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

Question

I am interested in undergoing chin lipo. I have never had a defined jawline and looking for more definition in my profile. Several months ago I noticed that when I tilt my chin upwards, or hyperextend my neck, I can see the platysmal heads/bands underneath my chin. They are not noticeable noticeable when my chin/head is in a neutral position. I also noticed that when I hyperextend my neck the double chin isn't noticeable but then reappears when I place my head/neck in a neutral position. My double chin is most noticeable from my side profile. I am considering chin/neck lipo accompanied with skin tightening (j plasma), but am wondering if this will worsen the appearance of those platysmal heads.

Lexie Wang, MD · Answer

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.

Anna Chacon, MD, FAAD · Answer

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.

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

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

Answers (2)

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Everything you need to know about Chin Liposuction

Our mission is to create a world where every investment in modern beauty is Worth It.