Platysma Thickness Change with Age: A Retrospective MRI Study

Platysma Thickness Change with Age: A Retrospective MRI Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Platysma Thickness Change with Age: A Retrospective MRI Study Elias Keyrouz, Georges Ziade, Sahar Semaan, Tracy El Khoury, Mia Harb, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7755090/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Purpose Platysma bands are among the earliest visible signs of neck aging, yet the mechanisms underlying their development remain debated. This study aimed to evaluate age-related changes in platysma thickness using axial MRI, with attention to the modifying effects of gender. Methods A retrospective review of 200 MRI neck scans from patients aged 18–99 years was conducted at two tertiary centers. Platysma thickness was measured bilaterally at six anatomical levels using standardized radiological protocols. Associations with age and gender were assessed through correlation analysis, group comparisons, and multivariable generalized linear models. Results Platysma thickness demonstrated a progressive, statistically significant decline with advancing age across all measured sites (p < 0.001), most pronounced at the hyoid and infrahyoid levels. Males consistently exhibited greater muscle thickness than females (p < 0.001), a difference that persisted after adjustment for age. Multivariable regression confirmed that both increasing age and female gender were independently associated with reduced platysma thickness. Conclusion This study provides MRI-based evidence of age-related platysma atrophy, particularly in regions critical for neck contour. These findings suggest that structural muscle degeneration contributes substantially to neck aging and support incorporating imaging metrics into individualized aesthetic assessment and treatment planning. Consideration of both age and gender may enhance the precision of surgical and nonsurgical rejuvenation strategies. Platysma muscle Neck aging Magnetic resonance imaging Muscle atrophy Gender differences Aesthetic surgery Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Background and Significance The platysma is a thin, sheet-like voluntary muscle innervated by the facial nerve. It originates broadly from the fascia of the upper thorax, including the clavicle, acromial region, and the pectoralis major and deltoid muscles. Its fibers course superiorly and medially in a rostral-caudal direction, inserting into the mandible, cheek skin, commissure of the mouth, orbicularis oris, and in some cases as high as the orbicularis oculi. Notably, the muscle has only a small bony insertion on the anterior third of the mandible [ 1 , 2 ]. Anatomically, the platysma exhibits several variations. In 75% of individuals, its medial fibers interdigitate below the chin for 1 to 2 cm; in 15%, this interdigitation extends to the thyroid cartilage; and in 10%, no interdigitation occurs. The muscle's striated fibers can vary significantly in thickness depending on age, gender, and nutritional status. In elderly or malnourished individuals, it may be indistinct from overlying adipose tissue. Deep to the platysma lie the sternocleidomastoid and digastric muscles laterally, and the strap muscles medially, covering the larynx and thyroid [ 1 – 3 ]. Platysma fiber arrangement and decussation patterns vary among individuals, influencing neck aesthetics and aging [ 4 ].Contraction of the platysma elevates the neck, accentuates platysmal bands, lowers midfacial tissues, and contributes to facial expressions such as surprise, horror, or disgust. It also assists in mandibular depression, thereby altering neck shape and contour. Physiologic variants include partial or complete absence, unusual termination points, or extension into facial musculature such as the zygomaticus or orbicularis oris [ 1 , 2 ]. Platysma bands are among the earliest visible signs of neck aging, often becoming apparent after the age of 55 [ 1 ]. Prior studies have identified shortening and thinning