The older I get, the more noticeable these vertical bands on my aging neck become. What are they, and can I do anything to minimize their appearance?

As Nora Ephron lamented in her 2006 book I Feel Bad About My Neck, you’re not alone. One of the first visible signs of aging often appears in the form of bands that run vertically on both sides of the neck. They are caused by contractions of the bilateral platysma muscle, a thin, flat muscle that goes from the collarbone up the front of the neck and crosses the jaw onto the lower cheek.

“The muscular action of the platysma muscle extends onto the lower face and is responsible for pulling the outer portions of the lower lip down and to some degree out laterally,” says Michael Cedars, MD, a plastic surgeon in Oakland, California.

The bands appear at any age when a person contracts their platysma muscles, as in a grimace, but they become more prominent in older people, as the already thin skin on the neck grows even thinner. Over time, a redistribution of subcutaneous fat and loss of collagen in the area also contributes to the bands becoming more visible.

It’s not entirely known what causes them. One school of thought is that the platysma muscles detach a bit from deeper muscles that had kept them flatter and more recessed; another is that the bands are caused by overactive platysma muscles. Whatever the cause, they are nearly universal and considered a sign of aging. “The fact is that most people, sooner or later, will develop these protruding vertical bands,” according to Dr. Cedars.

Unfortunately, there’s not much that can be done to permanently correct or prevent these bands. It’s tempting to think certain head and neck exercises might help, and online resources depict regimens that promise to restore the contours of youth—but no exercises have proven effective. And although using sunscreen is always a good idea to help prevent sun-related skin damage and reduce the risk of skin cancer, there’s no evidence it prevents the formation of platysmal bands.

There are various cosmetic surgery options, most of which aim to correct drooping structures based on the concept that platysmal banding is caused by loss of muscle tone, detachment of the platysma from underlying structures, and slack skin. Less invasive procedures might treat only superficial structures, such as skin and subcutaneous fat, while the more effective operations treat the deeper platysma muscles. Alas, the results from these surgeries don’t always last; some portion of the bands may even reappear within one year.

While most surgical treatments are geared toward tightening anatomical features, the use of botulinum toxin (Botox) arises from a different theory of what causes platysmal banding. Observing that some people with unilateral facial palsy have vertical bands on the healthy side of their face and neck but not on the paralyzed side, one researcher hypothesized that the vertical bands are caused by tension rather than laxity.

This would suggest that inducing paralysis via Botox—as it is used to decrease activity of facial muscles that leads to wrinkles around the eyes and forehead—might also help decrease the appearance of these neck bands. Botox treatments can achieve good results, but there is disagreement about the proper dosage. Also, as anyone who has tried to achieve a smooth forehead through Botox knows, the results are fleeting. It also may be more useful in younger patients, to prevent the vertical bands from forming rather than relaxing already prominent bands.

The good results achieved with pharmaceutical denervation (i.e., Botox) has led some researchers to go one step further and investigate surgical denervation of the platysma muscle. They’ve found this approach to be successful in preventing the formation of the bands over time in their patients. But they also acknowledged that surgical denervation needs further study to determine its safety and effectiveness.

Until the day arrives when we truly understand what causes platysmal bands and how to treat them for long-lasting results, for most people the best management will be to accept such signs of aging—or, when you really don’t want them to be visible, to don a scarf or turtleneck.