Platysmal bands are visible, vertical cords that appear on the front of the neck, representing a common aesthetic concern associated with the aging process. These prominent bands are not simply wrinkles or loose skin, but rather the thickened, separated edges of a superficial neck muscle. Their appearance is often more noticeable when the neck muscles are tensed or during certain facial expressions. Addressing these bands involves understanding their muscular origin and choosing between temporary muscle-relaxing treatments or permanent surgical correction.
The Platysma Muscle and Band Formation
The platysma is a broad, thin sheet of muscle that originates in the upper chest and shoulders, extending upward across the front of the neck to attach to the jawline and the skin of the lower face. This muscle is unique because it lies just beneath the skin and is involved in various movements, such as depressing the lower lip, drawing down the corners of the mouth, and tensing the skin of the neck. The cervical branch of the facial nerve controls the platysma’s movement, linking it closely to facial expressions.
Platysmal bands form primarily due to two age-related changes in this muscle sheet. First, repeated, forceful contractions of the platysma over time can lead to muscle hypertrophy, or thickening, making the muscle itself more prominent. Second, the two muscle halves, which meet at the midline of the neck, can separate and weaken as the overlying skin loses its natural elasticity.
When the medial edges of the platysma muscle separate, the resulting gap allows the distinct muscle borders to protrude, creating the visible vertical cords known as bands. These bands are most evident when the muscle is actively contracted. They represent the outer, thickened borders of the muscle sheet, which pull downward on facial structures.
Minimally Invasive Treatment Options
The most common non-surgical approach to treating platysmal bands involves the use of neurotoxins, such as botulinum toxin type A, often referred to by brand names like Botox or Dysport. These injectable treatments work by temporarily blocking the release of acetylcholine, the chemical messenger responsible for signaling muscle contraction. By injecting the neurotoxin directly into the prominent platysmal bands, the muscle fibers are relaxed, which reduces their ability to contract and pull the skin.
A practitioner identifies the bands by asking the patient to grimace or tighten the neck, then places small, superficial injections along the length of each band. Typical dosing ranges are between 40 to 60 total units of onabotulinumtoxinA, distributed across all visible bands, though this varies based on muscle strength.
Results from neurotoxin injections are temporary, with the muscle-relaxing effect typically lasting between three and six months. The non-permanent nature of the treatment means it must be repeated regularly to maintain the smoother neck contour.
Surgical Solutions for Neck Bands
For individuals seeking a more permanent correction of platysmal bands, surgical intervention, primarily a procedure called platysmaplasty, is the definitive solution. This surgery directly addresses the underlying muscular structure causing the bands, rather than just temporarily relaxing the muscle. The procedure involves making a small, discreet incision, most commonly placed under the chin, to access the platysma muscle.
Through this incision, the surgeon tightens the separated medial edges of the platysma muscle and sutures them together, often employing a technique called “corset platysmaplasty” because the muscle is laced up like a corset. This internal stitching re-establishes the continuity of the muscle sheet, eliminating the vertical bands and creating a smoother, more defined angle between the neck and jawline. The internal tightening of the muscle provides structural support that is not possible with non-surgical methods.
Platysmaplasty is frequently performed as part of a comprehensive neck lift, especially in patients with significant excess skin or fat. The surgical approach offers long-lasting results, typically enduring for five to ten years. This procedure is reserved for moderate to severe banding that is unresponsive to neurotoxin treatment.