Platysmal Bands Research Articles

Advanced Techniques for the Use of Neurotoxins in Non-Surgical Facial Rejuvenation.

Neurotoxins initially were used to treat hyperfunctional rhytids of the face, but now have been expanded to improve facial shaping, correct facial asymmetry and even improve skin texture and tone. The clinical approach to non-surgical facial rejuvenation is approached into four anatomical regions: the upper face, midface, lower face and neck. The key muscles of the upper face include frontalis, orbicularis oculi, corrugator supercilii, procerus, depressor supercilii and temporalis. The muscles in the midface to be discussed include the levator labii superioris, levator labii superioris alaeque nasi, depressor anguli oris, depressor septi nasi and nasalis. Treatment of the lower face focuses on the orbicularis oris, mentalis, depressor anguli oris and masseter muscles. Finally, treatment of the neck region will be reviewed with emphasis on platysmal bands and necklace lines as well as the Nefertiti lift. Non-surgical facial rejuvenation using neurotoxins should be performed safely and effectively in order to avoid and treat complications. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Surgical Denervation of Platysma Bands: A Novel Technique in Rhytidectomy.

Prominent platysma bands in the neck are one of the first signs of aging. There is increasing demand for surgical facial rejuvenation, including procedures to tighten skin and muscle in the neck; however, obtaining long-lasting results is a challenge. The aim of this study was to characterize the efficacy and safety of platysma muscle denervation for this indication. The authors performed surgical platysma denervation, involving selective cervical branch section simultaneously performed with rhytidectomy, in eight patients with unilateral facial paralysis (as a solution for visible platysma bands on the unaffected side of the face) and in one patient requiring aesthetic rhytidectomy (bilateral surgery). Patients were monitored for at least 3 months after surgery (in some cases, for up to 21 months). There were no major postoperative complications. Eight of the patients were unable to contract the platysma following surgery, leading to an improvement in the platysma band appearance. This study demonstrated the effectiveness and safety of the platysma denervation technique. Sectioning the cervical branch of the facial nerve provides a permanent solution to improve the cosmetic appearance of platysma bands and can be combined with rhytidectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

Platysma and the cervical superficial musculoaponeurotic system — Comparative analysis of facial crease and platysmal band development

ObjectiveThe superficial musculoaponeurotic system connects the mimic muscles to the skin, allowing mimic expressions with regional morphological architectural differences. The aim of this study was to perform an architectural analysis of the cervical platysma-skin interaction, determine the morphological implications in platysmal band development and compare the findings to the facial SMAS architectural types. MethodFull-thickness blocks of skin, SMAS and platysma from seven hemifaces (three male and two female) and full-thickness blocks of skin, SMAS and mimic muscles of the periorbital, perioral, forehead and midfacial regions from six hemifaces (three male and three female) of donor bodies were collected postmortem. Serial histological sections were cut and stained with Azan. After the morphological analysis, three-dimensional reconstruction of the tissue block was performed with AutoCAD. The morphological and mechanical properties of the different facial SMAS types were compared with those of the cervical SMAS. ResultsThe architecture of the cervical SMAS (type V) consists of parallel, aligned septum fibrosus profundus and septum fibrosus superficialis tissue connected by vertical, aligned septa fibrotica commisurales tissue delimiting fatty tissue compartments transferring platysmal contractions to the skin. The facial morphological dynamic mimic pattern (SMAS types I, II and III) describes the point-by-point transfer of mimic muscle bundle contractions to the skin, explaining facial crease formation. The cervical morphological dynamic mimic pattern (SMAS type V) can be explained by dual traction force collimation over the septum fibrosus superficialis and profundus in platysmal band development. ConclusionsThe cervical SMAS (type V) description supports the hypothesis that the SMAS and platysma have different morphological origins. The two different facial and cervical morphological dynamic mimic patterns support the phenotypical difference between facial fold and platysmal band development.

Safety and Efficacy of AbobotulinumtoxinA for the Treatment of Platysmal Bands

Safety and Efficacy of AbobotulinumtoxinA for the Treatment of Platysmal Bands

Novel Classifications for Muscular Contraction of the Lower Face and Neck.

