Neck Lift Surgery: Understanding Platysmal Bands and Surgical Treatment Options

By Dr Scott J Turner, Specialist Plastic Surgeon | Sydney & Brisbane

The neck is often one of the first areas to reveal visible signs of ageing. Whilst facial features may retain their definition for many years, the neck often shows structural changes that affect overall facial harmony. Among the most common concerns patients present with are platysmal bands—vertical cords that develop along the anterior neck.

Understanding the underlying anatomy driving these changes is essential for determining appropriate treatment approaches. This guide explores the mechanisms behind platysmal band formation and evaluates the spectrum of surgical techniques—from traditional platysmaplasty through to advanced deep-plane neck lift and 3D Z-platysmaplasty —performed by Dr Scott J Turner, Specialist Plastic Surgeon, at his clinics in Sydney and Brisbane.

The Platysma Muscle: Anatomy and Function

The platysma is a broad, thin superficial muscle that extends from the lower face to the clavicle and upper chest region. Unlike most skeletal muscles that attach bone to bone, the platysma inserts into the subcutaneous tissues of the lower face, creating a direct relationship between muscle activity and skin movement.

The platysma muscle continues superiorly as the SMAS (Superficial Musculoaponeurotic System) in the face. This SMAS-platysma complex functions as a unified structural unit, which explains why changes in the platysma muscle can affect jawline definition and lower facial contours. In younger individuals, muscle fibres typically decussate (cross over) at the midline, forming a unified muscular sheet across the anterior neck.

The platysma serves multiple functional roles, including depression of the mandible, tension of the anterior neck skin during expressions, and maintenance of the neck’s smooth contour. Because this muscle lies immediately beneath the skin, any changes in its structure or tone are readily visible externally.

Understanding Platysmal Bands

What Causes Neck Bands to Form?

Platysmal bands, or platysma prominence, develop through a combination of age-related changes and muscular adaptation. The process typically begins with the gradual separation of the platysma muscle along the midline—a phenomenon known as diastasis. As the medial borders of the muscle separate, the lateral edges begin to roll inward and thicken, creating visible vertical cords extending from the chin toward the clavicle.

Static vs Dynamic Bands

Platysmal bands may present as static, dynamic, or a combination of both. Static bands remain visible at rest and indicate established structural changes, including skin laxity, loss of subcutaneous volume, and permanent separation of the platysma muscle edges. These are typically present in patients over 50 years of age and require surgical correction for meaningful improvement.

Dynamic bands appear predominantly during facial animation, grimacing, or physical exertion. They result primarily from hyperactivity of the platysma muscle rather than fixed structural change. Dynamic bands may respond to non-surgical approaches in younger patients, though progression to static bands commonly occurs with advancing age.

Contributing Factors

Multiple factors influence the development and severity of platysmal bands:

• Chronological ageing: Progressive loss of skin elasticity and collagen degradation accelerates structural changes
• Genetic predisposition: Family patterns strongly influence the timing and severity of neck ageing
• Environmental exposure: Cumulative ultraviolet damage compromises skin quality and accelerates tissue degradation
• Weight fluctuations: Significant weight changes affect subcutaneous fat distribution and skin redundancy
• Postural habits: Repetitive neck flexion, often termed ‘tech neck’, may contribute to premature neck creasing
• Strenuous exercise: Excessive neck tension during exercise can contribute to increased muscle activity and band prominence

Non-Surgical Approaches to Platysmal Bands

Before recommending surgical intervention, Dr Turner discusses non-surgical alternatives with patients presenting early or mild neck changes. While these modalities offer temporary improvement with limited downtime, understanding their capabilities and limitations helps establish realistic expectations.

Neuromodulator Injections

Muscle-relaxing injections can temporarily reduce the prominence of dynamic platysmal bands by inhibiting muscle contraction. Published literature suggests that these treatments benefit approximately 30% of patients, typically those under 40 years old with predominantly dynamic rather than static bands. Results generally persist for three to four months, requiring ongoing maintenance treatments. This approach does not address skin laxity, structural muscle separation, or established static bands.

