Platysma Bands: Is a Change Needed in the Surgical Paradigm?

Background: Platysma bands are one of the first signs of aging of the neck. Current theories suggest that these bands develop because of skin sagging followed by loss of muscle tone. Treatment strategies therefore aim to tighten skin and muscle. The aim of the present study was to demonstrate that platysma bands are caused by muscular activity during the aging process and are not secondary to skin sagging. This suggests a new approach to managing platysma bands. Methods: The authors conducted a descriptive, prospective clinical study of 25 patients who presented with definitive, unilateral, facial palsy following otoneurosurgical treatment. The authors targeted their observations on anterior neck bands. Patients were followed for up to 10 years. Results: Of the 25 patients, 76 percent had visible platysma bands on the healthy side, but not on the paralyzed side, of their face. Platysma bands were present on both sides in the 12 percent of patients who had a spastic form of facial paralysis. There was no worsening of the platysma band appearance in any patient. No ptosis of the neck skin on the paralyzed side was observed. Conclusions: This study demonstrated that platysma bands are not related to relaxation of the platysma and skin laxity, but are caused by activity of the platysma muscle. The skin follows the muscle. These observations support a change in surgical management of the aging neck, moving from tightening the skin to denervating the platysma muscle. Further studies need to fully characterize the efficacy and safety of platysma muscle denervation in this indication.

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