51 Neck Bands

Rod J. Rohrich and Ira L. Savetsky

Abstract

A comprehensive and systematic facial analysis is critical in establishing goals and formulating a precise plan for neuromodulator facial rejuvenation. The degree of preplatysmal and subplatysmal lipodystrophy is noted and recorded. The presence of anterior platysmal banding and whether the bands are partial or full in relation to the mandibular border are also noted.

Neck bands – platysma – mandibular contouring – botulinum toxin – neurotoxin

51 Neck Bands

Key Points

A comprehensive and systematic facial analysis is critical in establishing goals and formulating a precise plan for neuromodulator facial rejuvenation.
Setting realistic expectations with the patient is critical in achieving high patient satisfaction.

51.1 Preprocedural Steps

51.1.1 Facial Analysis

The initial consult begins with a thorough facial analysis including facial proportions, identification of areas with volume deflations, rhytides, and tissue laxity.
The degree of preplatysmal and subplatysmal lipodystrophy is noted.
The extent of the jowls that extend into the neck and obscure the mandibular contour must be noted.
The presence of anterior platysmal banding and whether the bands are partial or full in relation to the mandibular border is also noted.

51.1.2 Criteria of a Youthful Neck (Ellenbogen and Karlin) (Fig. 51.1)

Distinct inferior mandibular border.
Visible subhyoid depression.
Visible thyroid cartilage bulge.
Visible anterior border of the sternocleidomastoid muscle.
Cervicomental angle of 105 to 120 degrees.

Fig. 51.1 Criteria of a youthful neck.

51.1.3 Stigmata of the Aging Neck

Obtuse cervicomental angle (skin laxity, preplatysmal fat, subplatysmal fat, low position of hyoid bone).
Platysmal bands.
Aging lower face/chin.
Indistinct mandibular border.

51.1.4 Platysmal Bands

Pathogenesis likely related to age-related weakening of the cervical fascia resulting in a bulge from deeper neck structures thus creating bands.
Evaluate for static (passive) or dynamic (active) central and/or lateral platysmal banding.
The location, course, and distance between bands are noted.

51.2 Procedural Steps

See Video 51.1.

51.2.1 Botulinum Toxin

Effective in treating platysmal bands, particularly dynamic bands.
Can be used to delay or supplement surgical intervention in a case of postoperative persistent banding or in patients who are reluctant to undergo surgery.
Toxin is injected directly superior and lateral (Fig. 51.2) to the band as well as directly into the platysmal band (Fig. 51.3) but only when grasped and distracted away from the neck to avoid potential complications such as dysphagia.
Starting dose is 10 to 30 units in women and 10 to 40 units in men; however, there is variability depending on the thickness of the band.
Inject 10 units along the mandibular border to improve jaw contour (Nefertiti effect).
Perform 2 to 12 injections per band, approximately 1 to 2 units every centimeter.
A total of approximately 40 to 100 units are used.
The best results are seen in patients with minimal skin laxity and active bands.

Fig. 51.2 Toxin is injected directly superior and lateral to the band.

Fig. 51.3 Toxin is injected directly into the platysmal band but only when grasped and distracted away from the neck.