What is the platysma muscle?

The platysma is a broad, thin, superficial muscle of the neck that lies directly beneath the skin and extends from the chest and shoulder region up through the neck to the lower jaw and the muscles of facial expression. It is the principal muscle targeted in neck lift and lower facelift surgery, and a thorough understanding of its anatomy, its variations, and the way it changes with age is fundamental to achieving natural, lasting results in neck rejuvenation.

This page provides a detailed account of platysma anatomy, the role of the platysma in neck ageing, the surgical approaches used to address it, and how it is managed in the context of neck lift and deep plane facelift surgery as performed by Dr Roth.

Anatomy of the Platysma

Origin and Insertion

The platysma is a broad, thin sheet of striated muscle — one of the muscles of facial expression — that lies within the superficial fascia of the neck, immediately deep to the dermis. It originates from the fascia overlying the pectoralis major and deltoid muscles in the upper chest and shoulder and passes superiorly over the clavicle and across the anterior neck.

Superiorly, the platysma has multiple insertions. Its medial fibres insert into the inferior border of the mandible (lower jaw), the skin and subcutaneous tissue of the lower face, and — in most individuals — decussate across the midline to varying degrees, interdigitating with fibres from the opposite side. Its lateral fibres blend with the musculature of the lower face, including the depressor anguli oris, depressor labii inferioris, and the orbicularis oris, as well as with the parotideo-masseteric fascia overlying the parotid gland. In this way the platysma forms a continuous myofascial sheet connecting the chest and shoulder to the lower face — a fact of considerable importance in facelift surgery, where the muscle and overlying skin are elevated and repositioned as a single unit.

Midline Anatomy and the Decussation Gap

The relationship between the left and right halves of the platysma at the midline is one of the most surgically relevant aspects of platysma anatomy, and it is also one of the most variable. Several patterns of midline decussation have been described in the anatomical literature, ranging from extensive interdigitation of fibres across the midline in the upper neck to a complete absence of midline fibres leaving a gap between the two muscle bellies throughout the full height of the neck.

In the majority of patients, the two platysma bellies are joined at the midline — at least in the upper portion of the neck — during youth. With age, the midline fibres attenuate and separate, and the gap between the two muscle bellies widens. As this occurs, the medial edges of the muscle become increasingly free and mobile, and under the influence of gravity and the repeated muscular contractions of daily expression, they descend and become visible as the characteristic vertical bands of the ageing neck. This is the anatomical origin of what is often referred to as “platysmal banding” — one of the primary targets of platysmaplasty surgery.

Relationship to the SMAS

The platysma is continuous with the superficial musculoaponeurotic system (SMAS) of the face. The SMAS is a fibromuscular layer that invests the muscles of facial expression and connects them to the overlying skin — providing the mechanical linkage through which facial expressions are transmitted to the skin surface. In the neck, the platysma is the SMAS equivalent: it is the superficial muscular layer that moves the skin of the neck and lower face and that transmits the changes of age-related muscle descent to the overlying skin.

This continuity between platysma and SMAS is the anatomical basis for the deep plane facelift — a technique that elevates and repositions the SMAS-platysma complex as a single continuous unit, repositioning both the facial and neck tissues in a single, integrated manoeuvre rather than addressing them as separate structures.

Relationship to the Retaining Ligaments

The platysma and overlying skin are tethered to deeper structures by a series of retaining ligaments — fibrous condensations that pass from the deep fascia or periosteum through the SMAS to the dermis. In the lower face and neck, the most relevant of these are:

• Cervical retaining ligaments — a series of fibrous attachments in the neck that tether the platysma and overlying skin to the deep cervical fascia. Release of these ligaments is necessary to allow adequate mobilisation of neck tissues in neck lift and deep plane facelift surgery.
• Mandibular retaining ligament (mandibular septum) — a dense ligamentous structure at the anterior jawline that tethers the lower facial soft tissues to the mandible. Its release allows correction of jowling and improvement of the anterior jawline contour.
• Masseteric cutaneous ligaments — a series of ligamentous attachments along the lateral jawline overlying the masseter muscle. Their release allows the entire jawline to be elevated and contoured.
• Zygomatic ligaments — the most superior group relevant to facelift surgery, tethering the cheek tissues to the zygoma. Their release allows elevation of descended cheek and midface tissue.

In the deep plane facelift, all four ligament groups are released in sequence, allowing the SMAS-platysma complex to be repositioned superiorly and posteriorly as a mobile unit — without tension on the overlying skin.

