Platysma bands and platysmaplasty

What causes neck bands

The platysma runs from the upper chest over the jawline into the lower face. In most people the left and right muscles meet just below the chin and separate lower down, leaving two free inner edges (PMID 7433553). The outer part of each muscle is held flat by a zone where it is fused to the deeper neck fascia; the free inner fibers are not, and they lift into a cord each time the muscle contracts (PMID 34529598). Ultrasound shows the same thing in living people: inside a band the muscle thickens and stops gliding (PMID 37418617).

For decades surgeons treated bands as loose skin over a slack muscle and tightened both. In 2017 Patrick Trévidic's group reported patients with one-sided facial paralysis followed for up to 10 years: bands formed on the side that still moved and not on the paralyzed side, and the neck skin on the paralyzed side did not sag. Their conclusion was that bands come from muscle activity and that the skin follows the muscle (PMID 27627054). Later dissections found the platysma bonded to the skin and to the deep fascia across both of its surfaces, which explains why some bands stay visible at rest and why bands can return after the muscle is cut (PMID 37186556).

The current view joins both ideas: an active muscle with free inner edges, held by its attachments to skin and fascia. That is why modern treatment works on the muscle itself and on how it is anchored, and treats skin as a separate problem (PMID 37653178).

Where it came from

• 1979: Sherrell Aston showed that surgery on the platysma improves facelift results and described the common platysma deformities and the pitfalls of treating them (PMID 397794).
• 1980: de Castro mapped how the two platysma muscles meet, the anatomy every later technique uses (PMID 7433553).
• 1990: the corset platysmaplasty closed the whole midline seam (PMID 2304983).
• 2016 and 2017: a surgeon who had cut the muscle fully for 25 years reported his own recurrences and moved to a lateral approach (PMID 27307341, PMID 28121859).
• 2017 to 2019: the facial paralysis observation led to planned denervation of the bands (PMID 27627054, PMID 31373989).
• 2021 to 2024: CT, ultrasound and layered dissection explained where bands form and why they return (PMID 34529598, PMID 37418617, PMID 37186556).
• 2025: phase 3 trials of botulinum toxin for platysma prominence reported (PMID 39442886, PMID 39475141).

Who it suits

• People with visible bands at rest or when the neck tenses; surgeons and trials grade them on a validated 0 to 4 photo scale (PMID 23650974).
• People with bands plus loose skin and fat under the chin: platysmaplasty is done as part of a neck lift or facelift (PMID 22106184).
• People whose bands show mainly on contraction, with little loose skin, or who do not want surgery: botulinum toxin is the tested non-surgical option (PMID 39442886).
• People with a short neck and a blunt neck angle: one technique cuts and repositions the muscle in two levels to lengthen the neck line (PMID 42517588).
• People whose bands came back after an earlier neck lift: a secondary operation through the chin opens the front of the neck and joins the muscle edges (PMID 27018694).

How it is done

Surgeons reach the muscle from the front of the neck, from the side through the facelift incision, or both. The choice depends on how strong the bands are, how much loose skin there is and which facelift is planned (PMID 37653178).

From the front (midline platysmaplasty)

• Through a short incision under the chin the surgeon removes excess fat and sews the two inner muscle edges together. Joel Feldman's corset platysmaplasty runs that seam down and back up most of the neck so no free edge is left to form a band (PMID 2304983).
• David Knize described the same repair through the single chin incision with no skin removed, followed by an elastic garment (PMID 9462784).
• Some surgeons add horizontal cuts across a band before closing the midline (PMID 19083530) or cut the muscle partly across at the level of the hyoid bone (PMID 42481793).

Cutting across the muscle (transection)

• Full-width transection cuts the whole muscle low in the neck so the upper part can be lifted and rotated; its 2002 case rested on patients reviewed many years after surgery (PMID 12397445).
• Surgeons who cut the muscle completely suggest that an incomplete cut, which leaves nerve supply to the inner fibers, may explain bands that return (PMID 37737877, PMID 30052756).

From the side (lateral platysmaplasty)

• Through the facelift incision the surgeon pulls the muscle edge back toward the ear and fixes it; one approach adds a release low in the neck and a lateral platysma window (PMID 28350662).
• Lateral skin-platysma displacement treats bands and loose skin from the side only, without opening the front of the neck (PMID 28121859).
• Other versions fix a flap of upper platysma to the firm fascia behind the ear (PMID 39266681) or add a platysma hammock flap to the extended deep plane facelift (PMID 35446382).

Denervation

• The surgeon cuts the small branch of the facial nerve that drives the band, so the muscle there stops contracting (PMID 31373989). A denervation neck lift combines this with platysmaplasty and skin removal (PMID 40456286).

Suture slings

• Closed techniques pass permanent sutures under the skin to support the muscle with only small incisions: the trampoline platysmaplasty (PMID 22231408), light-guided band division with suture suspension (PMID 36342786), barbed sutures (PMID 38055921) and crisscrossed sutures anchored behind the ears (PMID 40810907).

Botulinum toxin

• Injections into the bands weaken the muscle. In phase 3 trials onabotulinumtoxinA improved platysma prominence at two weeks with side effects similar to placebo (PMID 39442886, PMID 41612547).

Results and how long they last

In one long-running practice about 1 in 10 neck lifts had a second operation, on average about 10 years after the first, and returning bands were the main reason (PMID 27018694). Those authors credit the durability to opening the front of the neck and joining the muscle edges (PMID 27018694).

Results after full transection differ by surgeon. Pooled data from published transection series put band recurrence at about 1.4% (PMID 39406360), and one series scored by blinded raters found no recurrence at 5 years (PMID 37737877). Mario Pelle-Ceravolo audited his own full-transection patients and found bands back in almost half at one year (PMID 27307341); after he moved to lateral skin-platysma displacement, about 1 in 6 had bands back at one year (PMID 28121859).

