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Platysmal Band Reduction

Dr. Rad’s patients commonly complain about their aging necks. The neck often shows the first signs of aging: loose neck skin, wrinkling and creasing, and muscle bands. Neck lift surgery is the gold standard for restoring a lifted and angled neck contour, particularly with non-invasive devices that have failed. The degree of skin looseness determines whether a “closed” (minimal incisions) or “open” (visible, but well placed, scar) approach is needed.

For a platysmal band reduction, Dr. Rad works directly on the platysma muscles, more familiarly known as your neck bands. These muscles can be very prominent in the neck, so patients often seek this surgery to reduce these muscles and remove saggy excess skin to achieve a more sculpted and contoured neck.

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As the lowest point on the face, sagging tissues show most prominently in the neck and jowls, and our patients often seek correction. A blunted or full neck contour can be genetic (in younger patients neck skin is tight but underlying structures are bulky or full) or age-related (in order patients neck skin and muscle becomes loose and deeper tissues hypertrophy). In most cases, Dr. Rad must address 4 factors: loose skin, excess fat above and below the platysma muscle, excess digastric muscle bulk, a weak platysma muscular sling, and a small chin and weak jawline. Addressing each of these factors with high skill can lead to lifelong excellent results.

“Aesthetics are about nuance, subtlety, harmony and plausible deniability.”

- Ariel N Rad, MD, PhD, FACS

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01Artistry

Patients are most concerned to achieve a “natural” result and Dr. Rad makes a detailed assessment of facial and neck anatomy when planning neck lift. With mild skin looseness, scars can be minimized, an approach Dr. Rad has refined and known as the “scarless” or mini-neck lift technique. An open approach addresses significant laxity of all tissue layers. In the scarless approach, very small incisions behind the earlobes through which the platysma muscle is tightened and skin redraped. In the open technique longer incisions around the ear and under chin are necessary and all tissue layers are addressed: skin is redraped, deep fat removed, digastric muscles (“vestigial” muscles of no important function) reduced, and platysma muscle tightened. In both techniques, Dr. Rad endeavors to minimize tissue dissection and trauma. Dr. Rad places multiple ‘suspension’ sutures to contour the neck. Sutures are absorbable and over 6 months replaced by scar tissue which holds the beautifully lifted contour. The primary difference between the ‘closed’ and ‘open’ techniques is the length of the scar. A necklift is an artistic procedure requiring nuanced surgical judgment to create balance and harmony between the face and neck while maintaining a natural appearance.

02Safety

Your safety is Dr. Rad’s primary concern and he will review your medical history. You should inform Dr. Rad of any medical problems or medications that may affect your healing. If you are medically appropriate to undergo surgery then Dr. Rad’s focus will be to understand what specific aesthetic concerns you have. He prides himself in achieving beautiful, natural results for both women and men, and he operates with safety at top of mind by working with expert anesthesia and nursing teams at DC’s top hospital-based surgery centers. In Dr. Rad’s hands, necklift surgery entails low risk and safety is always top of mind. Dr. Rad’s innate familiarity with facial anatomy, knowledge of safe navigation of the delicate nerves, muscles and blood vessels, and working with expert anesthesia and nursing teams, all translate to keeping patients safe.

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03Technique

While performing the Platysmal Band Reduction, Dr. Rad carries out the following steps:

  1. Platysmal Band Reduction  must be done with light sedation/general anesthesia. Therefore the initial safety steps focus on reviewing your medical history to ensure no major health concerns such as heart, lung, or kidney disease. You will need a preoperative medical clearance by your primary physician and/or cardiologist or other specialists if indicated.
  2. Dr. Rad makes an incision behind the earlobe, under the chin, and by the sideburns to then perform liposuction and separate the neck skin from the underlying muscle (platysma) layer, and places multiple ‘suspension’ sutures to contour the neck.
  3.  After underlying facial tissues are restored to a lifted position, excess skin is removed and the incisions are closed in a tension-free manner.
  4. A light dressing is applied after which you can return home, driven by a friend or family member. The procedure is performed on an outpatient basis in almost all cases.

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05Aftercare

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frequently askedQuestions

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How do I know if I’m a good candidate for a Platysmal Band Reduction surgery?
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Ideal patients are generally healthy and of any age and any body type. Patients should have realistic goals: restoring a crisp neck and jawlines in order to refresh one’s appearance is a reasonable goal, whereas seeking the looks of another person is not. Friends, family and colleagues should notice that you look better, as if having lost weight or more refreshed. Patients planning facelift should also consider necklift for a balanced result. Nora Ephron once said “The neck is a dead give-away. Our faces are lies and our necks are the truth.” Dr. Rad is known in northern Virginia and Washington DC for achieving facial harmony and restoring youthful neck and face contours will give the most natural results.

