How can you tell the difference between excess skin and platysmal bands? (Photo)

Great question. Its hard to tell from your limited picture. However, those two bands that are prominent at the base of your neck, above your voice box, are the platysma muscle bands that have separated. The amount of loose skin that you have is hard to assess based on the photo you have sent. You are a candidate for some type of neck rejuvenation- it sound like you have tried non invasive options to help and have not seen the desired results. Yes, you are a candidate for a surgical procedure, however, more pictures or an in person consultation would be best to evaluate and suggest options. 

Thank you for your question.  After reviewing your pictures, I believe the problem is Playtisma muscle banding.  This condition will no improve with non surgical treatments including radiofrecuency.  If you pinch the bands they feel soft just like skin because the muscle has the same filing as the skin and the treatment is surgical

Your photo shows visible platysma muscle fibers of short length in a basically slender neck.  Although I would need to examine you to be sure, it seems to me that your skin has pretty good elasticity.  Platysma muscle bands can be active due to increased tone where they push forward on the skin, or more commonly passive where they loosen and sag down and forward.  Only the active bands would respond to Botox.  Passive bands require surgical correction.  Since your skin looks pretty healthy, I think you might see improvement just from tightening the muscles through an incision under your chin crease.  However, be aware that with a slender neck, without much fat padding between the muscles and skin, any active or passive muscle movement out of normal position will be more visible, as opposed to someone with more fat that camouflages the muscle fibers.

Thank you for your pictures and questions. From the basic appearance in the photos, and without the luxury of a physical exam to watch you animate, I would say that these are early and mild plastysmal bands. For this type of thing, my first treatment option would certainly be neurotoxin (Botox). If you have tried this before with absolutely no improvement, I would suggest that the injection technique or the dose has been off and I would consider having an injection done with a board certified plastic surgeon or another reputable injector with good experience and results with this type of thing. If you are sure that you have given Botox the best try and still not getting the results you want, then I would suggest you discuss with a plastic surgeon who is board certified by the American Board of Plastic Surgery a neck procedure to release the muscle and tighten the neck. But be aware of procedures sold as "mini" or "under local" or "minimally invasive." These are often designed to take your money and deliver less than impressive results and treating the neck is an area that seems to be flush with these scams.  Hope this helps!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery

Usually, a neurotoxins work but may not provide a lasting results, especially if you have very active neck platysmal bands. This procedure is also technique sensitive and from your picture, I think injection of a neurotoxin would help.  If you receive a temporary result, then a neck lift where the muscles are brought together in the middle of your neck and divided at the caudal edge would be helpful. Sincerely Dr. K San Francisco 

Based on this photo your only "deformity" are mild platysma muscle bands; there is no sagging and skin laxity. I do not see how would a neck lift improve this condition and I do not recommend it at this point. You may try to change  a person who was giving you Botox? In out experience Botox would be the beast treatment for your mild "deformity". Good luck.

In order to evaluate accurately- in person exam is essential. Generally speaking, facelift/ neck lift is a golden standard when it comes to removal of excess skin and muscle tightening. I suggest that you seek an experienced Board Certified PS with a wide gallery of before and after photos

based on your pictures, I would also have tried Botox first. Assuming that was ineffective at the appropriate doses(30 to 40 units), then it may be time to consider a lift. A true neck lift will tighten the muscles under the chin and often remove skin from behind the ears. After this is done, I still recommend Botox to the neck muscles every 6 months to keep the muscles from separating as time progresses. Discuss these options with a board certified plastic surgeon.
Best Regards, Prashant Soni M.D.

Thank you for sharing your question.  There are both hard and soft bands, typically differentiated by those always present and others when the muscle is activated.  In most cases the best treatment is a formal neck lift.  Hope this helps.

Platysmal bands are the visible expression of muscular activity underneath the skin of the neck, and they become more protrusive as we grow older. They are somewhere between soft and hard, depending on how muscularly engaged they are. In general, one has varying degrees of excess skin that overlies the platysmal bands as one ages. The evidence of this is clearly evident when you look at a child’s neck, as there are no visible platysmal bands and of course there is no overlying loose skin. In my patients from approximately age 40 on, I frequently address platysmal-band issues in my practice during neck-lift procedures. By addressing both the excess skin and the platysmal bands, results can be produced that lead to a beautifully defined jawline and snug neck reflective of youth.