ANATOMICAL STUDY
Anatomy of the Platysma Muscle
Kun Hwang, MD, PhD, Ji Yeon Kim, BS, and Jae Hyun Lim, BS
Abstract: The aim of this paper was to review the anatomy the
platysma systematically.
The term ‘‘platysma AND anatomy’’ was used to search
PubMed and Scopus, producing 394 and 214 papers, respectively.
After excluding 95 duplicate titles, 513 abstracts and 98 full papers
were reviewed. Among these 98 papers, 83 were excluded and 5
were added. Ultimately, 20 papers were analyzed.
The most common aging-related change of the platysma was
shortening (70.7%), followed by thinning (25.2%). The platysma
most commonly originated from the upper portion of thorax anterior
to clavicle (67.7%), followed by the subcutaneous tissue of the
subclavicular and acromial regions (22.6%) and pectoralis (9.7%).
The platysma ascended upward and medially (68.5%) or ascended
from the clavicle to the face (31.5%). The platysma most commonly
inserted on the cheek skin (57.5%), followed by the cutaneous
muscles around the mouth (18.6%), the mandibulocutaneous liga-
ment or zygoma (18.6%), and the parotid fascia or periosteum of the
mandible (5.3%). The platysma was most commonly innervated by
the cervical branch of the facial nerve (38.2%) or the cervical
branch and mandibular branch of the facial nerve (60.5%), followed
by the cervical plexus (0.6%), the cervical motor nucleus (0.6%),
and the glossopharyngeal nerve (0.1%). The most common action
of the platysma was drawing the lips inferiorly (83.3%) or poster-
iorly (12.9%). Four papers classified the platysma into subtypes;
however, these classification strategies used arbitrary standards.
Further studies will be necessary to establish the thickness of the
platysma and to characterize age-related changes of the platysma.
Key Words: Aging, anatomy, review, superficial
musculoaponeurotic system
(J Craniofac Surg 2017;28: 539–542)
A ccording to Gray’s Anatomy, the platysma muscle arises from
the fascia covering the upper parts of the pectoralis major and
deltoid. Its fibers cross the clavicle and ascend medially in the side
of the neck. The anterior fibers interlace across the midline with the
fibers of the contralateral muscle, below and behind the symphysis
menti. Other fibers attach to the lower border of the mandible or
attach to the skin and subcutaneous tissue of the lower face.1
From the Department of Plastic Surgery, Inha University School of
Medicine, Incheon, Korea.
Received August 30, 2016.
Accepted for publication September 30, 2016.
Address correspondence and reprint requests to Kun Hwang, MD, PhD,
Department of Plastic Surgery, Inha University School of Medicine, 27
Inhang-ro, Jung-gu, Incheon 400-711, Korea;
E-mail: jokerhg@inha.ac.kr
Supported by a grant from Inha University (INHA Research Grant).
The authors report no conflicts of interest.
Copyright # 2016 by Mutaz B. Habal, MD
ISSN: 1049-2275
DOI: 10.1097/SCS.0000000000003318
The Journal of Craniofacial Surgery  Volume 28, Number 2, March 2017
Copyright © 2017 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
A harmonious and youthful-appearing neckline is arguably the
most vital aspect of a successful facial rejuvenation procedure.2
Since the 1970s, surgical procedures on the platysma muscle,
aiming to achieve better results in face lifts, became popular and
became an important surgical step for plastic surgeons.3
The morphology and action of the platysma muscle have been
described previously; however, to the best of our knowledge, no
systematic review of these issues has been published.1,2
The aim of this paper was to perform a systematic review of the
anatomy and action of the platysma.
MATERIALS AND METHODS
The term ‘‘platysma AND anatomy’’ was used to search PubMed
and Scopus, resulting in 394 and 214 papers, respectively.
After excluding 95 duplicate titles, 513 titles were reviewed.
Among the 513 titles, 272 titles were excluded, while 241 abstracts
met our inclusion criteria (‘‘platysma’’ or ‘‘anatomy’’ appeared in
the title). Studies that did not discuss the anatomy or the action of
the platysma were excluded. Using these exclusion criteria, 143
abstracts were excluded and 98 full papers discussing the anatomy
or action of the platysma were reviewed. Of these 98 papers, 83
papers that did not have sufficient content or whose content was not
original were excluded, and 5 papers were added from the refer-
ences of the articles identified in the searches. Ultimately, 20 papers
were analyzed (Fig. 1).3 –22
No restrictions on language or publication form were imposed.
All the articles were read by 2 independent reviewers who each
extracted data from the articles. The data were summarized. A
statistical analysis was performed using Review Manager (Nordic
Cochrane Centre, Copenhagen, Denmark).
RESULTS
Characteristics of the Papers
The 20 papers included in this systematic review were published
in North America, Asia, Europe, and Latin America.3– 22
The platysma was observed by dissection (15 papers, 20.7% of
total platysmas) in most of the papers3– 17; however, in other papers,
it was observed during surgery (6 papers, 79.3% of total platys-
mas).5,18– 22
In 6 papers (318 hemifaces), the sex of the subject was specified
(129 males and 34 females).5,6,9– 11,17,22
Four of the papers (880 hemifaces) classified the platysma by
decussation pattern.3,8,9,19
Sex-Based Differences and the Aging Process
of the Platysma
The platysma was reported to have a bulky and well-defined
appearance in males, but was thin and atropic in females (2 papers,
34 hemifaces).6,10 Neck deformities were found to develop more
quickly with age in males than in females (1 paper, 43 hemifaces)5
(Table 1).
Four papers (443 hemifaces) presented information about the
aging process of the platysma.3,12,17,19 The most common aging-
related change of the platysma was shortening (2 papers, 308
539
Hwang et al The Journal of Craniofacial Surgery  Volume 28, Number 2, March 2017