of the platysma as the predominant age-related changes [ 2 ]. However, the etiology of these bands remains debated. While some researchers attribute them to progressive skin laxity and muscle atrophy [ 5 ], others emphasize the role of hyperkinetic platysmal activity, suggesting that muscle changes precede and influence skin draping [ 1 ]. A more refined understanding of platysma aging is vital, as it informs surgical and nonsurgical rejuvenation strategies. Surgical techniques that preserve the cervical branch of the facial nerve during subplatysmal procedures have been described to reduce morbidity and improve outcomes [ 6 ]. Current treatments may either aim to tighten lax tissues or target muscular hyperactivity. However, imaging studies exploring the structural integrity of the platysma with age remain scarce. This study aims to fill this gap by radiologically assessing platysma thickness changes with age and gender. Methods Study design, settings, and eligibility criteria This retrospective observational study was conducted at Lebanese American University Medical Centers—Rizk Hospital and Saint John Hospital. MRI neck scans from 2009 to 2023 were reviewed. Inclusion criteria included patients aged 18 years and older who underwent neck MRI for various clinical indications. Only scans with appropriate imaging protocol—axial T1-weighted sequences with sufficient resolution and no significant motion artifacts—were included to ensure reliable platysma measurements. Exclusion criteria encompassed prior neck radiation, surgeries involving subplatysmal dissection, previous neck or lower face botulinum toxin injections, FNA through the platysma, vocal cord pathology, poor-quality MRI scans with motion artifacts or missing slices at key measurement levels, and cases with abnormal neck anatomy such as congenital malformations or mass lesions impacting the platysma. Ethical approval This study was approved by the Institutional Review Board (IRB) of the Lebanese American University. Patient confidentiality was maintained in accordance with institutional and ethical guidelines. Measurements Platysma thickness was measured at six preset anatomical sites on axial MRI: suprahyoid level, infrahyoid level, hyoid level, angle of mandible, 4 cm below the angle of mandible, and the most inferior aspect of the orbicularis oris, bilaterally. All measurements were performed by two trained investigators using a standardized protocol. Interobserver agreement was assessed on a random subset of 20 MRIs to ensure reliability. A separate key sheet linking patient MRNs to study-specific IDs was maintained by the principal investigator and stored securely. Only de-identified datasets were used for analysis, and access was restricted to approved study personnel. Statistical analysis Descriptive statistics were performed to summarize participants’ demographic characteristics and platysma thickness values at different anatomical levels. Continuous variables were expressed as mean ± standard deviation or median and interquartile range, and categorical variables as frequencies and percentages. Normality was assessed using the Shapiro-Wilk test and complemented by visual inspection of histograms and Q-Q plots. Associations between platysma thickness and age (both as a continuous and categorical variable) and gender were examined using the appropriate statistical tests. These included Spearman correlation coefficients for continuous age, independent samples T-tests for gender, and ANOVA or Kruskal-Wallis tests for age categories (18–39, 40–59, 60–79, 80–99), depending on data distribution. Multivariable generalized linear models using a gamma distribution were constructed for each anatomical level due to skewed data, allowing simultaneous evaluation of age and gender as independent predictors of platysma thickness. Results from these models were reported as adjusted β coefficients with 95% confidence intervals. An alpha level of 0.05 was used to determine statistical significance. All analyses were conducted using IBM SPSS