Currently, there are no scales that address lower-face muscular contraction patterns, and there is only one that addresses platysmal bands. The goal of this article is to create scales to classify the strength and contraction patterns of the lower face and neck based on (1) the muscular anatomy and contraction patterns of the platysma and (2) the strength of the depressor anguli oris (DAO). Three hundred sixty patients participated in the study. Standardized photogarphs were taken in an effort to characterize muscle contraction patterns. A novel classification measuring the strength of the DAO is presented. For the DAO, 4 different contraction patterns were observed: Type 1 (38%), Type 0 (26.3%), Type 2 (25.2%), and Type 3 (8.6%). The remainder (1.9%) used asymmetric contraction. For platysmal bands, 3 different contraction patterns were observed: complete contraction (64.53%), lateral contraction (19.83%), and central contraction pattern (11.73%). A small percentage of patients (3.91%) had an asymmetric contraction pattern. Categorization of contraction of the DAO and platysmal bands into these proposed classifications provides objective measurements that can be helpful for designing treatment protocols and assessing response to treatment.

Commentary on: Cervical Branch of Facial Nerve: An Explanation for Recurrent Platysma Bands Following Necklift and Platysmaplasty.

Commentary on: Cervical Branch of Facial Nerve: An Explanation for Recurrent Platysma Bands Following Necklift and Platysmaplasty.

Commentary on: Botulinum Toxin Treatment for Mild to Moderate Platysma Bands: A Systematic Review of Efficacy, Safety, and Injection Technique.

Commentary on: Botulinum Toxin Treatment for Mild to Moderate Platysma Bands: A Systematic Review of Efficacy, Safety, and Injection Technique.

Characteristic features of neck skin aging in Chinese women.

Neck skin aging is of particular interest to skin scientists and dermatologists because of the increasing demand for neck wrinkle improvement. This study aimed to determine the neck aging features of Chinese women and to investigate the clinical alterations and mechanical, topographical, and biophysical properties of neck skin. A total of 450 Chinese women (age range: 16-66years) were clinically examined and graded by the same dermatologist using standardized photographs. The skin properties were assessed by noninvasive skin measuring devices. The results showed that different neck aging signs, including the horizontal neck fold, neck sagging, hollowing of emaciated neck, platysmal bands, and neck texture, appeared in different ages, and all of them worsened age-dependently since they manifested. The skin elasticity markedly changed before the onset of most of the aging signs and showed a negative correlation with both age and the severity of these signs. Transepidermal water loss (TEWL) was positively correlated with age, whereas hydration and pH were not significantly correlated with age. We also found that wrinkles (SEw) and average roughness (Ra) were significantly correlated with age. SEw, smoothness, the average depth of roughness (Rz), TEWL, and erythema index were significantly and positively correlated with the severity of the horizontal neck fold, neck sagging, hollowing of emaciated neck, and platysmal bands. This is the first study to emphasize that age causes diverse changes in Chinese women's neck skin. The changes in skin elasticity may effectively predict neck aging before the onset of most of the neck aging signs.

Botulinum Toxin Treatment for Mild to Moderate Platysma Bands: A Systematic Review of Efficacy, Safety, and Injection Technique.

Platysma bands are characteristic of an aging neck. Resection and plication of the platysma muscle is the basis of treatment. However, unfavorable surgical outcomes and improved understanding of platysma band etiology have shifted treatment towards nonsurgical rejuvenation. The aim of this paper was to assess the efficacy, injection techniques, and complications associated with botulinum toxin injection for the treatment of platysma bands. A systematic literature search was performed to identify articles reporting botulinum toxin injections for platysma bands in neck rejuvenation. The search included published articles in three electronic databases-Ovid MEDLINE, EMBASE, and the Cochrane Library-between January 1985 and December 2017. Three studies met the inclusion criteria, with a total of 78 patients undergoing botulinum toxin injection for platysma bands. Incobotulinumtoxin A was used in 62.3% (n = 45/78) of patients, with 38.4% (n = 30/78) receiving abobotulinumtoxin A. Efficacy was assessed using the Merz platysma score scale. A mean score improvement of 2.0 points, with a response rate of 93.7%, was observed after 14 ± 2 days. At 3 months, the mean score improvement was 1.2 points with a response rate of 86%. Patient-reported metrics demonstrated an improvement in 91% (n = 71/78) of subjects. The three studies used a standard injection technique, with a maximum 20 IU of incobotulinumtoxin A and 5 U abobotulinumtoxin A administered per band. Complications were reported in 15.4% (n = 12/78) of patients, with none requiring further intervention. Botulinum toxin is a highly effective treatment for isolated platysma bands. A safe injection technique is described and recommended for clinical practice.

