Thanks for the question Skylar - I know that your...

Steven H. Williams, MD answers: Treatment for neck bands when Botox and neck lift aren't options?

I am 39 and have decent skin tone and texture but hereditary Platysmal banding...no smoking at all and a positive history of sun exposure but no sun in the last 5 years (religious use of sunscreen in 7 years).

I have had several consults with surgeons (board certified plastic and facial plastic) regarding my neck. I have platysmal bands that go down from chin to my scapular bone and have had Botox 3 times in this area with no result and Total FX (conservatively done).

No improvement with Botox with three attempts by two surgeons (despite their incredible credentials). The two surgeons also didn't consider me a face lift/neck lift candidate and don't do isolated neck lifts in their practices due to inconsistency of results....therefore they won't work on me because I'm not a face lift candidate.

Can someone suggest another option for my platysmal bands besides a neck lift or Botox?


Steven H. Williams, MD
11 months ago

Thanks for the question Skylar -

I know that your research and interaction with surgeons has provided you with a great deal of information and it seems like you've gone down pathways that are reasonable places to start. 

In my practice, patients that are not facelift candidates because they have a minimal amount of lower face skin excess can benefit from Botox treatments.  Given the fact that you've failed that, you may be looking at surgical options.  In my experience, Total Fx treatments will not correct these issues.

Platysmal plication with a neck lift may be an option for you.  Of course it is difficult to assess without a consultation but many times patients can have excellent results with a combination of a neck lift and platysmal plication.  The scars would be similar for a facelift in this case.

Outside of these options there really isn't a great answer.

I hope this helps.

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A: I can understand your frustration and can see that you...

Sirish Maddali, MD
11 months ago

I can understand your frustration and can see that you have researched your options well. Botox has limited success with platysmal bands. As far as I am aware, surgically treating the platysmal bands is the only method to give you a reliable result.

Traditionally, we (plastic surgeons) do not do isolated neck lifts in patients that are not having a facelift or have not had a facelift in the recent past. However, someone with isolated platysmal bands can be a candidate for a "neck lift" procedure where we just focus on treating the bands and not truly tightening the skin.

My advice is to look for a plastic surgeon who would do an isolated neck lift.

Good luck.

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