Statistics for Windows, Version 29 (IBM Corp., Armonk, NY). Results Participants’ characteristics A total of 200 patients were included, evenly distributed across four age groups (18–39, 40–59, 60–79, 80–99), with a mean age ± SD of 58 ± 23 years. The sample consisted of 49% males and 51% females (Table 1). Bivariate associations between age, gender and maximum thickness of platysma Platysma thickness progressively declined with age at all measured sites. The steepest reductions were observed at the hyoid and infrahyoid levels(). The associations between continuous age and platysma thickness across all anatomical locations are detailed in Table 2 . The correlation coefficients demonstrated significant negative associations (p < 0.001), with the strongest effects noted at the left hyoid (ρ = -0.53) and left infrahyoid (ρ = -0.46) levels. Comparisons of platysma thickness by age category (18–39, 40–59, 60–79, 80–99) are shown in Table 3 . Differences in platysma thickness were most prominent between the youngest and oldest age groups across all anatomical sites except the angle of the mandible. These findings highlight a consistent stepwise decline with increasing age. The association between gender and platysma thickness is outlined in Table 4 . Males exhibited significantly thicker platysma at all measured points (p < 0.001). Multivariable analysis for the Maximum thickness of platysma at different locations Furthermore, multivariable regression models at each anatomical level showed that both increasing age and female gender were independently associated with reduced platysma thickness. These models simultaneously adjusted for all included variables simultaneously (Table 5) . Discussion This study presents the first MRI-based evaluation of age-related platysma changes across multiple neck levels, confirming a clear trend of muscular thinning with age. These findings support the theory that structural degeneration of the platysma contributes to visible neck aging, especially in the anterior cervical region. The most notable changes occurred at the hyoid and infrahyoid levels, regions critical for neck contour and the formation of platysmal bands. This aligns with theories suggesting that platysma changes precede or act independently of skin laxity in producing visible neck aging. Analyzing by age categories further clarified this trend: each advancing group demonstrated statistically thinner platysma compared to the younger one. This incremental decline in muscle thickness suggests a progressive degenerative process, which carries important clinical implications. From an aesthetic perspective, the stepwise atrophy of the platysma with age contributes significantly to the loss of cervicomental definition and the appearance of platysmal banding [1,5]. These observations underscore the value of incorporating age-based anatomical changes into personalized rejuvenation strategies, guiding the choice between dynamic treatments in earlier stages and structural reinforcement or surgical interventions in more advanced aging. Clinically, this implies that the degree of platysma thinning could be used as a radiologic marker for the progression of neck aging. Patients in the younger cohorts may benefit from dynamic treatments targeting muscular hyperactivity, while those in older groups may require structural lifting or reinforcement due to significant muscle atrophy. Gender-based differences were also significant. Males consistently exhibited greater muscle thickness, which may contribute to delayed or less pronounced neck aging. These findings suggest that sex-specific strategies might be warranted in both aesthetic assessment and treatment planning. Furthermore, our results are consistent with previous anatomical and aesthetic studies supporting the use of botulinum toxin injections to manage platysmal hyperactivity in the aging neck [7]. However, the application of botulinum toxin in this region requires nuanced understanding of the underlying anatomy and muscular changes. With increasing age and