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What anesthesia will I need?
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Your comfort and safety are most important and light “twilight” anesthesia ensures you won’t feel any discomfort, you won’t be aware of the procedure, and you’ll not have memories of surgery. This level of anesthesia is minimal, just enough so that you’re asleep and unaware of the procedure, but you are still breathing on your own (the machine is not “breathing for you”). The safest environment in which to perform surgery under anesthesia is a hospital-based operating room. Dr. Rad performs surgery at Sibley, GW and Inova Fairfax, the best hospitals in the northern Virginia and Washington DC areas.

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What are the risks of a Platysmal Band Reduction surgery?
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Platysmal Band Reduction surgery is very safe when performed by a skilled surgeon in a hospital-based operating facility. The risks related to anesthesia – Dr. Rad considers your safety to be the highest priority and for this reason he chooses not to perform your surgery in the office, and rather at Sibley, George Washington or Inova Fairfax hospitals, the best hospital systems in the Washington DC and northern Virginia areas, where skilled anesthesiologists and nursing staff create a safe and comfortable environment. Anesthesia risk is very low for healthy patients who have no heart, lung or kidney disease, many times lower than the risk of driving a car every day.

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Can I get a good result with just liposuction and skin tightening?
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There are many techniques and technologies available, and it can be confusing to know how much improvement can be achieved with each. Many patients ask Dr. Rad if liposuction combined with a skin tightening device can achieve as good a result as surgical neck lift. The short answer is no: surgical contouring addresses all tissue layers, i.e. skin, subcutaneous (under skin) fat, platysma muscle, sub-platysma fat and digastric muscles, whereas liposuction only addresses subcutaneous fat. Patients younger than 35 generally have good skin tone and so fullness in the neck can be related to excess fatty tissue (if overweight) but more commonly due to full digastric muscles and subplatysma fat which are not affected by liposuction. Older patients with loose skin won’t respond well to skin tightening because collagen content is low, and so redrawing of tissues is needed. Across all age groups, surgical neck contouring can be tailored to your exact needs, and Dr. Rad will guide you expertly towards the ideal results safely and effectively.

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What non-surgical alternatives to necklift are there?
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For patients with good skin elasticity and who are concerned with early laxity in the neck and jowl, jawline regions, Thermage FLX is the most effective and science-driven skin tightening device on the market. It is the “smartphone” equivalent as compared with all other devices which are like the “dumb flip phones.” The reason is because Thermage FLX can titrate the heat delivered to tissues to raise temperature to the narrow band of efficacy. This “smart” technology of real-time adjustment of heat delivery allows every pulse of treatment to reliably tighten skin. All other devices are not capable of adjusting energy and so providers often err on the side of undertreating, which results in no improvement, because overtreating can result in a burn. Therefore Thermage FLX is the only skin tightening device that delivers reliable results.

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What is the cost of a Necklift surgery in Washington DC?
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The cost of a facelift (midface, lower face, neck lift) under Dr. Rad’s care starts at $25,000 and increases depending on anatomical needs (specifically whether deep gland and fat reduction is needed), aesthetic goals, and whether other facial procedures are combined with the facelift. The cost for total facial aesthetic surgery ranges $30,000 to $125,000 for corrective work or comprehensive facial aesthetic enhancement that includes eyelids, brows, nose, lips, etc. Note that pricing is customized for each patient and these guidelines do not necessarily apply uniformly.

Total cost depends on multiple factors: your unique anatomy, your goals, complexity of the procedures, the technique used (non-surgical versus surgical), whether corrective work is needed, in-office or hospital-based operating facility, combining multiple procedures (increasing concessions apply for multiple procedures), and the training, certification (Board certification is essential), experience (at least 8 years of experience after residency is recommended), and eye and skill (the unteachable talent) of your surgeon.

Although you may receive varying cost estimates from other practices, keep in mind that your surgeon’s education and training, plastic surgery board certification, his/her experience (at least 8 years of experience after residency is recommended), and the “X” factor of aesthetic artistry and surgical skill (i.e., talent) of your surgeon are important factors in pricing. Dr. Rad’s goal for every patient is to achieve nuanced and natural results with minimal recovery, and we have mechanisms in place to bring your goals in financial reach.

Dr. Ariel Rad strives to deliver the best Neck Lift Washington, DC has to offer. To find out more about facial cosmetic surgery and our financing options, schedule your consultation by contacting our office today.

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