Dysport for Platysmal Bands - how many units should be used? (Photos)

Question

Hi! In December, I had 30 units of dysport to my platysmal bands (2 side and front right). The left front band wasn’t visible when flexing, so my injector didn’t treat much of it. I returned for a touch-up and received 10 additional units between the front two bands since the other front band got stronger. Despite these injections, the bands remain very prominent. I’m returning next week. Do you think 10 more units will suffice to flatten the front two bands? I expected them to be flatter after all these injections. Let me know your thoughts!

Anna Chacon, MD, FAAD · Answer

Platysmal bands can be surprisingly strong muscles, and it’s very common for them to need more than one treatment session before they noticeably soften or flatten. What you’re experiencing doesn’t necessarily mean anything was done “wrong,” but rather that your platysma may simply be more active or thicker than average.

Thirty units of Dysport for the neck is on the conservative side, especially if multiple vertical bands are present. An additional 10 units as a touch-up is also quite modest. In many patients, the total dose needed to adequately relax prominent front bands ends up being higher, sometimes significantly so, and it often has to be distributed carefully along the length of each visible band rather than just at one or two points.

If the untreated or lightly treated band became more prominent after the first session, that makes sense physiologically. When only some fibers are weakened, the untreated portions can appear stronger by comparison when you flex your neck. That’s why balancing both sides and the full length of the central bands is important for a smooth, flatter look.

Whether another 10 units will be enough depends on how much movement is still present when you strongly contract your neck. If the bands are still very visible at full flex, a slightly larger additional dose may be required to see a meaningful change. Many people need gradual layering of treatment over a couple of visits to avoid over-relaxing the neck muscles all at once, which can feel weak or unnatural if too much is used in a single session.

It’s also important to remember that neuromodulators like Dysport soften dynamic bands caused by muscle contraction. If part of the prominence is due to skin laxity or fixed, etched-in cords that are visible even at rest, toxin alone may not completely flatten them, though it can still make them less obvious and less tense.

Your expectation of seeing flatter bands is reasonable, but sometimes it takes dose adjustment and a bit of fine-tuning over successive treatments to reach that point safely. A cautious, stepwise increase is generally preferred to jumping straight to a very high dose, especially in the front of the neck where precision matters.

Dysport for Platysmal Bands - how many units should be used? (Photos)

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