About Double Chin Surgery
Video transcript: Let’s talk about ab inherited feature that many people would like to change: a double chin. In many cases what causes this is laxity of the platysma muscle and that is the muscle that envelopes the tissues of the neck. In these cases, what we often do is what is called a platysmaplasty and sometimes we’ll do removal of fat directly. In some cases a chin augmentation can be performed as well, depending on whether the patient needs that.
So here’s an example of someone with a double chin. Her chin position is normal, it’s lined up very nicely with her forehead. She just has some laxity of the skin and neck muscles, which causes some sagging in the area just behind the chin. So as I’ve mentioned before, the ideal mental cervico angle goes 105 to 120 degrees. In a situation where there’s lax plastysma muscle, often that angle is opened up to 130 to 140 degrees. Now when we’re accessing this patient it’s important to notice some of her other features: her chin is in a normal position, she doesn’t have extra lax skin, there’s no jowl formation, her skin is thick and healthy, so there aren’t any problems we need to correct other than the laxity of the platysma muscle.
When performing this procedure, I need to gain access to the mid line portion of the neck so I can modify that muscle and tighten it. That is done through a sub mental incision; the same incision we might use to place a chin implant. For platysmaplasty surgery a sub mental incision is created, the skin in the mid line neck probably out 5 to 6 centimeters on each side is elevated. That allows for exposure of the platysma muscle. Usually that muscle needs to be cut in a horizontal direction and allow it to be brought in the mid line, called a myotomy. Once that is performed, the mid line platysma is brought together with stitches very tightly, and then that skin is re-draped over the platysma and closed with a dissolvable stitche.
After the surgery, it is very important the patients wear a pressure garment to try and help retract the skin down to the newly tightened platysma. We ask them to wear it for about three weeks. The typical results after a platysmaplasty or double chin surgery is really to get a sharper mental cervico angle, and also to have a longer horizontal portion to the neck.
As for the risks and recovery of double chin surgery, of course bleeding and infection can occur although it is rare. Poor wound healing may occur, although in this particular area of the body the skin heals extremely well, and rarely do people ever see a scar from the incision. Recovery usually requires a week off of work. It is not a particularly painful procedure to have, so very light analgesics are used after the procedure. We ask that people wear a pressure garment for three weeks, and what that does is allows for contractions of the skin in an upward direction so it can re-drape over that tightened platysma muscle. And it’s best not to be too active, we ask that people stay at home and do sedentary activities predominantly. They can get back to normal activities after a week and as much exercise as they want after two weeks.
When is a platysmaplasty or double chin surgery not appropriate? I think the biggest problem with this surgery is that it requires fairly thick, healthy skin. So in patients that have very lax skin, just tightening the platysma muscle alone is not going to give enough of an improvement. There’s no absolute age range but generally speaking the platysmaplasty alone is best done in their patients in their 20’s and 30’s. Beyond that age, often people do get age related changes to the skin that can not be corrected just by the platysmaplasty.
In a situation where the patient has jowl formation, platysmaplasty does not correct that. A more appropriate procedure would be to do short or long incision face lift. That would not only correct the double chin deformity but also correct the jowl. I think in many situations, although people may like the idea of a very simple and straight forward procedure that’s done in the mid line neck. Often the results are poor because it doesn’t address the jowl. The big reward with platysmaplasty it that it substantially improves the neck angles. This is something we probably can’t achieve with something as simple as liposuction, and there isn’t any non surgical procedures that allow for significant tightening of the neck. The risk of a platysmaplasty of course, is the risk of having a surgical procedure. This is a fairly confined area. The amount of skin that is elevated is quite small and the complications are very rare.
So on a spectrum of procedures, double chin surgery is ideal for someone who doesn’t have lax skin; who just needs to have the neck tissues tightened. It wouldn’t have be appropriate in our last patient to perform a face lift, that’s much more surgery than she requires. She did not have jowls or other areas of her face that needed correction, she just needed to have the neck done. So this is an ideal isolated procedure for her.
So here’s our actual patient, she has some laxity of the sub mental tissues because of laxity of the muscle. This is her preoperative view. So what we did for her was we did a double chin surgery where we tightened her platysma muscle, I did remove a little bit of fat directly; that is directly excised. In her case, I did an ancillary procedure where I removed the fat from her cheeks with a buccal fat removal. So these are her results now. You will notice a much sharper mental cervico angle. She is probably about 100 to 105 degrees now; much tighter and she doesn’t have that laxity that she once had. Again, we did not perform a chin augmentation surgery for her because she just didn’t need it. Her chin was lined up nicely with her forehead. The reason we have a much longer horizontal neck in her was because we performed a platysma myotomy; we cut the platysma at the neck defining point and sutured it nice and tight in that area so this should be a nice, long lasting result for her.