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Chapter 8. Platysma

Platysma Anatomy

During aging, platysmal bands may become very visible forming the turkey neck in slim patients.

(Adapted with permission from Ipsen.)

The platysma covers the superficial fascia of the neck and is closely connected to the skin. It draws the lower jaw and the corners of the mouth down, expands the skin of the neck, and extends the skin in vertical lines. Platysmal bands occur due to diastasis of the midline platysmal muscle and loss of submental fat.

In the photo, the platysma, shaded in yellow, is a sheet-like muscle originating in the clavicle and fascia of the upper chest and inserts into the mandible and skin of the chin and cheek. The blue ovals indicate approximate appropriate injection zones for neurotoxin treatment of the platysma.

Platysma Approach to Treatment

(Adapted with permission from de Maio M, Rzany B. Botulinum Toxin in Aesthetic Medicine. Berlin, Springer-Verlag; 2007.)
Injecting directly into the contracted platysmal band.

Platysmal bands are typically treated via a series of superficial/intradermal injections directly into the contracted muscular band. The number of injection points depends on length of each band. Typical neurotoxin injection points for treatment of the platysma are shown as blue circles in the illustration. Grasping the band with the noninjecting hand might be helpful while injecting very superficially in the contracted muscle.

Platysma Case

Reducing vertical bands that appear when the patient contracts the platysma.

Individualized treatment for this patient is indicated by 7 injection points in an asymmetrical distribution (shown in the photo). The 3 blue circles in the photo indicate injection points with 5 DYSPORT Units each, 3 green circles indicate injections of 2.5 DYSPORT Units each, and the red circle marks an injection of 2 DYSPORT Units. The total dose for this treatment was 24.5 DYSPORT Units.

Platysma Injection Demonstration

The total dose was 24.5 DYSPORT Units.

Platysma Results

After anterior vertical bands have disappeared, lateral bands can be treated at follow-up.

In the video, the patient shown at rest and in full expression before and 17 days after treatment with DYSPORT 24.5 Units total dosage. Anterior vertical bands have disappeared. Lateral bands can be treated at follow-up 2 weeks later.

Platysma Treatment Summary

Neurotoxin treatment is very effective at softening the vertical banding in the platysma and may also improve lateral cheek lines and marionette lines. To minimize adverse events ecchymosis, difficulty swallowing, neck weakness, asymmetric smile from inadvertent diffusion into DAO, treatment approach should be conservative and conducted by experienced practitioners. Titrating the dose, with trial and follow-up, is recommended

It is important to obtain informed consent. Note that it is important to avoid the pharynx. Dysphasia and dysphonia are rare but have been reported after treatment with neurotoxin.