Why do I have loose skin after botox to platysmal bands?

Hi Kam, Botox can treat the muscle component of plastysmal bands, but its not just the muscle that causes these. Any excess or loose skin over the platysma muscle will also contribution to band formation and is usually best treated by removing the excess skin, as you referred to in your comment. A neck lift can be performed on its own or in combination with a facelift and may be - despite the hesitation related to recovery, which you are wise to consider - your best option. Thanks

Thank you for your question. While Botox is an effective solution for the temporary improvement of platysmal bands, it cannot reduce the amount of skin you have or correct skin that already has poor skin elasticity. If you also have those concerns, Botox may not be enough to rejuvenate your neck area. I recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon. Your surgeon may recommend a combination of procedures –both surgical and non-surgical –depending on your unique needs and goals. Possible treatment options include a neck lift, RF microneedling, and dermal fillers. By consulting with a skilled expert, you can rest assured you can safely achieve the best possible outcome.

Botox for the platysmal bands will soften the appearance of these bands but does not affect the skin directly. If you have loose skin in this area the reduction of the bands may make the loose skin more apparent. If you have good skin elasticity, this effect is not typically noticeable as the skin retracts naturally when the muscle activity is reduced.

This is a great question! Individuals who have a strong platysma, have a wider circumference of their neck when they activate this muscle. When you use botox/dysport to relax the muscle, the circumference of your neck will be smaller. If you have some elasticity to your skin, it will appear more loose as the circumference of your neck has gotten smaller. However, if your skin is nice and elastic, you will not see this.
Best,Rosa B Lipin, MD

Hello and thank you for your question. It is always best to see you face to face for a consult and examination however in this case when you relax the muscle it can lead to increased skin laxity in the area. Options include a non-surgical lift using an energy based device or as you mention surgery. I hope that helps answer your question. Always seek an experienced and qualified medical professional for these treatments. Very best wishes