What the platysma is and why it shows the age of the neck
The platysma is a thin, broad sheet of muscle that covers the front of the neck, from the collarbone to the edge of the jaw. It lies just beneath the skin and takes part in the movements that tense the neck and pull down the corners of the mouth.
Over the years the muscle loses tone and its two halves separate along the midline, while the skin over it loses elasticity. The result is a neck with no defined angle between the jaw and the front of the neck, where the jawline can no longer be seen clearly.
Platysmal bands and double chin: how they differ
Platysmal bands are the inner edges of the muscle once it separates. They show as two vertical cords running down from the chin and become more visible when talking, swallowing or tensing the neck. They are neither excess skin nor fat, and some slim people have them at forty while others never develop them.
A double chin is fat accumulated under the chin and is treated by removing it. A band is a problem of the muscle and is treated by repositioning it or cutting part of its edges. That is why telling them apart changes the treatment.
Deep neck: what lies beneath the platysma
A neck can look poorly defined because of volume sitting beneath the muscle, and no skin traction reaches that. The deep neck lift goes beneath the platysma to treat three structures:
- Subplatysmal fat. The fat that sits under the muscle and is not solved by superficial liposuction. If there is too much of it, the angle between chin and neck is not clean.
- Submandibular gland. When it descends or is prominent, it creates a bulge that no skin tightening corrects.
- Anterior bellies of the digastric muscles. If they are bulky, they fill the space under the chin and flatten the angle.
When the neck comes together with sagging of the face, the deep neck and the deep plane facelift are planned as a single, combined procedure.
Techniques and what each one corrects
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Technique: Platysmaplasty
- What it does
- Brings the two halves of the muscle together along the midline, tightens them and, depending on the case, cuts part of their edges. Access is through a small incision under the chin.
- When it is considered
- A mainly muscular problem: visible bands and a lost angle, with skin that keeps its elasticity.
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Technique: Removal of fat under the chin
- What it does
- Done in the same operation, before working on the muscle.
- When it is considered
- When there is fat accumulated under the chin. Tightening the muscle without dealing with it leaves a tight neck with no definition.
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Technique: Deep neck
- What it does
- Works beneath the platysma: subplatysmal fat, submandibular gland and digastric muscles.
- When it is considered
- When the angle is filled by deep volume.
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Technique: Cervicofacial facelift
- What it does
- Repositions the tissues of the face and neck and redistributes the excess skin, with incisions around the ear.
- When it is considered
- When, in addition to the muscle, there is sagging skin, or the sagging also affects the face.
The operation is planned under general anaesthesia or sedation, depending on the extent of the case and the anaesthetist's assessment. For a limited platysma correction, sedation or local anaesthesia may be enough, with an indicative recovery of 7 to 10 days.
When operating on the neck alone is enough
Platysmaplasty on its own makes sense when the problem is muscular and the skin still responds, which is more common in younger people or those with little laxity. If there is sagging skin, operating only on the muscle corrects the band and leaves the skin.
Operating only on the neck is a frequent indication when the cheek keeps good support. In a face with a midface that has descended, treating only the neck leaves an unbalanced contrast between the two areas, and the usual indication is a cervicofacial facelift.
The chin and the hyoid bone also decide the angle
A receding chin makes the neck look shorter and worsens the angle for bony reasons. Platysma surgery does not change the position of the chin, and in those cases it is worth considering chin surgery or a profileplasty plan.
The hyoid bone often comes as a surprise at the consultation. When it sits low and forward, the neck angle that can be achieved is smaller because of anatomy, however well the muscle is treated. Knowing this before surgery avoids expectations that anatomy cannot meet.
What neck surgery does not correct
- Skin quality and texture. Pigmentation, fine lines and sun damage need other treatments.
- The position of the chin.
- Later ageing. The muscle loses tone again over the years, at a pace that varies from person to person.
- Generalised excess fat, which is no substitute for losing weight.
How a neck is assessed at the consultation
The assessment separates skin, fat and muscle. The neck is examined at rest and when contracted, because a band can go unnoticed until the patient tenses it. The angle between neck and chin is measured, the position of the hyoid is assessed and the projection of the chin is studied.
Recovery
For the first few days a dressing or a compression garment is worn over the neck. Swelling and bruising are to be expected and go down over the first weeks.
Sensation in the chin and neck can be altered for a while and returns gradually. Sudden neck movements and physical effort are limited for the period the surgeon indicates. The result stabilises over the following months, evolving differently in each patient.
Risks
Like all surgery, it has risks, and they are explained at the consultation before anything is decided: haematoma, temporary or persistent changes in sensation, contour irregularities, a scar under the chin that is visible in some cases, and injury to nerve branches involved in the movement of the mouth. How often each one occurs depends on the case and the technique.
And without surgery?
Botulinum toxin can relax the muscle and soften the bands temporarily, especially when they are mild and appear with movement. It does not reposition the muscle or treat the skin, and its effect wears off over time. What each alternative can do is explained in facial rejuvenation.
Frequently asked questions
What is the difference between platysmaplasty and a neck lift?
Platysmaplasty treats the muscle. A neck lift is broader: it includes the muscle and also redistributes the skin and, where appropriate, treats the fat. Platysmaplasty is often one step within the lift.
Where is the scar?
The main incision is placed in the crease under the chin, where it sits in the natural shadow of the area. If the sides also need treatment, incisions around the ear are added. How any scar evolves depends on each person's skin.
Can neck bands be removed without surgery?
Botulinum toxin softens mild bands temporarily. It does not reposition the muscle or treat the skin, and the effect wears off over time. What is appropriate in each case is decided at the assessment.
At what age is it considered?
There is no set age. What decides is how far the muscle has separated, the quality of the skin and the anatomy of the neck. There are indications at thirty and necks that do not need it at sixty.
Can it be done at the same time as other facial surgery?
Yes. It is often combined with a cervicofacial facelift and, in some cases, with eyelid or midface surgery. It is decided when the case is planned, taking into account the total operating time and the combined recovery.
Do the bands come back?
The muscle keeps ageing after surgery, so the correction is not definitive. The pace at which the signs reappear varies a great deal with genetics, weight and skin care.