Energy-Based Treatments

Radiofrequency technologies penetrate deeper into the skin, generating heat that stimulates collagen and elastin production. Clinical studies indicate that radiofrequency treatments can improve skin elasticity by up to 40%, with results developing gradually over 3 to 6 months. Ultrasound therapy employs focused energy reaching approximately 5mm deep to stimulate collagen production, with effects lasting 12-18 months. However, these modalities cannot address the underlying muscular changes responsible for platysmal banding and are limited to mild skin laxity.

Limitations of Non-Surgical Approaches

Non-surgical treatments cannot tighten or repair the separated platysma muscle, remove redundant skin, address deep structural issues, or provide lasting correction of established neck bands. For patients with moderate to significant platysmal bands, skin laxity, or loss of neck definition, surgical intervention remains the most effective approach for achieving meaningful, long-lasting improvement.

Surgical Approaches: From Standard to Advanced Techniques

Neck lift surgery encompasses a spectrum of techniques, from traditional platysmaplasty, which addresses superficial muscle and skin concerns, to advanced deep-plane approaches that comprehensively reshape the neck’s deeper anatomical structures. Dr Turner tailors the surgical approach to each patient’s specific anatomical presentation, selecting techniques that address the underlying causes of their concerns while optimising long-term results.

All neck lift procedures are performed under general anaesthesia in fully accredited hospital facilities in Sydney and Brisbane, with qualified anaesthetists providing anaesthetic care throughout. Surgical duration ranges from two to four hours, depending on the complexity of the neck lift procedure performed.

Traditional Platysmaplasty

Platysmaplasty represents the foundational approach to neck lift surgery, addressing the platysma muscle layer and overlying skin without extensive work on deeper structures. This technique is appropriate for patients presenting with platysmal banding and skin laxity without significant subplatysmal fat accumulation or glandular concerns.

Incision Placement: Strategic incisions are positioned to provide surgical access while minimising visible scarring:

• Post-auricular incisions: Placed in the natural crease behind each ear, well-concealed by the ear’s contour
• Occipital hairline incisions: Extended along the lower hairline, hidden within the hair-bearing scalp
• Submental incision: A small incision beneath the chin in the natural submental crease when direct midline access is required

Platysmaplasty Techniques: The specific muscle repair techniques employed depend on individual anatomical findings:

• Medial Plication: The separated edges of the platysma muscle are sutured together along the midline, eliminating visible bands and creating a unified muscular sheet. This technique, also known as corset platysmaplasty, provides structural support and addresses the fundamental issue of muscle separation. 
• Lateral Suspension: The lateral portions of the platysma muscle are elevated and secured to stable anatomical points behind the ears, typically the mastoid fascia. This creates horizontal tension across the neck, supporting tissue repositioning without relying solely on skin tension.
• Selective Band Release: When prominent bands persist despite plication techniques, partial transection or selective release of the muscle may be incorporated. 

Skin Redraping and Excision: After muscle work, the skin is gently repositioned posteriorly and superiorly. Excess skin is carefully excised, and the remaining skin edges are precisely approximated to create smooth contours without excessive tension.

Deep Neck Lift

The deep neck lift represents a progression beyond standard platysmaplasty by engaging the deeper structural layers of the neck. This approach is indicated for patients presenting with subplatysmal fat accumulation, prominent submandibular glands, digastric muscle fullness, or structural concerns that cannot be adequately addressed through superficial techniques alone.

Rather than treating each tissue layer independently, the deep neck lift works with the SMAS-platysma complex as a unified unit, allowing comprehensive repositioning of multiple anatomical components through strategic dissection planes.

Anatomical Targets: The deep neck lift addresses structures beneath the platysma muscle that contribute to neck fullness and poor definition:

• Subplatysmal fat: Deep fat deposits that accumulate beneath the platysma muscle cannot be addressed through liposuction alone and require direct surgical excision
• Digastric muscles: These paired muscles, forming the floor of the mouth, can contribute to submental fullness, particularly in the midline; selective reduction may be performed in appropriate cases
• Submandibular glands: These salivary glands naturally descend with ageing and can create visible bulges below the mandible; techniques include suspension, repositioning, or partial reduction to improve jawline definition

Advanced Techniques: 3D Z-Platysmaplasty

One of the most persistent challenges in neck lift surgery is the potential for platysmal bands to recur over time. Traditional techniques, while effective initially, may not adequately prevent the transmission of muscle contraction forces that cause separated platysma segments to re-engage. Advanced 3D Z-platysmaplasty techniques address this challenge by repositioning muscles in three dimensions.