TABLE 3. Origin of Platysma

Origin Papers Hemifaces %

Upper portion of thorax anterior to clavicle19 1 300 67.7

Subcutaneous tissue of subclavicular and 1 100 22.6
acrominal regions3
Pectoralis fascia5 1 43 9.7
Total 3 443 100.0

TABLE 4. Directions of Platysma

Direction Toward Papers Hemifaces %

Upward medially3 Mandible, lower face 1 100 68.5

Upward5,10 Face 2 46 31.5
Total 3 146 100.0

TABLE 5. Insertion of Platysma

Insertion Papers Hemifaces %

FIGURE 1. Selection process of the papers included in this study.
Cheek skin10,19 2 310 57.5
Cutaneous muscles around the mouth3 1 100 18.6
Mandibulocutaneous ligament, zygoma13 1 100 18.6
TABLE 1. Sexual Differences of Platysma Parotid fascia, periosteum of the mandible7,17 2 29 5.3
Sex Differences Papers Hemifaces Total 6 539 100.0

6,10
Volume Male Bulky, well-defined 2 34
Female Thin and atrophic TABLE 6. Innervation of Platysma
Neck deformity5 Male Faster 1 43 Innervation Papers Hemifaces %
Female Slower to detect
Total 3 77 Cervical branch of VII Only3,4,6,13,16,19,22 7 633 38.2
Cervical branch of VII þ Mandibular br18 1 1000 60.5
þ Cervical plexus10 1 10 0.6
þ Cervical motor nucleus15 1 10 0.6
TABLE 2. Aging Process of Platysma þ Glossopharyngeal nerve11 1 1 0.1
Aging Process Papers Hemifaces % Total 11 1654 100.0

Shorten17,19 2 308 70.7

Thinner3,19 2 110 25.2
Anterior border 2 to 3 cm below the horizontal line12 1 10 2.3
was described as ascending from the clavicle to the face.5,10 In
Spastic17 1 8 1.8
another paper (100 hemifaces, 68.5%), the platysma was described
Total 4 436 100.0
as ascending upward and medially (Table 4).3