Nerve Supply

The platysma is innervated by the cervical branch of the facial nerve (cranial nerve VII), which emerges from the lower pole of the parotid gland and descends into the neck. Injury to the cervical branch during neck surgery is one of the recognised risks of the procedure and may result in weakness or asymmetry of the lower lip depressors. In practice, this complication is uncommon in experienced hands, as the cervical branch runs in the deep fascia below the platysma, well below the plane of dissection used in most neck lift approaches. Nonetheless, awareness of its course is an important component of safe neck anatomy.

The marginal mandibular branch of the facial nerve — which innervates the muscles of the lower lip and chin — runs at a deeper level along the inferior border of the mandible and is the branch most at risk during dissection along the jawline. A thorough knowledge of the course of the marginal mandibular branch and its relationship to the mandibular retaining ligament is essential in lower facelift and neck lift surgery.

Blood Supply

The platysma receives its blood supply from branches of the submental and superior thyroid arteries, as well as from contributions from the suprascapular and transverse cervical arteries inferiorly. The muscle has a rich perforating blood supply that also contributes to the vascularisation of the overlying neck skin — a fact of some surgical importance, as aggressive deep dissection or liposuction of the subplatysmal fat can devascularise the skin flap and increase the risk of skin necrosis, particularly in patients with a prior history of neck surgery or significant subcutaneous scarring.

Anatomical Variations

Platysma anatomy is notably variable between individuals, and this variation has direct implications for surgical planning. Key variables include:

• Midline decussation pattern — the extent to which the two platysma bellies are joined at the midline, as discussed above. Patients with a wide midline gap tend to develop more prominent vertical banding and typically benefit most from midline platysmaplasty.
• Muscle thickness — the platysma varies considerably in thickness and bulk. In some patients it is a robust, well-defined muscular sheet; in others it is attenuated and difficult to distinguish from the overlying subcutaneous fat and dermis. Thin platysmal muscle is more challenging to manipulate surgically and requires greater care to avoid inadvertent injury.
• Superior extent — the degree to which the platysma extends superiorly into the lower face varies. In some individuals the muscle fibres extend well into the cheek; in others the superior border of the platysma ends at or near the inferior border of the mandible. This variation affects how far superiorly the muscle can be elevated in a facelift procedure.
• Lateral fibres and parotid investment — the relationship of the lateral platysmal fibres to the parotideo-masseteric fascia and the inferior pole of the parotid gland is variable. In some patients the platysma wraps around the posterior edge of the parotid; in others it remains clearly anterior. This variation is relevant to the lateral approach in facelift dissection.

The Platysma and Neck Ageing

The platysma plays a central role in the characteristic changes of the ageing neck. Understanding these changes — and the anatomical mechanisms that underlie them — is essential for appreciating why different surgical approaches are indicated in different patients, and why the results of neck surgery differ so markedly depending on the technique used.

Platysmal Banding

The most visible manifestation of platysmal change with age is the development of vertical bands in the anterior neck — one on each side of the midline, corresponding to the medial edges of the two platysma bellies. As the midline fibres attenuate and the gap between the two muscle bellies widens, the free medial edges of the muscle become increasingly prominent. They are most visible when the neck musculature is tensed — during swallowing, speaking, or deliberate neck contraction — but with advancing age they may be visible even at rest.

Platysmal banding is sometimes accompanied by a hollow or concave area between the two bands in the central neck — a consequence of the widening gap between the muscle bellies and loss of soft tissue volume in this region. This gives the anterior neck a corrugated or ridged appearance that is one of the more difficult aspects of neck ageing to address with non-surgical approaches.

Neck Skin Laxity and the Role of the Platysma

The skin of the neck is intimately attached to the platysma through numerous small fibrous connections. As the platysma descends and loses tone, the overlying skin follows — becoming lax, wrinkled, and redundant. In this sense the platysma acts as the structural scaffold for the neck skin: when the scaffold loses its integrity, the covering degrades with it.

This is why interventions directed solely at the neck skin — skin-only neck lifts, or non-surgical tightening technologies — tend to produce modest and short-lived results. The skin is lax because the underlying muscular scaffold has descended; without repositioning the scaffold, any improvement in skin quality is temporary at best.

