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 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?

Doctor Answers 7

Platysmaplasty can be performed alone or with additional facial surgery

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Immediately under the skin of the neck is the platysma muscle, which you can easily see in a mirror when you clench your teeth and tighten your jaw. In youth, this paired muscle meets in the midline below the chin. With age, the right and left sides of the platysma often separate, producing vertical 'cords' in the anterior neck.

The platysma can be divided anteriorly and tightened during neck lift cosmetic surgery to permanently eliminate these 'cords' and improve the neck contour. One tightened in the midline below the chin, lateral traction on the platysma then creates a 'sling' which elevates the soft tissues below the jawline.

No two facial rejuvenation procedures are ever exactly the same because no two patients are exactly the same. Find an experienced plastic surgeon with expertise in neck rejuvenation, he or she will design a plan with you to help you achieve the results you desire.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Platysmal Bands Require Neck Lift and Platysmal Plication

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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.

Treating neck bands with minimally invasive treatments

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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.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

Platysmal Bands

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                  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. 

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

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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.

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

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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.

Sirish Maddali, MD
Portland Plastic Surgeon

Treatment for neck bands with a neck lift with platysma plasty

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 39 years of age is rather unusual to have significant anterior platysmal muscle neck bands. As long as the skin has excellent tone, a neck lift with a platysma plasty can be performed. This will involve tightening the Platysma muscles from the Adam's apple to the chin area.   The platysmal cords are also released down low over the thyroid area which helps them  disappear.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.