• Flaps from the side, including the hammock flap in the deep plane facelift, kept bands corrected in most patients at about 18 months (PMID 35446382, PMID 39266681).
• Suture slings report few returning bands in the first year or two, and bands that came back after the trampoline sling were corrected by replacing the sutures (PMID 36342786, PMID 22231408).
• After a denervation neck lift, the bands that returned were all in patients over 63 (PMID 40456286).
• Botulinum toxin is temporary: the effect stays above placebo through about 4 months and then fades (PMID 39475141); repeat treatments kept working (PMID 41329600).
• Most published results are graded by the operating surgeon, and reviews ask for standard, long-term measures (PMID 37653178, PMID 39406360).

Risks and how surgeons lower them

Bleeding

• Opening the front of the neck raises the chance of a hematoma, a collection of blood under the skin. In a large facelift review, anterior platysmaplasty was an independent risk factor, along with high blood pressure, male sex, aspirin or anti-inflammatory drugs and smoking (PMID 11513508).
• Across transection series the hematoma rate was about 1.8% (PMID 39406360). Surgeons lower it by controlling blood pressure, stopping aspirin and anti-inflammatory drugs before surgery and asking patients not to smoke (PMID 11513508).

Nerves

• The nerve branches to the platysma and the lower lip run on the deep surface of the muscle. Pooled nerve injury after transection was about 0.9% (PMID 39406360); in recent series the nerve injuries were temporary (PMID 42517588, PMID 36342786).
• In cadavers, undermining the platysma spared its nerve supply unless the dissection went past the facial vessels (PMID 30052756). A mapped corridor guides release from the side (PMID 33903900), and the lower lip muscle draws on two nerve branches in the same plane (PMID 40876005).

Other

• A sialoma, a pocket of saliva, followed transection in about 3 in 1,000 patients (PMID 39406360).
• Swelling that lasts for months is the main complaint after full neck undermining (PMID 28121859).
• Suture techniques carry a risk of sutures showing through or infection at the suture site (PMID 39266681, PMID 36342786).
• After repeated toxin treatments a few people had mild trouble swallowing or mild facial weakness (PMID 41329600).

Recovery

• Swelling is the longest part of recovery, and it lasts longer when the whole neck is undermined and the muscle is cut across (PMID 28121859, PMID 27307341).
• An elastic neck garment is used after the chin-incision technique to help the skin settle (PMID 9462784).
• Smaller techniques recover faster: patients returned to everyday activities right away after the flap fixed behind the ear (PMID 39266681), and the composite platysmaplasty with closed muscle release is reported with a fast recovery (PMID 19825461).
• Toxin needs no recovery time; the trials measured the effect at two weeks (PMID 39442886).

With a facelift

• The type of facelift changes how much neck work is needed. In cadavers, a deep plane lift moved the inner platysma edge several times further than SMAS plication, so the authors add a midline repair to most SMAS plication facelifts and keep it for severe bands with the deep plane (PMID 22106184).
• In a randomized study, pulling the muscle from the side did not widen the gap between the front bands (PMID 32766034).
• In facelift patients, radiofrequency-assisted liposuction gave a neck angle similar to open platysmaplasty (PMID 37992758).

Questions to ask a surgeon

• Ask whether the bands will be treated from the front of the neck, from the side or both, and why (PMID 22106184).
• Ask how often bands return in the surgeon's own patients, and after how long (PMID 27018694).
• Ask how bleeding is prevented when the front of the neck is opened (PMID 11513508).
• Ask how the nerve to the lower lip is protected (PMID 40876005).
• Ask whether botulinum toxin would be enough for now, and how often it would be repeated (PMID 39475141).
• Ask how long swelling usually lasts after the planned technique (PMID 28121859).

Open questions

• What causes bands: muscle activity (PMID 27627054) or the fascial anchoring of the inner fibers (PMID 34529598); the platysma's bonds to skin and fascia link both (PMID 37186556).
• Whether to cut the muscle fully, move it from the side or keep it whole: results by technique differ between surgeons (PMID 27307341, PMID 37737877).
• Planned denervation has short follow-up, and lower lip function depends on nerve branches in the same plane (PMID 40456286, PMID 40876005).
• Suture slings and toxin have the shortest follow-up of the options (PMID 36342786, PMID 41329600).

Terms

• Platysma: thin sheet of muscle under the skin of the neck and lower face (PMID 7433553).
• Platysmal band: vertical cord at the front of the neck formed by the inner edge of the platysma (PMID 34529598).
• Platysma prominence: bands and a softer jawline when the platysma contracts; the term used in the toxin trials (PMID 39442886).
• Platysmaplasty: any surgery on the platysma: stitching, cutting, suspending or denervating it (PMID 37653178).
• Corset platysmaplasty: a running midline seam joining the two muscle edges down the neck (PMID 2304983).
• Transection: cutting across the muscle (PMID 12397445).
• Lateral skin-platysma displacement: moving skin and muscle together toward the ear without opening the front of the neck (PMID 28121859).
• Platysma hammock flap: a platysma flap added to the extended deep plane facelift (PMID 35446382).
• Denervation: cutting the nerve branch to the muscle so it can no longer contract (PMID 31373989).
• Cervical branch: the facial nerve branch that supplies the platysma and part of the lower lip (PMID 30052756, PMID 40876005).
• Cervicomental angle: the angle between the underside of the chin and the front of the neck (PMID 38055921).
• Hematoma: a collection of blood under the skin after surgery (PMID 11513508).

Papers