Understanding Band Recurrence: Platysmal band recurrence occurs because:

• The cervical branch of the facial nerve continues to stimulate the platysma contraction after surgery
• Simple midline plication may not prevent transmission of contraction forces between muscle segments
• Linear scar contracture can pull separated muscle edges back together over time

The 3D Z-Platysmaplasty Concept: This advanced technique involves horizontal transection of the platysma muscle below the hyoid bone, dividing it into distinct upper (cranial) and lower (caudal) segments. Rather than simply suturing the muscle edges together in one plane, the medial edges of these segments are separated as far apart as possible, moving in opposing directions along all three spatial axes to create a Z-shaped configuration.

Advantages of 3D Separation:

• Mechanical disconnection: Complete separation of the upper and lower platysma segments prevents transmission of contraction forces between them
• Three-dimensional stability: The Z-configuration distributes tension across the surgical site rather than concentrating it in one plane, resisting reformation
• Reduced muscle activity: Strategic transection affects nerve supply to the lower platysma segment, reducing its ability to contract and improving skin quality in the lower neck
• Multiple anchoring points: The repositioned platysma is secured to stable anatomical structures, including the digastric muscles, hyoid bone, and mastoid fascia, from multiple vectors

Comparing Surgical Approaches

The choice between standard, deep, and advanced techniques depends on individual anatomical presentation and treatment goals. Standard platysmaplasty is suitable for patients with primarily superficial concerns—muscle banding and skin laxity without significant deep tissue involvement. Deep neck lift is indicated when subplatysmal structures contribute to neck fullness. Advanced 3D techniques provide the most comprehensive correction with the lowest band recurrence rates, particularly valuable for patients with significant pre-operative banding or those seeking the longest-lasting results.

Combining with Facelift Surgery: Neck lift is often performed in conjunction with facelift surgery to achieve comprehensive improvement of the lower face and neck. The anatomical continuity of the SMAS-platysma complex means that addressing both regions in a single surgical session often produces more harmonious results than treating either area in isolation. Combining procedures also means shared recovery time rather than separate healing periods.

Risks and Potential Complications

As with all surgical procedures, neck lift surgery carries inherent risks. Common postoperative effects include temporary swelling, bruising, and numbness or altered sensation in the treated areas. Haematoma (fluid accumulation) represents the most common early complication, occurring in up to 15% of patients, though most are minor and manageable. Approximately 4% are larger haematomas requiring prompt intervention, typically developing within the first 12 hours and are more common in male patients. Less frequent complications include infection (very rare, <1%), visible scarring, nerve injury affecting sensation or movement (temporary weakness of the lower lip occurs in approximately 4% of cases), and seroma formation. 

Summary

Platysmal bands are among the most common concerns associated with neck ageing, developing from a combination of muscle separation, skin laxity, and ongoing platysma activity. Understanding the distinction between static and dynamic bands, along with the multiple anatomical layers contributing to neck appearance, is essential for determining appropriate treatment approaches.

Surgical correction ranges from traditional platysmaplasty—addressing the platysma muscle and skin through medial plication and lateral suspension—through to deep neck lift procedures targeting subplatysmal fat, digastric muscles, and submandibular glands. Advanced 3D Z-platysmaplasty techniques offer the most comprehensive correction by mechanically separating platysma segments in three dimensions, thereby significantly reducing the risk of band recurrence.

Dr Scott J Turner is a Specialist Plastic Surgeon and Fellow of the Royal Australasian College of Surgeons (FRACS) practising exclusively in facial surgery at FacePlus Aesthetics in Sydney and Brisbane. Dr Turner employs the full spectrum of neck-lift techniques, selecting the most appropriate method for each patient’s individual anatomy and goals.

Book a Consultation in Sydney or Brisbane

If you are considering facelift surgery, Dr Scott J Turner offers comprehensive assessments at his Sydney and Brisbane clinics. As a Specialist Plastic Surgeon specialising in facial aesthetic surgery, Dr Turner can evaluate your individual concerns and recommend the most appropriate surgical approach.

To arrange your consultation, please contact us or telephone 1300 437 758.