Rhytidectomy; neck with platysmal tightening (platysmal flap, P-flap)

CPT4 code

Name of the Procedure:

Summary

In simple terms, this procedure, often called a "neck lift," involves tightening the muscles in the neck to create a smoother, more youthful appearance. The surgeon also removes excess skin and fat to refine the contours of the neck and jawline.

Purpose

This surgical procedure targets sagging skin and muscles in the neck, which can occur due to aging or significant weight loss. The aim is to tighten and lift the neck muscles and skin, creating a smoother and more youthful neck contour.

Indications

Loose, sagging skin on the neck
Muscle banding in the neck
Excess fat under the chin and along the jawline
Patients who seek to improve the appearance of their neck and jawline due to aging or weight loss
Generally healthy individuals who are non-smokers and have realistic expectations

Preparation

Patients may be instructed to fast for a certain period before surgery.
Medications might need to be adjusted; certain medications such as blood thinners may need to be stopped.
Pre-operative assessments like blood tests, and sometimes imaging studies, will be conducted.

Procedure Description

The patient is given general anesthesia or local anesthesia with sedation.
Incisions are typically made around the ears and sometimes under the chin.
The surgeon tightens and repositions the platysma muscle using a technique called the platysmal flap or P-flap.
Excess skin is trimmed away, and the remaining skin is repositioned to create a smoother appearance.
Fat may be removed or redistributed for better contouring.
The incisions are closed with sutures, and the area is bandaged.

Tools and technology used include surgical scalpels, sutures, possibly liposuction equipment, and specialized surgical instruments.

Duration

The procedure usually takes between 2 to 3 hours.

Setting

Rhytidectomy with platysmal tightening is typically performed in a hospital, an accredited outpatient surgical center, or a specialized clinic.

Personnel

Surgeon specializing in plastic or cosmetic surgery
Anesthesiologist or nurse anesthetist
Surgical nurses and possibly a surgical technician

Risks and Complications

Common risks: bleeding, infection, swelling, and bruising
Rare risks: nerve injury, unfavorable scarring, asymmetry, and prolonged numbness
Complications: hematoma, wound healing issues, and adverse reactions to anesthesia

Benefits

A more youthful and defined neck and jawline appearance
Improved self-confidence and satisfaction with one's appearance
Results are typically long-lasting, though they do not halt the aging process

Recovery

Patients are usually advised to rest and avoid strenuous activities for at least 2 weeks.
Specific instructions include keeping the head elevated, applying cold compresses to reduce swelling, and taking prescribed medications.
Sutures are typically removed within 7-10 days.
Most individuals can resume normal activities and return to work within 2-3 weeks.
Follow-up appointments are necessary for monitoring recovery and removing stitches.

Alternatives

Non-surgical options: Botox, dermal fillers, and thread lifts (less dramatic results, temporary)
Other surgical options: traditional facelift (more comprehensive rejuvenation including the face) Each alternative has its pros and cons, varying in terms of invasiveness, cost, longevity, and recovery time.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel discomfort. Post-procedure, there may be mild to moderate pain, managed with prescribed pain medication. Patients often experience swelling and bruising, which subsides over a few weeks. Ensuring a comfortable recovery might include using pillows to keep the head elevated and taking prescribed medications as directed.