Platysmaplasty

Platysmaplasty, commonly referred to as a neck lift, is a form of cosmetic plastic surgery involving tightening and removing skin from the human neck.

Aging in the neck skin does not follow one predictable pattern because neck skin varies with skin quality, fat, and the platysma muscle, and how those layers change relative to each other. Accordingly, neck lift surgery is individualized to one person's anatomy.

Over time and in a non-uniform manner, the skin loses elasticity as collagen and elastin decline, which leads to laxity, wrinkling, and visible aging changes. Further, the platysma muscle begins to change, as it can separate, descend, and become more visible, creating vertical banding and loss of jawline definition. The neck also has thinner skin compared to other areas, which makes it more prone to showing lines and contour changes earlier.

When evaluating the neck, the layers actually contributing to the change are assessed, with restoration of structure as a surgical goal rather than a concern for skin tension.

Techniques

Submental dissection during combined platysmaplasty to address deeper neck structures and improve cervicomental contour.

Platysmaplasty is a group of approaches to reposition and support the platysma muscle based on what the neck actually needs. In practice, surgeons choose (or combine) techniques depending on banding, laxity, and deeper anatomy.

Platysmaplasty techniques include medial (corset) repair, lateral suspension, and combined approaches, often supplemented by subplatysmal procedures depending on the underlying anatomical contributors to neck aging.

• medial platysmaplasty (corset technique) is performed through a submental incision under the chin. The medial borders of the platysma are brought together in the midline to reduce platysmal banding and restore central neck support. StatPearls describes anterior or medial platysmaplasty as midline approximation of platysmal diastasis from the chin toward the thyroid cartilage.
• lateral platysmaplasty / platysmapexy, often described as lateral platysmapexy or lateral suspension, supports the platysma laterally rather than repairing the central muscle edges under the chin. StatPearls describes lateral platysmapexy as suturing the platysma to the upper quarter of the sternocleidomastoid fascia, while Labbé’s PubMed-indexed article describes suspending the free edge of the platysma and fixing it to resistant tissue near the earlobe.
• combined medial and lateral platysmaplasty addresses both the central and lateral components of the platysma. A modified medial and lateral platysmaplasty paper specifically compares medial platysmaplasty with lateral pulling and reports that medial platysmaplasty was generally more effective than simple lateral pulling for multiple neck deformities, especially midline deformity.
• subplatysmal / deep neck techniques are not platysmaplasty alone, but they are often performed with platysmaplasty when deeper structures contribute to fullness. These may include subplatysmal fat, anterior digastric muscle, and submandibular gland management. Auersvald’s article on submandibular gland management states that common neck concerns include hypertrophy of subplatysmal fat, the anterior belly of the digastric muscle, and/or the submandibular salivary glands.
• layered / comprehensive neck lift approach evaluates the skin, fat, platysma, and deeper structures rather than treating the neck as a surface problem. Current review literature describes neck management in three key areas: anterior platysma, subplatysmal structures, and lateral neck support.

Incision closure

Layered platysmaplasty closure with tension-free skin.

Closure after a platysmaplasty is performed using a layered, tension-free technique designed to preserve the underlying structural repair. Following approximation or suspension of the platysma muscle, the subcutaneous tissues are reapproximated to reduce dead space, and the skin is redraped and closed without tension to optimize scar quality and contour.

Modern neck lift literature emphasizes that platysma manipulation, including midline plication or lateral suspension, provides the primary structural support, while skin closure serves a secondary, non–load-bearing role.

This layered approach is consistent with established surgical principles in facial plastic surgery, where reliance on deep structural support rather than skin tension improves long-term definition of the cervicomental angle and reduces recurrence of platysmal banding.

See also

• Rhytidectomy (face lift)