Noticeable platysmal heads underneath chin. Do I need a platysmaplasty? (Photos)

Nearly everyone has visible platysma when extending the neck. You don't have natural bands, at least from what I can tell of these photos (one way you can check is when you smile from the front, do you see the vertical bands in the neck). I think lipo/skin tightening would be fine, but I would consider a chin implant too.

Hi! Dr Peterson here - Thank you for sharing these details and photos—they are very helpful. Based on your description, your platysmal bands are mild and only visible with neck hyperextension, which is common. In a neutral position, they’re not prominent, but fat removal can sometimes make bands more noticeable if the skin contracts unevenly.
Chin/neck liposuction with skin tightening (such as J-Plasma) can reduce submental fullness and improve jawline definition. In most patients with good skin elasticity, skin tightening smooths the area, and platysmal bands remain subtle.
If platysmal bands are a concern, they can also be relaxed or softened using neuromodulators (Botox), sometimes called a Nefertiti lift, which reduces tension in the platysmal bands and improves neck contour.
The best next step is an in-person consultation with a board-certified cosmetic or dermatologic surgeon. They can evaluate your neck dynamically, discuss how your bands may behave after liposuction, and develop a personalized plan—potentially combining fat removal, skin tightening, and neuromodulator therapy for optimal results.

Thank you for your thoughtful question and for sharing your photos. You’re absolutely right. Botox helps smooth dynamic wrinkles in areas like the forehead, between the brows, and crow’s feet, but under-eye lines can be more complex.

The under-eye area is delicate. When you smile, you see a mix of fine skin texture, natural movement, and sometimes a bit of volume loss. Filler can be useful in some cases, especially if there’s hollowing or shadowing. However, if it's placed incorrectly or too superficially, it can make the area look puffy or highlight any bunching when you smile.

Here are some options to consider:

- Very conservative filler in the tear troughs, if you have hollowing, to smooth the transition, but only in skilled hands.

- Skin-boosting treatments like microneedling with PRP, laser resurfacing, or radiofrequency microneedling to improve fine lines and skin quality.

- Topical treatments with retinol (specially made for the eye area), peptides, or growth factors to support skin texture over time.

- Light Botox, or "micro-Botox," under the eyes can sometimes be used in tiny doses to soften lines without affecting movement too much.

So, to answer your question: filler usually doesn’t help with wrinkles caused by skin bunching from smiling, and in some cases, it could make them look worse. However, the right mix of treatments can improve skin texture, soften lines, and refresh the under-eye area without overfilling.

You’re asking all the right questions, and with a careful approach, you can certainly improve this area in a natural way.