Cervical Branch of Facial Nerve: An Explanation for Recurrent Platysma Bands Following Necklift and Platysmaplasty

Recurrent platysma bands remain a common problem in neck rejuvenation. The goals of this cadaver study were to document the course of the cervical branches of the facial nerve and investigate the pattern of platysma muscle innervation before and after various platysmaplasty maneuvers. A total of 8 fresh cadaver specimens were dissected for a total of 16 hemifaces/necks. After subcutaneous undermining and identification of the main trunk of the facial nerve, the cervical branch was dissected as distally/anteriorly as possible under loupe magnification. The following 4 platysmaplasty maneuvers were each performed on 4 hemifaces/necks: platysma window, extended SMAS with platysma flap, full width platysma transection, and lateral skin-platysma displacement (LSD). Upon completion of the techniques, the integrity of the cervical branches was evaluated. Contrary to some reports, all specimens in this study had only 1 main cervical branch. There were no branches detectable under 3.2× magnification until branches were given off to the platysma muscle at approximately the location of the facial vessels. The main cervical branch continued distally/anteriorly to the medial edge of the muscle below the thyroid cartilage. After performing the various platysma techniques, all cervical branches were in continuity in all specimens. Specifically, the main cervical branch was in continuity to the medial border of the muscle caudal to all platysmaplasty maneuvers. Undermining the platysma muscle results in no injury to platysmal innervation unless continued beyond the facial vessels. Recurrent bands are likely related to persistent innervation of the medial platysma, which remains intact cranial and caudal to any described platysmal transection maneuvers.

Neck rejuvenation by direct anterior medial cervicoplasty: the modified zigzag-plasty according to Tschopp.

Conventional cervicofacial rhytidectomy has become the standard treatment of skin excess of the ageing neck. However, some patients want to avoid an extensive surgical procedure, especially if the anterior neck is the predominant problem zone. To report on the efficacy and safety of a zigzag-shaped skin excision combined with platysma plication. We present a retrospective case review series of six female patients. Skin excess was marked preoperatively using the skin pinching technique, then transferred to a zigzag-shaped area and finally excised using the method according to Tschopp, which is described. Patients were followed up for at least 1year. All patients (age: 55-82years, median: 65years) were very satisfied with the results. On an overall patient satisfaction scale of 1-10 (1 being the best), the scars were graded on average 1.85 (median: 2) 1year after surgery. No scar hypertrophy, functional impairment, nerve damage or other serious complications were observed. In selected patients, the direct anterior zigzag-shaped excision poses an effective, safe and easy surgical option for both skin excess and fat excess and platysma banding. The technique is easily reproducible, with low morbidity and high patient satisfaction.

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

Sir: It was with great pleasure that we read the article by our colleagues Patrick Trévidic and Gisella Criollo-Lamilla.1 We warmly congratulate the authors for this interesting publication. We agree with their hypothesis on the cause of platysma bands, and we appreciate their therapeutic proposal of denervation of the muscle to weaken the muscular tonicity at the origin of the muscular contractions. We wanted to support the work of our colleagues by remembering some of our scientific works on the same subject. We would like to mention some of our congress presentations on the cause, pathophysiology, and treatment of the platysma bands.2–6 In 1996, we proposed a new classification based on the anatomy of the platysma muscles, elaborated on in a large series of cadaver dissections (100 cadaver dissections). We also confirmed that the platysma bands are a result of muscular contraction: we demonstrated this fact by making comparative electromyographic recordings on patients with facial palsy. Our hypothesis on the origin of this contraction was the appearance during aging of a cervical hyperlordosis with reflex muscular contraction of the platysma muscles. All of this was presented in a communication at the French Society of Plastic Surgeons conference in 2003.7 We also propose to refer to two publications of ours that recall our therapeutic proposals to improve the cervical contour in the presence of platysma bands and our different methods intended to treat platysma bands and perform more logical platysmaplasties.8,9 DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Patrick Knipper, M.D.Vladimir Mitz, M.D.Private practiceParis, France

Male Surgical Neck Rejuvenation.