progressive platysma atrophy, injections should be administered superficially within the muscle layer to avoid diffusion into deeper structures such as the laryngopharyngeal muscles. Improper technique or deeper injections risk impairing swallowing and phonation, with reported complications including dysphagia and aspiration. Ensuring a safe plane of injection, particularly in patients with already thinned platysma, is therefore critical. Several authors have advocated for conservative dosing and superficial intramuscular placement to mitigate these risks, especially in elderly patients [7]. In patients with significant age-related thinning or degenerative changes in the platysma, botulinum toxin injections may be insufficient. In such cases, deeper structural interventions such as platysmaplasty or neck lifts are more appropriate, as they address the underlying muscular laxity and volume loss. As the platysma thins with age, cervical platysmal bands often recur after traditional facelift procedures, where the platysma is simply tightened and anchored to the mastoid fascia. The recurrent laxity may be attributed to the inability of the aging, thinned platysma to maintain tension with this method. To address this, resection of central redundant platysma combined with double or triple imbrication techniques and central tightening closure has been proposed to yield more durable and aesthetically satisfying outcomes in cervical contouring [8]. Integrating imaging-based platysma assessment into treatment algorithms can refine decision-making, ensuring that interventions align with each patient’s anatomical aging profile and aesthetic goals. This imaging-based approach may guide the threshold for transitioning from minimally invasive to surgical interventions depending on measurable muscle atrophy and structural integrity. Importantly, multivariable analysis confirmed that age and gender exert independent and simultaneous effects on platysma thickness, reinforcing the need to consider both variables when developing individualized treatment plans. Clinically, the data support a shift in paradigms—beyond skin-focused approaches, practitioners should consider underlying platysma integrity when planning rejuvenation. Younger patients with hypertrophic or hyperactive platysma may benefit more from neurotoxins, while older patients with significant atrophy might require structural lifting. The clinical relevance of our findings extends across several specialties. Surgeons may use these data to better predict which patients are likely to benefit from more durable surgical approaches such as central platysma imbrication or resection, particularly in older individuals with significantly thinned platysma. Relying solely on lateral platysma fixation may not provide lasting results in such cases. Dermatologists, who often manage early neck aging non-surgically, can utilize platysma thickness data to determine candidacy for neuromodulators or energy-based treatments. Thicker, more hyperactive platysma muscles in younger patients may respond well to botulinum toxin, while thinner muscles in older patients may show diminished returns. Radiologists can contribute meaningfully by incorporating platysma thickness assessment into structured reports, especially when evaluating patients undergoing pre-aesthetic or reconstructive consultation. Routine reporting may offer valuable objective data for multidisciplinary planning. Strengths and Limitations This study offers several strengths, including a large sample size spanning a wide age range, standardized radiological measurements across six anatomical levels, and multivariable analysis adjusting for age and gender. To our knowledge, it is among the first to quantitatively evaluate platysma thickness using axial MRI across a full adult lifespan. However, its retrospective nature introduces potential selection bias, and functional correlates such as electromyography or muscle tone assessment were not included. Additionally, MRI scan protocols may have varied slightly across