Face lift, part 2: Etiology of platysma cording and its relationship to treatment.

Based on examination of many necks and observations at surgery and on cadavers, we believe that "platysma cords"' or cervical folds are normal when the muscles are being contracted. In the aged, they do not disappear when the muscle is relaxed. We believe that they are caused by a stretching and loss of contractility of skin and fat overlying the anterior platysma muscles from aging and from the many contractions of these muscles which selectively stretch the overyling tissues. In addition, we believe that the superficial musculoaponeurotic system (SMAS), which in youth holds the muscle strongly and closely to the confines of the concavity of the neck, stretches so that the muscle webs more easily out of the concavity when contracted and is returned less completely into it upon relaxation. Treatment and prevention should be directed toward tightening the skin and the SMAS and supporting the muscle in its retrodisplaced, more youthful position.