Subplatysmal Fat and Deep Neck Anatomy

Below the platysma lies the subplatysmal space, which contains fat, the anterior bellies of the digastric muscles, the submandibular glands, the hyoid bone, and various vascular and lymphatic structures. Accumulation of subplatysmal fat — between the digastric muscles and below the platysma — contributes to neck fullness that cannot be addressed by liposuction alone (which removes only the superficial, supraplatysmal fat). Fullness arising from subplatysmal fat, prominent digastric muscles, or a low-lying hyoid bone requires a different surgical approach, typically involving direct access to the subplatysmal space through a submental incision.

The submandibular glands — paired salivary glands that sit at the posterior floor of the mouth and extend inferiorly into the upper neck — are another source of neck fullness that is frequently overlooked. With age, the glands tend to prolapse inferiorly through the mylohyoid muscle, becoming visible as soft, rounded fullness in the upper lateral neck just below the jawline. This cannot be addressed by any approach that is limited to the skin and superficial platysma. In the context of a comprehensive neck lift or deep plane facelift, the submandibular glands can be suspended using a platysmal hammock technique, or partially reduced in volume where this is clinically appropriate.

Jowling and the Lower Face

The descent of the platysma contributes not only to neck changes but to the development of jowls — the accumulation of soft tissue below and along the jawline that disrupts the clean separation between the face and neck. The platysma and SMAS, as a continuous unit, carry the soft tissues of the lower face and neck downward as they descend. The mandibular retaining ligament and masseteric cutaneous ligaments — which tether the SMAS-platysma complex to the jawline — become the pivot point around which this descent occurs, such that tissue accumulates below these tethering points (producing jowling) while hollowing develops above them. Addressing jowling requires release of these ligaments and repositioning of the entire SMAS-platysma unit — the central manoeuvre of the deep plane facelift.

Surgical Approaches to the Platysma

Several distinct surgical approaches to the platysma are used in neck lift and facelift surgery, each with different indications, advantages, and limitations. The appropriate approach — or combination of approaches — depends on the individual patient’s anatomy, the degree and nature of the changes being addressed, and whether the neck is being treated in isolation or as part of a more comprehensive facelift procedure.

Midline Platysmaplasty (Corset Platysmaplasty)

The midline platysmaplasty — sometimes called a corset platysmaplasty — addresses platysmal banding and midline neck laxity by suturing the separated medial edges of the two platysma bellies together in the midline. Access is obtained through a small incision (typically 1.5–3 cm) in the submental crease, directly below the chin. Through this incision, any supraplatysmal or subplatysmal fat is addressed, and the medial edges of the platysma are identified and approximated with a series of interrupted or running sutures, effectively creating a single midline muscular sling from the chin to the level of the thyroid cartilage.

This creates a firm muscular support in the central neck that eliminates the visible bands, reduces the midline hollow, and provides a supportive scaffold for the overlying skin. The procedure may be performed in isolation in younger patients with isolated platysmal banding and good skin quality, or as a component of a more comprehensive neck lift or facelift procedure.

The midline platysmaplasty is particularly valuable in patients with prominent platysmal bands, a “cobra neck” deformity (where the bands are prominent with a hollow between them), or in revision cases where previous lateral approaches have left residual midline banding. It is less useful in isolation for patients who have generalised neck laxity, jowling, or significant skin excess — these patients require additional lateral elevation of the platysma as part of a neck lift or facelift.

Lateral Platysmal Elevation (Neck Lift)

In a conventional neck lift, the platysma is accessed through incisions around the ears and, where required, in the submental crease. The skin of the neck is elevated as a flap off the platysma, and the platysma is then separately elevated off the deeper structures and repositioned by suturing it to a fixed point — typically the mastoid fascia or the deep temporal fascia — in a more superior and posterior position. Excess skin is then removed from around the ear.

This lateral elevation of the platysma tightens the neck from the sides, improving the jawline and eliminating some of the neck laxity. However, it does not address the midline — platysmal banding and central neck laxity may persist if a midline platysmaplasty is not also performed — and the results may not be as comprehensive or durable as those achieved with the deep plane technique.

The Deep Plane Approach — SMAS-Platysma as a Continuous Unit

In the deep plane facelift — the technique that Dr Roth uses as his primary facelift approach — the platysma and SMAS are not separated from the overlying skin but elevated as a single continuous unit. The dissection proceeds in the plane immediately deep to the SMAS, below the investing fascia, releasing the retaining ligaments sequentially as the dissection advances. This allows the entire SMAS-platysma complex — with its attached skin and subcutaneous fat — to be mobilised and repositioned as one structure.

