Treatment for Neck Bands when Botox and Neck Lift Aren't Options?

Question

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?

Raffy Karamanoukian, MD, FACS · Answer

Platysmal bands occur because of a diastasis of the midline platysmal muscle and a laxity of the submental fat.  Serious thought should be placed into performing the gold standard for correction, neck lift and platysmal plication, rather than other non-invasive procedures that do not address the muscle.
In my practice, I adhere to surgical guidelines to correct problems that are surgical in nature.  Performing lesser treatments lead to dissatisfied results.

Jed H. Horowitz, MD, FACS · Answer

It would be best to consult with a board-certified surgeon in-person as you may have more than one option. The presence of banding down the front of the #neck, and, amount of excess skin and condition of your skin are among some factors which determine if you are a #candidate for #rejuvenating the neck. Chin deficiency with the neck and jawline are also taken into consideration. A weak #chin implies a lack of chin support for the skin along the neck line. As a stand-alone procedure, chin augmentation can be performed in the office under local #anesthesia. For individuals with signs of aging in the neck, a chin implant added to one of the recommended procedures above, will provide optimal results.
Patients who desire facial rejuvenation that is affordable, quick, and effective should also consider the Lite-lift™. Like the Life-Style™ facelift, this is a modified facelift, individualized for each patient, that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.
A board certified plastic surgeon should evaluate both your anatomical features and aesthetic goals to suggest which procedure best suits your needs. In some cases there may be more than one option to choose from. If you are not a candidate at the time of your #consultation, your board surgeon can recommend non-surgical alternatives to address your concern.

Richard J. Bruneteau, MD · Answer

Several
factors contribute to the development of platysmal bands. These include
separation of the paired platysma muscles, weakness and laxity of these muscles
and loose overlying skin. Correction of this problem requires that all of these
components be addressed.

It’s
virtually impossible to make a recommendation without a physical exam or
pictures. In the majority of patients a neck lift with plication of the paired
platysma muscles will be necessary to correct this problem.

It’s
important to consult a board certified plastic surgeon with experience in this
area. This surgeon should be able to formulate a treatment plan to address your
problem.

Brent Moelleken, MD · Answer

Neck bands are usually a combination of three things:
1.  Loose skin of the face and neck
2.  Loose muscles
3.  Loss of volume of the face
The reason you did not have success with minimally invasive tightening treatments and Botox to the neck muscles lies in the weaknessof those treatments.
Botox relaxes muscles.  It does not tighten them.
Radiofrequency treatments or fractionated lasers offer only a very small amount of permanent tightening, much less than what is typically bothering patients.
With proper medical clearance and optimization of the medical status, most patients can have a facelift, even if it performed under light sedation under the watchful eye of a board certified anesthetsiologist.
The difference between a neck-only lift performed from behind the ear and a facelift is not that much in experienced hands.  A facelift/necklift with platysmal tightening is from your description the right procedure without respect to medical issues.
An experienced surgeon will perform the procedure quickly and with minimal blood loss.  A novice will take a great deal of time and incur a large blood loss, a physiologic burden the patient must carry.
If several experienced surgeons do not believe you are a candidate for surgery for medical reasons, this is something to listen to.  While you will undoubtedly find somebody to perform surgery on you who does not have concerns about your underlying medical conditions, this is obviously to be avoided.
You may have a decent result from having just a platysmaplasty procedure, accepting that this will give only modest results.

Steven H. Williams, MD · Answer

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.

Treatment for Neck Bands when Botox and Neck Lift Aren't Options?

Answers (8)