Patients who are aging, with weight gain, and increased skin laxity, request dermatologists to improve their neck area. Surgical and nonsurgical options are reviewed as well as benefits and side effects. This article will focus on how surgical techniques can be applied for male patients in particular. To review surgical neck rejuvenation therapies available currently to find the best option for male patients. Surgical treatment of the male neck to improve mandibular contour and loose neck skin requires tightening of the platysmal muscle and usually skin removal in the postauricular sulcus and into the hairline. Most patients choose to have this performed underline tumescent anesthesia when given the choice of sedation versus local anesthesia. The other surgical variations of improving the neck contour on a male include using a direct excision by a midline incision starting in the submental crease and extending down the anterior neck. This approach allows for maximum tightening of the platysmal bands. The incision line can be minimized using intraoperative laser resurfacing immediately after suturing. Chin implants are necessary in some patients to give good neck improvement. The isolated neck lift is one the most common procedures requested by men asking for neck improvement.

Prévention du vieillissement, techniques chirurgicales récentes et voies d’avenir de la chirurgie du rajeunissement facial

Prevention of aging is mainly obtained through appropriate health practices, modulated by the genetic causes of aging. Causes of facial structural aging include gravity, volume loss, contraction of the mimic muscles and obviously biological aging of tissues. Among the very numerous new surgical technique of facial rejuvenation, we could point out: for the frontal region, obviously we are focus on the endoscopic and non-endoscopic frontal lifts. But also, we should note the transcutaneous Brow Shaping which with a well defined, step by step technique is indeed a simple way to improve a possible difficult situation; concerning the mid-face lift, as the main risk is the secondary eyelid malposition, a high Smas or a temporo-malar lift can be performed. It ensures a good temporal effect but there is nearly no improvement at the mid-pupilla level. A mid-face lift is nevertheless mandatory to achieve an efficient skin removal on the mid-pupilla line. This is performed most of the time with a complete orbicularis oculi muscle opening, and only with a small lateral opening in case of the concentric malar lift, which minimize the risk of eyelid malposition. Based on a new description of the lymphatic draining of the lower lid, a new treatment of the chemosis is proposed with a corticoid injection at infero-lateral part of the malar area, in the preperiosteal plane. For the oval, the DAO section and the suspension of the middle premasseter space beyond the anterior border of the masseter where the Smas overlies the buccal fat pad, stay efficients. Regarding the neck, the suspension of the posterior border of the platysma to the Loré's fascia, the digastric corset with or without a platysma corset are advanced and valuable techniques. Lately, a new option was described using a lateral skin-platysma flap to minimize platysma bands and even more recently a neck lift with fixation of the anterior platysma to the deep cervical fascia and suspension of the lateral platysma flap.

Invited Commentary on "A Simplified Method for Management of Platysmal Bands: Platysmotomy as an Office Procedure".

Invited Commentary on "A Simplified Method for Management of Platysmal Bands: Platysmotomy as an Office Procedure".

A Simplified Method for Management of Platysmal Bands: Platysmotomy as an Office Procedure.

Restoration of the esthetic neck contour is an integral component of facial rejuvenation. Characters of the aging neck include lipodystrophy, platysmal bands and jowls that extend into the neck, reducing the esthetic characters of the lower face. The authors present a new, simplified and economic method to manage platysmal bands as an office procedure under local anesthesia using a standard 18-gauge syringe needle as a cutting tool. The new technique was used on a selected group of female patients classified as non-surgical cases according to Rorich classification. Twenty-five female patients shared in this study, with a follow-up period standardized to 1year; one patient showed up after 1.5years with preserved esthetic outcome. One patient showed residual band managed by recutting immediately after bruising and edema resolved. The technique was proven safe regarding important neurovascular structures of the neck. Patients gave no negative comments regarding results of surgery. Kappa statistical analysis showed perfect interobserver agreement between patients and an independent assessor. The authors concluded that the studied new technique is safe, effective, and valuable for management of platysmal bands in a selected group of patients. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Botulinum Toxin for Neck Rejuvenation: Assessing Efficacy and Redefining Patient Selection.

