ABSTRACT
The platysmal muscle is a large muscle, which inserts into the pectoralis major and minor along the thoracic inlet and extends vertically up the neck to interdigitate with the lower muscles of facial expression. As with horizontal ‘necklace’ lines, the vertical platysmal bands are external to the muscles of deglutition, speech and neck flexion. The simplest approach is to inject 1–2 U of BOTOX approximately 1 cm apart along each ‘necklace’ line with some massage. Raising a wheal as in a deep dermal injection is preferable as this is an area that does tend to bruise easily. The commonest is to grasp the band and to inject approximately 15 U divided into three injection sites along each band. Alternatively, a 1.5 inch 27 gauge EMG needle can be used and passed across the width of the muscle, listening to the EMG signal to ensure that the needle remains in the muscle.
