Neck Lift: Better to Cut over Active Platysma Band, or Tie Bands Together? Under the Chin?

In the case of neck "bands", it appears popular technique is to tie bands together in a corset method. I've also heard of a few surgeons who choose to eliminate the platysma portion that protrudes - by excising it. I had platysma work previously, which I believe made my platsyma band more apparent. I am also skeptical that tightening muscles under the chin will not have a favorable effect on the mouth area - may pull it down. What are the risks of removing a very small portion of platsyma?

Doctor Answers 11

There are a number of different methods to treat prominent bands in the neck, using

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either a surgical or non surgical approach.  The bands in the neck are due to muscular activity of the platysma muscle, and can be relieved by cutting the muscle or re-directing the vector pull of the muscle through sutures.  Botox or Dtsport, by interfering with the function of the muscle, can temporarily relieve the banding in the neck.  The muscle can also be excised or back cut, both of which serve to limit the pull, or banding in the neck.  The surgeon can also suture the separated edges of the muscle together across the midline in a "corset" fashion, thus re-directing the pull of the muscle and eliminating the banding effect.  In general, where multiple approaches are used to treat the same problem, no one approach is consistently superior, and the experienced surgeon will match the technique used to the specific patient and his or her needs.  Either of the approaches you mentioned, or a combination of both surgical approaches may in fact be best for you, and the best way to tell is by a consultation with an experienced cosmetic surgeon...

Mount Kisco Plastic Surgeon

The treatment of neck bands has to be tailored to the individual anatomy

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1)  The goal is to have a smooth right angle under the chin.  How you achieve that is based on the anatomy. Very seldom is a significant amount of platysma removed.  In some patients, suturing together the muscles in the middle works well (the corset approach).  In others, the bands have to be divided (not removed) low in the neck to interrupt the "bowstring" effect.

2)  There often are other anatomical problems besides bands that contribute to a bad neck (fat under the platysma. hanging salivary glands, a low hyoid bone).  These are dealt with at the same time.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Management of neck "bands"

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Management of platysmal bands during open neck plasty may be approached several ways.  Described techniques include midline suturing of the edges (corset, popularized by Dr. Joel Feldman), Z-plasty, transverse myotomy or myotomies (Dr. Bruce Connell), and others.  Use of Botox described (closed), and T-Z direct excision described by Biggs and by Gradinger.  Probably other methods as well.  Dr. William Little recently presented a series of facelifts without specific management of the neck at all.  No need to excise it, and this risks marginal mandibular nerve injury.  Complete excision unreasonable because the muscle crosses the mandibular margin superiorly and extends over a wide transverse expanse in the supraclavicular area beyond normally undermined anterior triangle skin.  Tightening the platysma in the midline below the chin has no appreciable effect on perioral dynamics.  The risks of removing a "very small" portion of the platysma depend on which portion and how small.  Certainly, neck skin surface contour irregularity may result, and injury to underlying structures.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

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What is the Best Technique for a Neck Lift

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Addressing platysmal bands in neck and face lifting

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Removing part of the platysma is never indicated.  In my practice it is not extremely common to manipulate the platysma any more than I do in my routine SMAS-platysma suspension laterally.  When it is indicated I prefer to tighten further at midline in a corset type manner and transcet th pltysma low to elevate the cerico mental angle,  excision of the medial edges may only be necessary to reduce bulk in cases of extreme laxity but cutting parts of bands out would likely result in contour deformity and unnecessary risk.


All the best,


Rian A. Maercks M.D.

Tightening the neck muscles is the best option. It will not pull down your mouth at all

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I have done over 1200 neck and face lifts and can tel you that tightening the neck muscle (platysma) should have little effect on pulling your mouth done, if done correctly. Cutting the platysma muscle is not good in most necks, like 95% of the time. 

Philip Young, MD
Bellevue Facial Plastic Surgeon

Neck Lift: Better to Cut over Active Platysma Band, or Tie Bands Together? Under the Chin?

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Interesting question. With no photos posted in at rest and active contraction of the P-bands very hard to advise. Some also cut and plicate the P-bands as a combination techniques. One risk in excising a small portion of the P-bands is submandibular gland ptosis. Seek in person opinions. 

Neck bands and their treatment.

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Removing a part of the platysma bands and suturing the remainder with a back cut is the usual treatment of this problem. Since your's is a revision this may be different and without seeing you or a photo one can't give an accurate answer.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

MACS-lift combined with anterior bands approximation

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Dear lady, it would have helped to see which is the degree of platysmal banding you have, and to know whether these bands are dynamic or static. Also which "work" did you have previously on the platysma?

My management of the neck usually only involves a vertical lifting of the platysma with a MACS-lift, which I designed in Belgium together with my associate Dr Tonnard. In the cases where preoperative assessment shows that vertical lifting doesn't correct the bands, an small incision under the chin is added to either remove the bands or to approximate them in the midline, however not pulled as tight as Dr Feldman's corset platysmaplasty. This usually gives a smooth neck with disappearance of the vertically visible platysmal bands.

Dynamic bands without a static component can often be treated with botox alone.

Alexis Verpaele, MD
Belgium Plastic Surgeon

What to do with platysma

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The answer is that it depends.  Each neck has its only unique anatomy and  require one, two, or all of the techniques that you mentioned

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

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.