The "Nefertiti lift" consists of injecting the platysmal bands and the inferior border of the mandible with botulinum toxin. No clinical trial has evaluated its effect on the different lower face and neck aging components, and little is known about the clinical characteristics that predict treatment success. Patients were injected with abobotulinumtoxinA along the inferior border of the mandible and into the platysmal bands. Using standardized preinjection and postinjection photographs, the jowls, marionette lines, oral commissures, neck volume, and platysmal bands at maximal contraction and at rest were assessed with validated photonumeric scales. In addition, the overall appearance of the lower face and neck was evaluated by the Investigators and Subjects Global Aesthetic Improvement Score. Pain and patient satisfaction rates were also evaluated. Thirty patients were injected with a mean dose of 124.9 U of abobotulinumtoxinA per patient. Platysmal bands at rest and with maximal tension reached a statistically significant improvement. The other components showed a tendency for improvement but did not reach statistical significance; 93.3 percent of investigators and patients rated the overall results as improved, and 96.6 percent of patients were satisfied with their results. When comparing the patients who improved the most to all the other patients, they had lower preinjection region-specific scores. The Nefertiti lift can be used on its own or in conjunction with other rejuvenating procedures. It is particularly helpful in younger patients with platysma muscle hyperactivity and retained skin elasticity. Therapeutic, IV.

Treatment of Anterior Neck Aging without a Submental Approach: Lateral Skin-Platysma Displacement, a New and Proven Technique for Platysma Bands and Skin Laxity.

A high rate of recurrence of anterior platysma bands and anterior skin laxity was reported at the 1-year follow-up of 150 patients who underwent complete neck undermining and full-width platysma transection for neck rejuvenation. The authors propose a new technique-lateral skin-platysma displacement-to treat these two aesthetic problems using only a lateral approach to avoid "opening" the anterior neck. The authors' objective was to compare outcomes following full-width platysma transection technique and lateral skin-platysma displacement technique in terms of patient satisfaction, complications, and long-term effectiveness in the treatment of bands and anterior skin laxity. A prospective study was carried out on 100 patients. All patients were operated on by the senior surgeon (M.P.C.). Patient questionnaires were used to assess their levels of satisfaction. Patient satisfaction was extremely high following both techniques. Successful correction of bands at 1 year was observed in 83.5 percent of the lateral skin-platysma displacement patients and 56 percent of the full platysma section patients. Regarding recurrent skin laxity, 68 percent of those who underwent lateral skin-platysma displacement did not show any obvious recurrence of excess skin at 1 year compared with 52 percent of the full platysma section group. Prolonged edema was the main complication and was considerably more frequent in the patients undergoing complete neck undermining. The 1-year patient satisfaction ratings were higher for those treated with the lateral skin-platysma displacement technique. The lateral skin-platysma displacement technique has proved to have a much shorter recovery and better outcomes in the correction of platysma bands and of the anterior neck skin laxity. Therapeutic, IV.

Discussion: Treatment of Anterior Neck Aging without a Submental Approach: Lateral Skin-Platysma Displacement, a New and Proven Technique for Platysma Bands and Skin Laxity.

Discussion: Treatment of Anterior Neck Aging without a Submental Approach: Lateral Skin-Platysma Displacement, a New and Proven Technique for Platysma Bands and Skin Laxity.

Hyoid Suspension Neck Lift.

The shape of the deep cervical structures is the shape of an aesthetic neck. With age, changes can obstruct visualization of that shape. Achieving a youthful contour requires removal of excess skin and fat but also control of the platysma to allow skin to redrape like a blanket over an underlying framework. The authors' technique makes the platysma part of the deep cervical structures whose shape underlies an attractive neck and allows the skin to redrape to that contour. To make the platysma conform closely to the deep cervical structures and allow the skin to show that new form, the authors developed a procedure that includes removal of excess fat, attaching the platysma to the hyoid fascia, approximating the edges of the platysma above and below that suture, and wide undermining of skin to allow it to re-drape naturally over those deeper structures. Over 7 years, 110 patients underwent aesthetic facial surgery that included hyoid suspension of the platysma. One patient had recurrence of platysmal bands after failure of the key suture. Complications included hematoma in three patients and submental seromas in three patients, but no permanent nerve injury, no skin loss from vascular compromise, no reported changes in vocal resonance, and no complaints of difficulty swallowing. This method allows the skin to redrape over a youthful framework and produces reliable aesthetic and long lasting results. It is a simple, reproducible, teachable technique that enables surgeons to achieve results previously difficult to obtain in a single operation. Therapeutic, IV.