Insertion of the Platysma

17,19
hemifaces, 70.7%), followed by thinning (2 papers, 110 hemi-
faces, 25.2%).3,19 The anterior border of the platysma moved 2 to
3 cm below the horizontal line (1 paper, 10 hemifaces, 2.3%).12
Only rarely did the platysma become spastic (1 paper, 8 hemifaces,
1.8%)17 (Table 2).
Origin of the Platysma
Three papers (443 hemifaces) discussed the origin of the pla-
tysma.3,5,19 The platysma most commonly originated from the
upper portion of thorax anterior to clavicle (1 paper, 300 hemifaces,
67.7%),19 followed by the subcutaneous tissue of the subclavicular
and acromial regions (1 paper, 100 hemifaces, 22.6%),3 and the
pectoralis (1 paper, 43 hemifaces, 9.7%) (Table 3).5
Direction of the Platysma
Three papers (146 hemifaces) reported the direction of the
platysma.3,5,10 In 2 papers (46 hemifaces, 31.5%), the platysma
Six papers (539 hemifaces) discussed the insertion of the pla-
tysma.3,7,10,13,17,19 The platysma inserted mostly onto the skin of the
cheek (2 papers, 310 hemifaces, 57.5%),10,19 followed by cutaneous
muscles around the mouth (1 paper, 100 hemifaces, 18.6%),3 and the
mandibulocutaneous ligament or zygoma (1 paper, 100 hemifaces,
18.6%).13 Two papers reported the parotid fascia or periosteum of the
mandible as an insertion site (29 hemifaces, 5.3%) (Table 5).7,17
Innervation of the Platysma
Eleven papers (1654 hemifaces) discussed the innervation of the
platysma.3,4,6,10,11,13,15,16,18,19,22 The platysma was found to be most
commonly innervated by the cervical branch of the facial nerve (7
papers, 633 hemifaces, 38.2%)3,4,6,13,16,19,22 or the cervical branch
and mandibular branch of the facial nerve (1 paper, 1000 hemifaces,
60.5%).18 Rarely, however, the platysma was also innervated by the
cervical plexus (1 paper, 10 hemifaces, 0.6%),10 the cervical motor
nucleus (1 paper, 10 hemifaces, 0.6%),15 or the glossopharyngeal
nerve (1 paper, 1 hemiface, 0.1%) (Table 6).11

540 # 2016 Mutaz B. Habal, MD

Copyright © 2017 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery  Volume 28, Number 2, March 2017 Anatomy of the Platysma

