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. 2011 Aug 17;35(5):866–877. doi: 10.1007/s00266-011-9782-0

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© The Author(s) 2011

This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

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Fig. 3 — a Preoperative views of a 47-year-old Caucasian woman, with the platysma muscle contracted to provide a better view of the bands for skin demarcations. b, c Two longitudinal skin demarcations are made along the two bands. One side has five and the other side six transversal lines to indicate the number of myotomy sections to be performed. The outpatient surgery is performed with the patient under local anesthesia without preoperative medication. d–g The needle transfixes the skin behind the muscle band. The steel wire is threaded inside the needle tip and emerges from it, leaving the wire behind the muscular band and the two ends exposed. h–k The needle is removed and reinserted from the same skin entrance. It contours the muscular band and exits from the parallel skin puncture. The steel wire is again threaded through the needle to exit in the opposite direction, completing the loop around the muscular band. Light manual traction is applied to the wire to confirm that it has completed the loop around the band. l–n Both ends of the wire are inserted through the holes of the device and knotted. The excess is cut. o–q The device is placed gently against the skin with the wire ends protruding. When the handle of the platysmotome is turned, the metal loop cuts the muscle, and the wire emerges from the skin. It is important to realize that the circular plate, with the small center hole through which the two ends of the wire pass, is essential to keeping the wires held tightly together, preventing them from separating in the effort to cut the muscle, which could widen the puncture hole or cut the skin. Maintaining the puncture holes of the steel wire point-like is an indispensable condition of this technique because it guarantees rapid closure of the holes without scarring. r Final aspect of the neck. In this specific case, the central line of skin holes was used to treat both sides of the platysma bands. s, t An ice pack is applied for 15 min after surgery. u Final aspect of the neck skin after removal of the ice pack. v Another surgical option in which all the steel wires are previously transfixed to the specific sites on the platysma band

Fig. 3 — a Preoperative views of a 47-year-old Caucasian woman, with the platysma muscle contracted to provide a better view of the bands for skin demarcations. b, c Two longitudinal skin demarcations are made along the two bands. One side has five and the other side six transversal lines to indicate the number of myotomy sections to be performed. The outpatient surgery is performed with the patient under local anesthesia without preoperative medication. d–g The needle transfixes the skin behind the muscle band. The steel wire is threaded inside the needle tip and emerges from it, leaving the wire behind the muscular band and the two ends exposed. h–k The needle is removed and reinserted from the same skin entrance. It contours the muscular band and exits from the parallel skin puncture. The steel wire is again threaded through the needle to exit in the opposite direction, completing the loop around the muscular band. Light manual traction is applied to the wire to confirm that it has completed the loop around the band. l–n Both ends of the wire are inserted through the holes of the device and knotted. The excess is cut. o–q The device is placed gently against the skin with the wire ends protruding. When the handle of the platysmotome is turned, the metal loop cuts the muscle, and the wire emerges from the skin. It is important to realize that the circular plate, with the small center hole through which the two ends of the wire pass, is essential to keeping the wires held tightly together, preventing them from separating in the effort to cut the muscle, which could widen the puncture hole or cut the skin. Maintaining the puncture holes of the steel wire point-like is an indispensable condition of this technique because it guarantees rapid closure of the holes without scarring. r Final aspect of the neck. In this specific case, the central line of skin holes was used to treat both sides of the platysma bands. s, t An ice pack is applied for 15 min after surgery. u Final aspect of the neck skin after removal of the ice pack. v Another surgical option in which all the steel wires are previously transfixed to the specific sites on the platysma band