Platysmaplasty

Platysmaplasty means tightening the platysma muscle specifically. A neck lift, or lower rhytidectomy, is the broader operation that may also include liposuction of fat under the chin and excision of loose skin. In practice a full neck lift contains a platysmaplasty as its muscular component, which is why the two words are used interchangeably in most patient-facing material.

It flattens visible bands reliably, but recurrence over long time frames is well documented and we would rather you heard that now.

Botulinum toxin softens dynamic platysmal bands and is used both as a non-surgical alternative and to manage bands that persist after surgery. It does not remove excess skin or fat, and its effect is temporary. When laxity and volume are the main problem, it is not a substitute.

The primary incision sits in the natural crease under the chin and is short and well concealed once healed. Scar maturation takes several months. Unfavourable scarring is a recognised risk and varies with skin type, healing and smoking status — we cannot promise you a particular scar.

It depends on the midface. If there is significant jowling or descent where the neck meets the face, an isolated neck procedure will not correct it and the result will be suboptimal, so a combined facelift is indicated. People whose laxity is confined to the neck, with a stable midface, are the ones who do well with neck surgery alone.

Most people return to non-physical work in 7 to 14 days, once the bulk of the bruising has settled. More strenuous activity and sport usually wait 2 to 3 weeks. It takes several months for the last of the swelling to go and the final contour to appear.

In domestic practice this is a day case and people go home the same evening. We keep travelling patients one night because roughly 90% of haematomas after face and neck lifting present within the first 24 hours, and that is the window in which you want to be in a building that has an operating theatre.

The American Society of Plastic Surgeons lists an average surgeon fee of $7,885 for a neck lift in the United States. That figure excludes anaesthesia, operating room and facility costs, tests, prescriptions and garments, so the real total is meaningfully higher. In Istanbul the operation is typically quoted as €2350 to €4100 that does include theatre, anaesthesia and one night — so the two numbers are not measuring the same thing.

Anyone still using nicotine in any form — smoking constricts the very vessels that have to keep lifted skin alive, and it is the single clearest reason we postpone. Uncontrolled high blood pressure and bleeding disorders, or blood thinners that cannot safely be paused, all belong in the same category, because haematoma is the complication this operation is most likely to hand you. We also decline where the psychiatric picture is unstable or where what is being asked for is a neck the underlying anatomy cannot produce; and if the midface has descended, the honest answer is a facelift, not a neck operation that will look unfinished.

Swelling that increases quickly, especially on one side, with tightness and pain out of proportion to what you were told to expect — that is how an expanding haematoma presents, and it is an emergency that goes back to theatre rather than something to sit on overnight. Any difficulty breathing or swallowing means immediate care. So do fever, spreading redness, or discharge from the incision, and so does calf pain or sudden breathlessness, which point at clot rather than wound. Use the 24-hour number rather than waiting for your next scheduled review; there is nothing on that list we would rather hear about late.

This is the commonest misunderstanding about neck surgery. How crisp an angle your neck can hold is set largely by things the operation does not move: the position of the hyoid bone, the bulk and drop of the submandibular gland, the digastric muscles, and how far the chin projects. A low or forward-set hyoid puts a ceiling on the angle no amount of muscle tightening will lift. Platysmaplasty works on muscle, fat and skin, and within those limits it works well — which is why we assess the skeleton and the glands at consultation and tell you the ceiling then, rather than after.

€2,350 to €4,100 with us, confirmed after a consultation rather than quoted blind. For comparison it is typically £5,000 – £9,000 in the United Kingdom, $9,000 – $15,000 in the United States and €6,000 – €10,000 in Western Europe. It depends on whether the platysma is tightened alone or liposuction and skin excision are added. A neck with loose skin is a different operation from one with a loose muscle.