TABLE 7. Actions of Platysma TABLE 9. Structure Near the Platysma

Action Papers Hemifaces % Structure Papers Hemifaces %

Draw the lips inferiorly3,4,6,10,17 5 155 83.3 Posterior Arteries Inferior labial a3 1 100 56.0
Draw the lips posterioly6 1 24 12.9 Facial a4 1 80 44.0
Late phase of vertical jaw opening movements21 1 7 3.8 Veins External jugular v3 1 100 56.0
Total 6 186 100.0 Muscle Sternocleidomastoid m3 1 100 56.0
Nerves Mandibular br3,4 2 180 100.0
Main br of cervical plexus3 1 100 56.0
Glands Lower portion of parotid gland3 1 100 56.0
Submandibular gland3 1 100 56.0
Action of the Platysma Total 2 180 100.0
Six papers (186 hemifaces) described the action of the platysma.
The most common action was drawing the lips inferiorly (5 papers, a, artery; br, branch; m, muscle; v, vein.
155 hemifaces, 83.3%)3,4,6,10,17 followed by drawing the lips
posteriorly (1 papers, 24 hemifaces, 12.9%).6 In 1 study, however,
the platysma was described to be involved in the late phase of
vertical jaw-opening movements (7 hemifaces, 3.8%) (Table 7).21 Le Louarn17 stated that the platysma shortens and becomes
spastic with advanced age. Fogli12 reported that in the elderly, the
superior fibers of the platysma muscles were situated an average of
Types of Platysma Muscle 2 to 3 cm below the horizontal line passing by the risorius and
Four papers (880 hemifaces) classified the platysma according crossing the mandible more anteriorly than in young subjects.12
to subtypes (Table 8).3,8,9,19 However, the posterior border of the platysma muscle is not
In 2 papers (700 hemifaces), the platysma was classified accord- modified by aging.
ing to the level of interlacing.3,19 The most frequent type was not The platysma has been reported to be bulky in males, but
interlacing (46.9%, 328 hemifaces among 700 hemifaces). relatively thin and atrophic, or hypoplastic, in females.6,10
One paper classified the platysma according to right or left The platysma was found to be innervated mostly by the cervical
predominance. The other paper classified the platysma in terms branch, or by the cervical branch and mandibular branch, of the
of coverage, merging, complete interdigitation, and U-shaped facial nerve (1 paper, 1000 hemifaces, 60.5%).18 It is notable that
dehiscence. the platysma was also found to be innervated by the cervical plexus
(1 paper, 10 hemifaces, 0.6%),10 the cervical motor nucleus (1
Structures Near the Platysma paper, 10 hemifaces, 0.6%),15 and the glossopharyngeal nerve (1
Two papers (180 hemifaces) described the structures near the paper, 1 hemiface, 0.1%).11
platysma.3,4 Four papers (880 hemifaces) classified the platysma into sub-
The mandibular branch of the facial nerve was consistently types.3,8,9,19 However, the methods of those classifications appear
found on the posterior side of the platysma (100%) (Table 9). to be arbitrary.3,8,9,19 Moreover, their purpose was unclear. Should
the surgical method differ according to the type of the platysma? It
is possible that the surgical method should differ according to the
DISCUSSION type of the platysma, but the authors did not explain the practical
Gray’s Anatomy describes the platysma. The platysma is innervated ramifications of their classification schemes.
by the cervical branch of the facial nerve, which descends into the Among the papers we identified, very few papers contained the
deep surface of the muscle close to the angle of the mandible.1 The number of the cadavers or patients included in the study. We were
contraction of the platysma diminishes the concavity between the jaw not able to find papers that measured the depth or thickness of the
and the side of the neck and produces tense oblique ridges in the skin platysma muscle. Only 2 papers described the structures (arteries,
of the neck.1 The platysma may assist in depressing the mandible, and veins, and nerves) near the platysma.
via its labial and modiolar attachments it can draw down the lower lip Further studies will be needed to determine the thickness of the
and corners of the mouth in expressions of horror or surprise.1 platysma and to characterize age-related changes of the platysma.

TABLE 8. Types of Platysma

Classification Description De Castro3 Type (Hemifaces, %) Connell19 Type (Hemifaces, %)

Interlacing types Do not interlace III (76, 76.0) I (252, 40.0)

At the level of thyroid cartilage II (14, 14.0) II (228, 38.0)
At 1 to 2 cm below the chin I (10, 10.0) III (108, 18.0)
Variable degrees IV (12, 2.0)
Total 100 (100.0) 600 (100.0)

8
Type Progrel Description (Hemifaces, %) Kim9 Description (Hemifaces, %)

Other classification A Interlacing (16, 40.0) Converge (57, 40.7)

B Rt dominant (14, 35.0) Merge (41, 29.3)
C Lt dominant (6, 15.0) Complete interdigitation (22, 15.7)
D No decussation (4, 10.0) U-shaped dehiscence (20, 14.3)
Total 40 (100.0) 140 (100.0)

# 2016 Mutaz B. Habal, MD 541

Copyright © 2017 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Hwang et al The Journal of Craniofacial Surgery
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