Indications

Platysmal bands are vertical bands in the neck that are seen at rest and are accentuated with neck tightening and forced jaw opening. This procedure may be used in younger patients who are not yet ready for surgery, or in older patients who do not desire surgery, and to treat recurrent bands in postoperative patients.

An additional indication is the patient who has been treated with submental fat therapies that have unmasked platysmal banding.

Anatomic Considerations

The platysma muscle is a thin, superficial muscle that originates on the clavicle and upper chest and inserts onto the superficial musculoaponeurotic system (SMAS), the skin of the lower face, the facial muscles, and the mandible. Although in youth it is considered a continuous sheet, in the elderly this muscle may splay centrally and produce prominent vertical bands. Platysmal bands can be prominent in patients with thin necks, with thin skin, and without abundant overlying fat.

Injection Technique

Having the patient grimace to tighten the neck will often bring out the problem muscles and make the injection easier to perform. Ask the patient to sit upright and lean forward slightly, with the chin elevated just above the horizontal plane. With the platysma muscle in full contraction, the edge of the muscle band is grasped with two fingers while the muscle is injected. The needle is placed deeply into the muscle, between the fingers and perpendicular to the muscle fibers. Approximately 3 to 5 BU is injected into each injection site, for a total of 15 BU per band or 35 to 45 DU per band. A series of approximately three injections is placed down the length of the band approximately 1.5 to 2.0 cm apart. If lateral bands are prominent on full contraction, then these can be injected in the same fashion, though they may need fewer units. Begin injections at the cervicomental angle and work inferiorly, staying approximately 2.0 to 2.5 cm below the mandibular border so as not to affect the upper facial muscles of expression.