What are the treatment options for platysmal band release?

Treatment Options for Platysmal Band Release

For patients with mild to moderate platysmal bands, botulinum toxin injection is the first-line treatment, with incobotulinumtoxin A at 15-20 units per band demonstrating 100% response rates and excellent safety profiles, while surgical platysmal band release should be reserved for severe cases with significant skin redundancy. 1, 2

Non-Surgical Treatment: Botulinum Toxin Injection

Efficacy and Outcomes

• Botulinum toxin injection achieves response rates of 93.7% at 2 weeks and 86% at 3 months, with a mean improvement of 2.0 points on the Merz platysma score scale. 1
• IncobotulinumtoxinA produces 100% response rates by day 8 post-treatment when assessed at maximum tension, with effects lasting 20-21 weeks. 2
• Patient satisfaction is high, with 91% of subjects reporting improvement and approximately 70% rating their bands as "improved" or "markedly improved" at follow-up visits. 1, 2

Injection Technique and Dosing

• The standard technique uses 15-20 units of incobotulinumtoxinA or 5 units of abobotulinumtoxinA per band, with a maximum of 4 bands treated per session. 1, 2
• Injections should be administered directly into each visible platysmal band using careful technique to avoid diffusion to underlying structures. 1
• The conversion ratio between formulations is approximately 3:1 (abobotulinumtoxin to onabotulinumtoxin). 3

Safety Profile and Complications

• Complications occur in only 15.4% of patients, with none requiring intervention beyond observation. 1
• Dysphagia can occur even with conservative doses as low as 60 units of abobotulinumtoxin (equivalent to 20 units onabotulinumtoxin), though this is rare. 3
• The most common adverse effect is bruising at injection sites, with no reported cases of airway obstruction when proper dosing is followed. 4, 1
• Risk of dysphagia likely relates to diffusion to deglutition muscles, larynx, or neck flexors, emphasizing the importance of precise injection technique. 3

Limitations of Non-Surgical Treatment

• Botulinum toxin results are temporary, typically lasting 4-5 months, requiring repeated treatments for sustained improvement. 4, 2
• Efficacy is limited in patients with significant skin redundancy or laxity, where surgical intervention becomes necessary. 4
• No evidence supports facial lifting effects from platysmal botulinum toxin injection—treatment addresses banding only. 4

Surgical Treatment Considerations

While the provided evidence focuses primarily on non-surgical approaches, surgical platysmal band release (involving resection and plication of the platysma muscle) remains the definitive treatment for:

• Severe platysmal banding unresponsive to botulinum toxin
• Cases with significant neck skin redundancy
• Patients seeking permanent correction

Treatment Algorithm

For mild to moderate isolated platysmal bands (2-4 bands scoring ≥1 on 5-point scale):

1. Initiate treatment with incobotulinumtoxinA 15-20 units per band 1, 2
2. Assess response at 2 weeks and 3 months using validated 5-point photonumeric scale 5
3. Repeat injections every 4-5 months as needed for maintenance 2

For severe banding or significant skin laxity:

• Consider surgical platysmal band release with plication 4

Clinical Pitfalls to Avoid

• Do not exceed 20 units of incobotulinumtoxinA per band or treat more than 4 bands per session to minimize dysphagia risk. 1, 2
• Avoid superficial injection technique that may increase risk of intravascular injection or unintended diffusion. 3
• Counsel patients that results are temporary and do not provide neck lifting—manage expectations appropriately. 4
• Assess for skin redundancy before treatment, as this limits botulinum toxin efficacy and may necessitate surgical referral. 4