institutions and over the years. Despite these limitations, our findings provide a valuable framework for integrating objective muscle metrics into aesthetic evaluation. Conclusion Platysma thickness declines significantly with age, especially at the hyoid and infrahyoid levels. These findings enhance our understanding of neck aging and may refine both surgical and nonsurgical rejuvenation strategies. Multivariable analysis confirmed that age and gender have independent and cumulative impacts on platysma morphology. Future research should integrate functional muscle assessments to further optimize patient-specific treatment protocols. Declarations Competing Interests The authors declare that they have no competing financial or non-financial interests related to the content of this article. Funding The authors received no financial support for the research, authorship, or publication of this article. Ethics Approval This study was approved by the Institutional Review Board (IRB) of the Lebanese American University Medical Center–Rizk Hospital. All procedures were conducted in accordance with the ethical standards of the institutional research committee and with the principles of the Declaration of Helsinki. Consent to Participate The requirement for informed consent was waived due to the retrospective nature of the study. Consent for Publication Not applicable, as no patient-identifiable data are included in this article. Author Contribution Keyrouz: Project development, Data collection, Data analysis, Manuscript writing Ziade: Project development, Manuscript editing Harb: Data collection, Manuscript writing Swaidan: Data collection Saade: Project development, Supervision, Manuscript editing Semaan: Data collection, Data analysis El Khoury: Data collection, Data analysis Akiki: Data analysis, Manuscript editing References Trévidic, Patrick, and Gisella Criollo-Lamilla. “Platysma Bands: Is a Change Needed in the Surgical Paradigm?.” Plastic and reconstructive surgery vol. 139,1 (2017): 41-47. doi:10.1097/PRS.0000000000002894 Hwang, Kun et al. “Anatomy of the Platysma Muscle.” The Journal of craniofacial surgery vol. 28,2 (2017): 539-542. doi:10.1097/SCS.0000000000003318 Gordon, Neil A, and Stewart I Adam. “The deep-plane approach to neck rejuvenation.” Facial plastic surgery clinics of North America vol. 22,2 (2014): 269-84. doi:10.1016/j.fsc.2014.01.003 Thomas, J Regan, and Tatiana K Dixon. “Preoperative evaluation of the aging neck patient.” Facial plastic surgery clinics of North America vol. 22,2 (2014): 171-6. doi:10.1016/j.fsc.2014.01.004 Cardoso de Castro, C. “The changing role of platysma in face lifting.” Plastic and reconstructive surgery vol. 105,2 (2000): 764-75; discussion 776-7. doi:10.1097/00006534-200002000-00047 Righini, C A et al. “An original submandibular approach technique sparing the cervical branch of the facial nerve.” European annals of otorhinolaryngology, head and neck diseases vol. 131,2 (2014): 143-6. doi:10.1016/j.anorl.2013.04.003 Trévidic, Patrick et al. “Anatomy of the Lower Face and Botulinum Toxin Injections.” Plastic and reconstructive surgery vol. 136,5 Suppl (2015): 84S-91S. doi:10.1097/PRS.0000000000001787 Citarella, Enzo Rivera et al. “Triple suture for neck contouring: 14 years of experience.” Aesthetic surgery journal vol. 30,3 (2010): 311-9. doi:10.1177/1090820X10374096 Tables Table 1. Participants’ characteristics N=200 Age Mean ± SD 58 ± 23 Median (Q1; Q3) 59 (39; 81) Min – Max 18 - 99 Age categories 18 – 39; n (%) 50 (25%) 40 – 59; n (%) 50 (25%) 60 –79; n (%) 50 (25%) 80 – 99; n (%) 50 (25%) Gender Male; n (%) 98 (49%) Female; n (%) 102 (51%) Maximum thickness of platysma Suprahyoid level – right Mean ± SD 1.56 ± 0.48 Median (Q1; Q3) 1.5 (1.3; 1.8) Min – Max 0.5 – 3.6 Suprahyoid level - left Mean ± SD 1.60 ± 0.51 Median (Q1; Q3) 1.5 (1.3; 1.8) Min – Max 0.5 – 4.2 Infrahyoid level - right Mean ± SD 1.52 ± 0.47 Median (Q1; Q3) 1.4 (1.2; 1.8) Min – Max 0.6 – 3.7 Infrahyoid level - left Mean ± SD 1.60 ± 0.54 Median (Q1; Q3) 1.5 (1.22; 1.8) Min – Max 