The advantages of this approach relative to techniques that separate the skin from the SMAS are substantial. Because the skin is not completely detached from its underlying muscular support, its blood supply is preserved, healing is generally better, and the risk of skin discolouration, prolonged swelling, and noticeable scarring is reduced. Because the repositioning is achieved by moving the entire myocutaneous unit rather than by pulling the skin, the result is more natural — the face does not appear tight or operated upon, and the vertical vectors of lift more closely reproduce the anatomical direction of tissue loss. And because the retaining ligaments are released, the tissues can be repositioned to their correct anatomical position under minimal tension — producing a result that is durable and maintains its natural quality over time.

In the deep plane approach, a midline platysmaplasty is required in a minority of patients. The lateral and vertical repositioning of the SMAS-platysma complex typically provides sufficient mobilisation of the central neck tissues that the midline bands are eliminated without a separate midline procedure. Whether a platysmaplasty is needed can be assessed during the procedure itself: if the neck appears fully corrected when the face is lifted from the sides without excessive tension, a platysmaplasty is usually not necessary.

The Vertical Platysmal Advancement Technique

Dr Roth also employs the vertical platysmal advancement technique — sometimes called the vertical neck lift — as described and popularised by Dr Andrew Jacono and Dr Neil Gordon in the United States. This is an extended deep plane facelift approach in which the deep plane dissection is carried further inferiorly into the neck, elevating the platysma and overlying skin as a single unit in a more vertical direction of lift than traditional approaches.

The key principle of vertical platysmal advancement is that the optimal vector of lift — the direction in which tissues need to be moved to reproduce their youthful position — becomes increasingly vertical as the degree of descent increases. Traditional lateral approaches move tissues posteriorly (toward the ears and hairline), which can flatten the cheeks, distort the sideburn hairline, and produce an unnatural, windswept appearance. The vertical approach moves tissues superiorly — which is the direction in which they descended — creating a more natural, three-dimensional correction.

The vertical platysmal advancement is particularly effective for patients with significant neck laxity, prominent platysmal banding, and descent of facial tissue below the mandibular border, and for those who have had prior facelift procedures and present with residual or recurrent neck and jawline changes.

Platysmal Myotomy

In some patients — particularly those with thick, hypertrophic platysmal bands that are prominent even at rest — the platysma may be partially divided (a platysmal myotomy) rather than, or in addition to, being plicated in the midline. Partial division of the muscle weakens it, reducing the visible banding. This approach is used selectively and is typically reserved for cases where the banding is primarily a consequence of muscular hypertrophy or hyperactivity rather than simple structural descent.

Botulinum Toxin Injection for Platysmal Bands

In patients with early platysmal banding who are not yet ready for surgery, or as an adjunct to surgical treatment in the postoperative period, injection of botulinum toxin into the platysma can temporarily reduce the appearance of visible bands. This is performed as an in-office procedure with no recovery time required. The effect is temporary — typically lasting three to six months — and repeat injections are needed to maintain any benefit. Botulinum toxin injection is not a substitute for surgical correction in patients with significant structural descent, skin laxity, or subplatysmal pathology, but it can be a useful conservative option in appropriately selected patients.

The Platysma in the Context of Comprehensive Neck and Facelift Surgery

The platysma does not age or change in isolation — its descent is part of a more generalised process of soft tissue descent that involves the skin, subcutaneous fat, and deeper structures of the neck and lower face. A surgical approach to neck rejuvenation that addresses only one component of this process — the skin alone, the platysma alone, or the subplatysmal fat alone — will produce results that are incomplete, short-lived, or both.

The most comprehensive and durable approach to neck rejuvenation addresses each relevant layer in an integrated fashion:

• Supraplatysmal fat — addressed with conservative liposuction or direct excision where volume excess is present
• Platysmal bands — addressed with midline platysmaplasty where required
• Subplatysmal fat — addressed with direct excision through the submental approach where it contributes to neck fullness
• Digastric muscles — partially reduced where prominent digastric bellies contribute to submental fullness
• Submandibular glands — suspended or partially reduced where gland ptosis contributes to upper neck fullness
• SMAS-platysma complex — elevated and repositioned as a unit using the deep plane technique, with release of all relevant retaining ligaments
• Skin — redraped and any modest excess removed, under minimal tension, with care to preserve the skin’s blood supply and achieve the finest possible scars

This layered, systematic approach is what distinguishes a comprehensive facelift and neck lift from simpler procedures, and it is what accounts for the difference in longevity, naturalness, and overall quality of result that is consistently observed between deep plane techniques and more limited approaches.

