Muscle Versus Skin · Correct Diagnosis · CityLink Mall
The two vertical cords that appear down the front of the neck are the medial edges of the platysma. They are a muscle problem, and energy devices that tighten skin do not address them — which is why a course of neck tightening can leave the bands exactly where they were.
The platysma is unusual among facial muscles: a broad, paper-thin sheet with no bony insertion at its lower end. It rises from the fascia over the upper chest and deltoid, crosses the clavicle, and fans upward across the front and sides of the neck to attach at the mandible and blend into the lower face. In youth its medial fibres interdigitate across the midline and the whole sheet lies flat against the underlying structures, held there by fascial attachments. It is a muscle of expression, not of movement — which is why it contracts when you grimace, speak or tense, and why it is invisible at rest in a young neck.
With age two things change. The medial borders separate, leaving a gap at the midline where the fibres once met, and the free edges of that gap thicken and shorten with decades of repeated contraction. At the same time the fascial attachments that held the sheet flat weaken, so the edges are no longer tethered down. What was a flat sheet becomes two vertical cords with free borders that stand forward from the neck when the muscle contracts.
This is why the bands behave the way patients describe. They are far more obvious in speech, in photographs taken mid-sentence, and when the jaw is clenched, because that is when the muscle is contracting. They are less obvious lying down. They are unrelated to weight, and losing weight often makes them more conspicuous rather than less, because the soft tissue that was softening their outline has gone.
The platysma also exerts a downward pull on the lower face. Its upper fibres attach around the mandibular border and, as the muscle tightens with age, that vector works against everything holding the jawline up. Relaxing the muscle therefore does two things at once: it softens the visible cords and removes a persistent downward force on the jaw margin.
Classification
An ageing neck almost never presents with one problem. The reason treatment disappoints is that a plan is chosen for the neck as a region rather than for the findings within it, and the patient receives a modality that is excellent for a different component of what they have. These are told apart by examining the neck at rest and then on forced contraction.
You can tighten the skin of the neck perfectly and leave the bands exactly where they were. They are not a skin problem.
Management
Botulinum toxin placed along a contracted platysmal band relaxes the muscle fibres in that cord, so the free edge no longer stands forward. The effect on visible banding is usually clear within two weeks. Dosing is deliberately conservative in this region — the platysma sits close to the deeper muscles of swallowing and neck flexion, and excessive or poorly placed dose can produce transient difficulty with swallowing or neck weakness. This is a site where anatomical knowledge and restraint matter more than the amount of product used.
The secondary effect is often the one patients notice most. Because the upper platysmal fibres pull downward on the mandibular border, relaxing them removes a constant opposing force on the jawline and the lower face appears slightly lifted and more defined. Treating the band and the jawline together as a single vector problem produces a better result than treating either alone, and it is the rationale behind combining neck and lower face treatment in the same plan.
Where laxity or horizontal lines coexist — and they usually do — those components are treated with their own modalities alongside. A neck that has bands, crepiness and necklace lines needs three different things, sequenced, and will not be finished in one appointment. Atelier Aesthetics will also say plainly where banding is severe enough, or skin redundancy great enough, that the honest answer is surgical: a neck with substantial hanging skin is beyond what any non-surgical approach can deliver, and pretending otherwise wastes a patient's money.
Continue
Atelier Aesthetics · Owned by AYA
1 Raffles Link, #B1-28, CityLink Mall, Singapore 039393 · +65 8023 7170
Book a Consultation