0.7 - 5 Hyoid level - right Mean ± SD 1.81 ± 0.57 Median (Q1; Q3) 1.7 (1.4; 2) Min – Max 1 - 4.7 Hyoid level - left Mean ± SD 1.85 ± 0.63 Median (Q1; Q3) 1.7 (1.4; 2.1) Min – Max 1 – 5.9 Angle of mandible - right Mean ± SD 1.20 ± 0.30 Median (Q1; Q3) 1.2 (1; 1.4) Min – Max 0.5 – 2.5 Angle of mandible - left Mean ± SD 1.23 ± 0.30 Median (Q1; Q3) 1.2 (1; 1.4) Min – Max 0.5 – 2.3 4 cm below angle of mandible - right Mean ± SD 1.43 ± 0.48 Median (Q1; Q3) 1.3 (1.1; 1.6) Min – Max 0.6 – 3.2 4 cm below angle of mandible - left Mean ± SD 1.48 ± 0.48 Median (Q1; Q3) 1.4 (1.1; 1.7) Min – Max 0.5 – 3.1 Most inferior aspect of orbicularis oris - right Mean ± SD 1.67 ± 0.56 Median (Q1; Q3) 1.6 (1.3; 1.9) Min – Max 0.8 – 4.7 Most inferior aspect of orbicularis oris - left Mean ± SD 1.72 ± 0.56 Median (Q1; Q3) 1.6 (1.3; 2) Min – Max 0.8 – 5.0 Min. Minimum; Max. Maximum Association between age and Maximum thickness of platysma at different locations Table 2. Association between age and Maximum thickness of platysma Age Spearman correlation coefficient ρ P-value Suprahyoid level – right -0.29 <0.001 Suprahyoid level - left -0.30 <0.001 Infrahyoid level - right -0.39 <0.001 Infrahyoid level - left -0.46 <0.001 Hyoid level - right -0.49 <0.001 Hyoid level - left -0.53 <0.001 Angle of mandible - right -0.15 0.04 Angle of mandible - left -0.18 0.01 4 cm below angle of mandible - right -0.28 <0.001 4 cm below angle of mandible - left -0.33 <0.001 Most inferior aspect of orbicularis oris - right -0.38 <0.001 Most inferior aspect of orbicularis oris - left -0.42 <0.001 Association between age categories and Maximum thickness of platysma at different locations Table 3. Association between age categories and maximum thickness of platysma Age P-value 18-39 Mean ± SD 40-59 Mean ± SD 60-79 Mean ± SD 80+ Mean ± SD Suprahyoid level – right 1.80 ± 0.67 1.58 ± 0.38 1.46 ± 0.42 1.39 ± 0.28 0.002* Suprahyoid level - left 1.89 ± 0.72 1.55 ± 0.37 1.52 ± 0.42 1.43 ± 0.27 < 0.001** Infrahyoid level - right 1.78 ± 0.56 1.61 ± 0.44 1.36 ± 0.38 1.35 ± 0.35 < 0.001*** Infrahyoid level - left 1.94 ± 0.74 1.70 ± 0.41 1.40 ± 0.38 1.37 ± 0.30 < 0.001 # Hyoid level - right 2.18 ± 0.74 1.91 ± 0.44 1.65 ± 0.45 1.52 ± 0.33 < 0.001 ## Hyoid level - left 2.31 ± 0.87 1.93 ± 0.40 1.67 ± 0.50 1.49 ± 0.29 < 0.001 ### Angle of mandible - right 1.27 ± 0.32 1.21 ± 0.25 1.16 ± 0.31 1.17 ± 0.30 0.3 Angle of mandible - left 1.35 ± 0.35 1.24 ± 0.29 1.15 ± 0.28 1.2 ± 0.26 0.03 & 4 cm below angle of mandible - right 1.56 ± 0.49 1.55 ± 0.48 1.27 ± 0.46 1.32 ± 0.43 < 0.001 && 4 cm below angle of mandible - left 1.68 ± 0.51 1.58 ± 0.39 1.31 ± 0.46 1.35 ± 0.46 < 0.001 &&& Most inferior aspect of orbicularis oris - right 1.89 ± 0.76 1.89 ± 0.50 1.49 ± 0.38 1.42 ± 0.29 < 0.001 $ Most inferior aspect of orbicularis oris - left 1.97 ± 0.72 1.92 ± 0.55 1.53 ± 0.41 1.46 ± 0.28 < 0.001 $$ Post-hoc analysis using Tukey test *P =0.002 for “18-39” and “60-79”; P<0.001 for “18-39” and “80-99” **P=0.003 for “18-39” and “40-59”; P=0.001 for “18-39” and “60-79”; P<0.001 for “18-39” and “80-99” ***P<0.001 for “18-39” and “60-79”; P<0.001 for “18-39” and “80-99”; P=0.03 for “40-59” and “60-79”; P=0.02 for “60-79” and “80-99”. # P<0.001 for “18-39” and “60-79”; P<0.001 for “18-39” and “80-99”; P=0.01 for “40-59” and “60-79”; P=0.004 for “40-59” and “80-99”. ## P=0.04 for “18-39” and “40-59”; P <0.001 for “18-39” and “60-79”; P<0.001 for “18-39” and “80-99”; P=0.001 for “40-59” and “80-99”. ### P=0.004 for “18-39” and “40-59”; P <0.001 for “18-39” and “60-79”; P<0.001 for “18-39” and “80-99”; P<0.001 for “40-59” and “80-99”. & P =0.005 for “18-39” and “60-79” && P =0.01 for “18-39” and “60-79”; P=0.02 for “40-59” and “60-79” &&& P<0.001 for “18-39” and “60-79”; P=0.002 for “18-39” and “80-99”; P=0.02 for “40-59” and “60-79” $ P =0.001 for “18-39” and “60-79”; P<0.001 for “18-39” and “80-99”; P<0.001 for “40-59” and “60-79”; P<0.001 for “40-59” and “80-99”; $$ P <0.001 for “18-39” and “60-79”; P<0.001 for “18-39” and “80-99”; P=0.002 for “40-59” and “60-79”; P<0.001 for “40-59” and “80-99”; Association between gender and Maximum thickness of platysma at different locations Table 4. Association between gender and Maximum thickness of platysma Gender P-value Male Mean ± SD Female Mean ± SD Suprahyoid level – right 1.73 ± 0.52 1.39 ± 0.37 < 0.001 Suprahyoid level - left 1.82 ± 0.57 1.38 ± 0.31 < 0.001 Infrahyoid level - right 1.64 ± 0.47 1.41 ± 0.44 < 0.001 Infrahyoid level - left 1.75 ± 0.59 1.46 ± 0.44 < 0.001 Hyoid level - right 1.99 ± 0.66 1.65 ± 0.41 < 0.001 Hyoid level - left 2.08 ± 0.75 1.63 ± 0.40 < 0.001 Angle of mandible - right 1.27 ± 0.29 1.14 ± 0.29 0.001 Angle of mandible - left 1.31 ± 0.31 1.16 ± 0.29 < 0.001 4 cm below angle of mandible - right 1.61 ± 0.50 1.25 ± 0.39 < 0.001 4 cm below angle of mandible - left 1.70 ± 0.50 1.27 ± 0.36 < 0.001 Most inferior aspect of orbicularis oris - right 1.78 ± 0.66 1.57 ± 0.40 0.008 Most inferior aspect of orbicularis oris - left 1.85 ± 0.66 1.60 ± 0.41 0.001 Multivariable analysis for the Maximum thickness of platysma at different locations Adjusted β (95% CI) P-value Model 1. Suprahyoid level – right as dependent variable Male vs. Female 0.21 (0.13; 0.28) <0.001 40 - 59 vs. 18 - 39 -0.09 (-0.19; 0.02) 0.1 60 - 79 vs. 18 - 39 -0.17 (-0.27; -0.07) <0.001 80 - 99 vs. 18 - 39 -0.24 (-0.34; -0.14) <0.001 Model 2. Suprahyoid level – left as dependent variable Male vs. Female 0.26 (0.19; 0.32) <0.001 40 - 59 vs. 18 - 39 -0.15 (-0.25; -0.06) 0.002 60 - 79 vs. 18 - 39 -0.17 (-0.27; -0.08) <0.001 80 - 99 vs. 18 - 39 -0.25 (-0.35; -0.16) <0.001 Model 3. Infrahyoid level – right as dependent variable Male vs. Female 0.14 (0.07; 0.22) <0.001 40 - 59 vs. 18 - 39 -0.07 (-0.18; 0.03) 0.2 60 - 79 vs. 18 - 39 -0.25 (-0.35; -0.15) <0.001 80 - 99 vs. 18 - 39 -0.27 (-0.37; -0.17) <0.001 Model 4. Infrahyoid level - left as dependent variable Male vs. Female 0.17 (0.09; 0.24) <0.001 40 - 59 vs. 18 - 39 -0.11 (-0.21; -0.008) 0.04 60 - 79 vs. 18 - 39 -0.30 (-0.40; -0.20) <0.001 80 - 99 vs. 18 - 39 -0.34 (-0.44; -0.24) <0.001 Model 5. Hyoid level - right as dependent variable Male vs. Female 0.17 (0.10; 0.23) <0.001 40 - 59 vs. 18 - 39 -0.10 (-0.19; -0.005) 0.04 60 - 79 vs. 18 - 39 -0.25 (-0.34; -0.15) <0.001 80 - 99 vs. 18 - 39 -0.35 (-0.44; -0.25) <0.001 Model 6. Hyoid level – left as dependent variable Male vs. Female 0.22 (0.15; 0.29) <0.001 40 - 59 vs. 18 - 39 -0.14 (-0.23; -0.04) 0.004 60 - 79 vs. 18 - 39 -0.29 (-0.38; -0.19) <0.001 80 - 99 vs. 18 - 39 -0.42 (-0.51; -0.32) <0.001 Model 7. Angle of mandible - right as dependent variable Male vs. Female 0.11 (0.05; 0.18) <0.001 40 - 59 vs. 18 - 39 -0.03 (-0.12; 0.07) 0.6 60 - 79 vs. 18 - 39 -0.08 (-0.17; 0.02) 0.1 80 - 99 vs. 18 - 39 -0.07 (-0.16; 0.02) 0.1 Model 8. Angle of mandible - left as dependent variable Male vs. Female 0.11 (0.04; 0.17) 0.001 40 - 59 vs. 18 - 39 -0.07 (-0.16; 0.02) 0.1 60 - 79 vs. 18 - 39 -0.15 (-0.24; -0.06) 0.002 80 - 99 vs. 18 - 39 -0.11 (-0.20; -0.02) 0.02 Model 9. 4 cm below angle of mandible - right as dependent variable Male vs. Female 0.25 (0.17; 0.32) <0.001 40 - 59 vs. 18 - 39 0.03 (-0.08; 0.14) 0.6 60 - 79 vs. 18 - 39 -0.17 (-0.28; -0.07) 0.001 80 - 99 vs. 18 - 39 -0.14 (-0.25; -0.04) 0.009 Model 10. 4 cm below angle of mandible – left as dependent variable Male vs. Female 0.28 (0.21; 0.35) <0.001 40 - 59 vs. 18 - 39 -0.02 (-0.12; 0.09) 0.8 60 - 79 vs. 18 - 39 -0.21 (-0.31; -0.11) <0.001 80 - 99 vs. 18 - 39 -0.20 (-0.30; -0.09) <0.001 Model 11. Most inferior aspect of orbicularis oris - right as dependent variable Male vs. Female 0.12 (0.05; 0.20) <0.001 40 - 59 vs. 18 - 39 0.03 (-0.07; 0.14) 0.6 60 - 79 vs. 18 - 39 -0.21 (-0.32; -0.11) <0.001 80 - 99 vs. 18 - 39 -0.27 (-0.38; -0.17) <0.001 Model 12. Most inferior aspect of orbicularis oris – left as dependent variable Male vs. Female 0.14 (0.07; 0.21) <0.001 40 - 59 vs. 18 - 39 0.001 (-0.10; 0.10) 0.9 60 - 79 vs. 18 - 39 -0.23 (-0.33; -0.13) <0.001 80 - 99 vs. 18 - 39 -0.28 (-0.38; -0.18) <0.001 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 20 Mar, 2026 Reviews received at journal 06 Oct, 