What is the best treatment for platysmal bands in the neck?

Best Treatment for Platysmal Bands in the Neck

Botulinum toxin A injection is the most effective first-line treatment for platysmal bands, with FDA approval specifically for this indication and demonstrated high response rates of over 90% in clinical studies. 1

Understanding Platysmal Bands

Platysmal bands are vertical muscle bands in the neck that become more prominent with aging. They result from hypertrophy and increased tone of the platysma muscle, creating an aesthetically undesirable appearance that impacts jawline definition.

Treatment Algorithm

First-Line Treatment: Botulinum Toxin A

• FDA-approved indication: OnabotulinumtoxinA (BOTOX Cosmetic) is specifically approved for treating moderate to severe platysmal bands 1
• Dosing options:
  • 26-36 Units of onabotulinumtoxinA (FDA-approved range) 1
  • For AbobotulinumtoxinA: 120-180 Units (using a 3:1 conversion ratio from onabotulinumtoxinA) 2

Efficacy Data

• Response rates:
  • 31-32% of patients achieve both clinician and self-assessed improvement of at least 2 grades 1
  • Individual assessment response rates of 40-45% 1
  • Up to 93.7% response rate at 14 days post-injection 3
• Patient satisfaction:
  • 65-71% of patients report being "satisfied" or "very satisfied" with treatment results 1
• Duration: Effects typically last 3-4 months, with gradual return to baseline 3

Injection Technique

1. Patient positioning: Seated upright with neck extended
2. Band identification: Ask patient to grimace or contract platysma to visualize bands
3. Injection pattern:
   • Multiple small injections (0.1-0.2 mL per site)
   • Spaced 1-1.5 cm apart along each band
   • Superficial injections (2-3 mm deep) directly into the muscle
4. Recommended approach: Two-stage technique with initial treatment followed by touch-up for optimal results 2

Patient Selection Considerations

• Best candidates: Patients with Type II (mild) and Type III (moderate) platysmal bands 4
• Less ideal candidates: Patients with excessive skin laxity (Type IV) may have limited improvement with botulinum toxin alone 4
• Contraindications:
  • Neuromuscular disorders
  • Infection at injection site
  • Pregnancy/breastfeeding

Safety Considerations and Complications

Potential Complications

• Common (15.4% of patients) 3:

  • Bruising at injection site
  • Temporary neck weakness
  • Asymmetry

• Rare but serious:

  • Dysphagia (difficulty swallowing) can occur even with low doses 5
  • Neck weakness affecting head position

Risk Minimization Strategies

1. Use proper dilution and concentration (higher concentration with lower volume reduces spread)
2. Maintain proper injection depth (too deep increases risk of affecting deeper structures)
3. Avoid injecting near midline/hyoid area to reduce dysphagia risk
4. Start with conservative dosing in first-time patients
5. Consider using the FDA-approved two-stage approach with initial treatment followed by touch-up 2

Alternative Treatments

For patients with significant skin laxity or those who don't respond adequately to botulinum toxin:

• Surgical neck lift with platysma plication
• Thread lifting procedures
• Combination approaches (botulinum toxin + energy-based skin tightening)

Follow-up Care

• Assess results at 2 weeks post-injection
• Consider touch-up treatment if needed
• Schedule maintenance treatments every 3-4 months based on individual response

Botulinum toxin treatment for platysmal bands offers a safe, effective, and minimally invasive approach with high patient satisfaction rates. The key to success lies in proper patient selection, appropriate dosing, and precise injection technique.