Frequently Asked Questions About the Platysma

What causes the vertical bands in the neck?

Vertical neck bands are caused by the separation and descent of the medial edges of the platysma muscle. As the fibres that join the two platysma bellies in the midline weaken with age, the muscle edges become increasingly free and mobile. Under the influence of gravity and repeated muscular activity, they descend and become visible as vertical ridges beneath the skin of the anterior neck. The bands are most prominent when the neck muscles are contracted but may be visible at rest in more advanced cases.

Can neck bands be treated without surgery?

Botulinum toxin injection into the platysma can temporarily reduce the appearance of prominent bands by weakening the muscle and reducing its visible contraction. This is an appropriate conservative approach in younger patients with early banding and good skin quality. The effect is temporary — typically three to six months — and repeat treatments are required. In patients with significant structural descent, skin laxity, or subplatysmal pathology, botulinum toxin alone is unlikely to produce a satisfactory result and surgical correction is required.

Why does the neck often look worse than the face in an otherwise well-preserved individual?

The neck skin is thinner, less supported by underlying bone, and more exposed to gravitational forces than most of the face. The platysma — which provides the structural scaffold for the neck skin — loses its midline attachment relatively early, and the retaining ligaments of the neck are less robust than those of the midface. As a result, the neck often shows more advanced descent and redundancy than areas of the face that are better supported by the underlying skeletal framework.

Is a platysmaplasty always needed as part of a neck lift or facelift?

No. The need for a midline platysmaplasty depends on the degree of platysmal banding and midline laxity in the individual patient. In many patients treated with a deep plane facelift using the vertical platysmal advancement technique, the lateral and vertical repositioning of the SMAS-platysma complex provides sufficient correction of the central neck that a separate midline procedure is not required. In patients with prominent midline bands, a significant midline gap, or a “cobra neck” deformity, a platysmaplasty is added to the procedure.

What is the recovery from platysma surgery?

Recovery depends on the extent of the procedure. When a midline platysmaplasty is performed in isolation, most patients experience a few days of tightness and mild swelling in the neck, with most presentable within one to two weeks. When platysmaplasty is combined with a neck lift or deep plane facelift, the recovery reflects the broader procedure: significant bruising and swelling are expected for two to three weeks, most patients are presentable socially by three to four weeks, and final results — including full resolution of swelling and softening of scars — take several months to fully emerge.

Can the platysma be addressed through keyhole or endoscopic approaches?

Limited endoscopic approaches to the neck have been described in the literature, typically using a small submental incision and fibreoptic telescopes to access and plicate the platysma under direct vision. Dr Roth uses endoscopic assistance in selected cases for submental fat removal and platysma identification. However, comprehensive neck rejuvenation — particularly in patients with significant skin excess — requires open access to allow adequate skin removal and tension-free redrapin. Endoscopic approaches alone are not adequate for most patients presenting for neck lift surgery.

The Platysma in Non-European and Ethnic Anatomy

Platysma anatomy and the pattern of neck ageing vary between individuals of different ethnic backgrounds. In patients of East Asian, South Asian, and other non-European backgrounds, the platysma may be thicker and more robust, the overlying skin thicker and more sebaceous, and the pattern of fat distribution different from that seen in patients of Northern European descent. These differences have implications for surgical planning — the approach to the platysma, the amount of fat removed, and the vectors of lift all need to be adjusted to the individual’s anatomy rather than applied as a standardised template.

A surgical approach that is appropriate for a patient with thin skin, significant platysmal banding, and an advanced degree of descent may produce an unnatural result if applied unchanged to a patient with different soft tissue characteristics. Dr Roth’s approach to neck and facelift surgery is individually tailored following careful assessment of each patient’s specific anatomy, skin quality, fat distribution, and degree of platysmal change at the time of consultation.

Summary

The platysma is the anatomical foundation of the ageing neck. Its descent, separation, and loss of midline integrity are responsible for the most characteristic and visible signs of neck ageing — platysmal banding, neck skin laxity, jowling, and loss of the cervicomental angle. A thorough understanding of platysma anatomy, its variations, and its relationship to adjacent structures is essential for planning and executing effective neck rejuvenation surgery.

In Dr Roth’s practice, the platysma is addressed as part of a layered, systematic approach to neck and lower face rejuvenation — incorporating the deep plane technique, vertical platysmal advancement, and midline platysmaplasty where indicated. The goal in every case is a natural, lasting result that is specific to the individual patient’s anatomy.

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