under the chin to retract toward the chin and pucker or bunch up? Just curious?

No, my patients don't experience a vertical constriction. I think a lateral platysmaplasty typically gives a noose, garrot, or choking sensation and not the feeling you are describing. The recovery is about 1-2 weeks, and they don't get the noose-like sensation. The backcut is about 1/2-3/4" which is not very much. I have not seen the platysma retract toward the chin or pucker up. It is designed to prevent bands from reforming.

-I recently consulted with a doctor who feels very strongly about the Feldman approach to corset platysmaplasty. He said he never has patients experience the muscle bowing away from the cervicomental angle following full corseting down the neck (I specifically asked him about that and how the muscle may not be long enough to lay flat without a backcut). He showed me a very elaborate pattern of stitch that not only went through the midline up and down several times but also swooped out toward outer edge of cervicomental angle. I'm curious if you're familiar specifically with the Feldman stitching pattern and was that a pattern that you have found still blunts the cervicomental angle? He also said the only period when he might see a ridge down the front of the neck is during the first few months before the corset stitches have a chance to dissolve, but that is rare in his experience and always goes away. He said the inventor of the corset platysmaplasty says "don't backcut the platysma" very emphatically. Proponents of both corset approaches seem to feel very strongly that the alternative approaches are harmful or inferior or will yield an undesireable result. It has left me feeling terribly uneasy about which approach will work best for me. Can you comment on why doctor's like Feldman would caution against employing a backcut in the platysma?

Some surgeons completely transected the platysma muscle and repositioned it behind the ears. It was a paradigm shift to tighten the muscle in the middle instead of pulling it to the sides. I am not so attached to the platysma muscle that I would never "cut it" By cutting it, and allowing the ends of the cut to get further away from each other likely lengthens the muscle. Since the tissues heals together, most likely the 1/2" cut ends of the platysma are not that far away from each other and the scar tissue may have healed the ends together with scar tissue.

The temporary nature of the central band makes sense to me. I guess since I was using permanent sutures at the time, I was worried the central band would not go away, so I stopped doing that as soon as I started. Also, since the platysma muscle gets further and further away as it approaches the collar bone, I felt it was pulling the lateral neck skin toward the midline and causing more bunching in the middle of the neck. The more the surgeon tightens the platysma in the middle, the harder it is to perform the SMAS tightening of the face laterally. This is only reason some surgeons prefer not to perform a midline platysmaplasty at all since they feel it may interfere with the facelift.

As far as cutting the platysma muscle at all, I have no problems trimming the platysma if I need to. It is not a sacred muscle. Some patients with severely hanging platysma muscle overlap a lot in the middle. If the muscle is sewn edge to edge, there may be some looseness in the foundation of submental area due to excess platysma. In those cases, I pull the platysma to the midline and trim any excess platysma muscle, and the same to the opposite side. Then I sew the remaining edges together.

Since you are already flying around the country to interview surgeons, why not consult with Dr. Feldman in Boston. See if the originator of the corset platysmaplasty would have peformed it on you in the first place and whether he would recommend it as part of a revision. This will put your other consultation with the doctor who feels strongly about the Feldman corset into perspective.

Is a successful revision possible at this time? Rushing into more heartache?
As you know, I am not sure whether a revision is possible yet. I am not competing to be your revision surgeon with the other surgeons. I am not throwing techniques out there as magic bullets which will restore you to your pre-operative state. I am merely observing what was already done and reporting back to you my honest assessment. If I think a revision is possible I will describe to you what the plan is and why I think it will work. If I don't think a revision is possible so soon after the initial surgery, I will also explain to you why I don't think it is a good idea, and perhaps patience and observation is safer than rushing into another surgery.

I am listening and understand that you are trying to figure a way out of your current predicament. But, in addition to your search for the magic bullet procedure, these are the questions that is going through my mind.

-How is the corset platysmaplasty going to help even out the uneven skin removal and pixie ear to the right side?
-Will pulling the divergent platysma muscles as they attach to the collarbones cause even more tension?
-Is the natural anatomy of the platysma covering the windpipe and voicebox?
-Will the scar tissue of the full corset platysmaplasty disrupt the natural "sliding" planes of the neck and prevent the windpipe and voicebox from smoothly sliding upwards when a person talks or swallows?

In my other post, I wrote about the good surgeon knowing how to operate and the wise surgeon knowing when not to operate. I enjoy what I do to help people look better. But sometimes this also means saying no to some patients if I think it will not enough of an improvement to be worth performing or it may cause a problem or sequelae which is worse than the original problem (as in your case.) My general philosophy is simple, safe, and reliable surgeries which make a big difference or giving the patient a lot of bang for the buck. I think patients seek me to be their surgeon because of my thoughtful process and honesty. The thoughtful process is where the patient is examined and evaluated as an individual and the procedures are customized to them and they are not fit into a magic bullet procedure which the surgeon is known for. Patients who consult with me will want a specific result which my simple, safe and reliable surgeries will not be able to deliver, so I simply refer them to the surgeons who perform the more complex, risk, and more demanding surgeries which have the potential for giving those results.

I think the full corset platysmaplasty has it's place in the spectrum of neck procedures and where I would use it would be for patients with hanging platysma muscle down the from their chin to the collar bone. For patients with platysma bands mainly just under the chin, but does not extend down the lower part of the neck, I think the full corset may be too much surgery for those patients, let alone 25-35 year old patients with not platysmal bands at all.

If we use the quote from the other post, to put things into perspective, since you seem focused on the full corset platysmaplasty, and the fact that another surgeon feel strongly that the platysma should never be cut.

"A good surgeon knows how to perform a full corset platysmaplasty.
A better surgeon knows when to perform a full corset platysmaplasty.
The best surgeon knows when not to perform the full corset platysmaplasty."

Is it possible that for some people, they should't have this procedure? or should all people have this done because it is the "best." Maybe there is no best procedure for all patients, and it is up to the wise surgeon to know the difference.

Based on the latter half of this last response, if you had known better you would not have had the procedure. Now that you are seeking a revision, does your neck issues fit the indications for a full corset platysmaplasty, and will that improve the skin draping issues.

Best,

Dr. Yang

Thank you Dr. Yang,
You are right. Though I know it is logically impossible, I am still hoping for something that will save me from my first decision (the results of which have left me filled with shame).
But another part of what is going on is that I am trying to use logic and knowledge to squash the emotional overwhelm (I'm sure this is very common of those in my position) and to make sense of the conflicting advice I am receiving. In no way am I trying to induce you to compete with other doctors. Rather, I consider it an act of generosity that you are willing to take the time to share so much of the science and thoughtfulness behind your approach. Your help is invaluable. And I fully understand that you may not feel comfortable offering to revise my problems.
I am not flying around the country consulting with doctors. With the exception of you, the four doctors I have met are in my home town. Given what you have said about the full corset, though, it makes sense that it couldn't solve the problems of my first surgery and would open me to a host of unnecessary risks. Hopefully when you examine me in person you will be able to shed more specific light on what could solve my problems and in what time frame that it could happen. Until then, I will give you a break from my tiresome questioning. Thank you for your patience.
See you soon.

Hi naturesculptor,

You're welcome. Looking forward to meeting you.

Best,

Dr. Yang