2025 Reviewers agreed at journal 05 Oct, 2025 Reviewers invited by journal 05 Oct, 2025 Editor assigned by journal 02 Oct, 2025 Submission checks completed at journal 02 Oct, 2025 First submitted to journal 30 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7755090","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":529921798,"identity":"e504abef-bfc9-42ee-a437-ebbd7ed17206","order_by":0,"name":"Elias Keyrouz","email":"","orcid":"","institution":"Lebanese American University","correspondingAuthor":false,"prefix":"","firstName":"Elias","middleName":"","lastName":"Keyrouz","suffix":""},{"id":529921802,"identity":"8de4321f-a65c-44c0-a3d5-ad325adb186e","order_by":1,"name":"Georges Ziade","email":"","orcid":"","institution":"Lebanese American 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02:23:42","extension":"html","order_by":22,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":113370,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7755090/v1/e52b0ee13164bfd7476216a3.html"},{"id":93729748,"identity":"40862555-a2ef-4dbf-8e02-7711f19726f3","added_by":"auto","created_at":"2025-10-17 02:15:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":290144,"visible":true,"origin":"","legend":"\u003cp\u003eMaximum thickness of platysma at suprahyoid level on axial images\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7755090/v1/09b07533472cb6ddcc8429b4.png"},{"id":93729753,"identity":"6757124b-0fce-4512-800c-07ac54d5dd68","added_by":"auto","created_at":"2025-10-17 02:15:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":281170,"visible":true,"origin":"","legend":"\u003cp\u003eMaximum thickness of platysma at infrahyoid level on axial images\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7755090/v1/4de22391df100cf391a050f0.png"},{"id":93729747,"identity":"3ac93077-719f-43fe-a158-bea9b94f5ace","added_by":"auto","created_at":"2025-10-17 02:15:42","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":277541,"visible":true,"origin":"","legend":"\u003cp\u003eMaximum thickness of platysma at the hyoid level on axial images\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7755090/v1/9968cd71dcde294b0912bf41.png"},{"id":93729749,"identity":"48cf5d3b-0b84-4bb3-a471-d83cfe4607ca","added_by":"auto","created_at":"2025-10-17 02:15:42","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":223493,"visible":true,"origin":"","legend":"\u003cp\u003eMaximum thickness of platysma at angle of mandible on axial images\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7755090/v1/5cdfa2ed84e8ed0c439c3659.png"},{"id":93729745,"identity":"91a09da2-a190-4420-bdb0-e1cd2252426d","added_by":"auto","created_at":"2025-10-17 02:15:42","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":299054,"visible":true,"origin":"","legend":"\u003cp\u003eMaximum thickness of platysma 4 cm below angle of mandible on axial images\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7755090/v1/8ab1d3a7a15353d6aa205017.png"},{"id":93729750,"identity":"5e64aad8-e420-4779-bf14-d27f9b5f9a2c","added_by":"auto","created_at":"2025-10-17 02:15:42","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":182075,"visible":true,"origin":"","legend":"\u003cp\u003eMaximum thickness of platysma at most inferior aspect of orbicularis oris on axial images\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7755090/v1/e98d8663505026716209355e.png"},{"id":93731575,"identity":"e5d7bb8d-ad65-46e4-87ca-8a7d6af710fa","added_by":"auto","created_at":"2025-10-17 02:23:42","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":206711,"visible":true,"origin":"","legend":"\u003cp\u003ePlatysma Thickness by Age Group at Different Neck Locations\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-7755090/v1/a845b2ffd7cfe66120167439.png"},{"id":93729762,"identity":"4c5b8801-ac36-4dbe-884e-e80b02855d86","added_by":"auto","created_at":"2025-10-17 02:15:42","extension":"jpeg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":781670,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eFigure 1. Maximum thickness of platysma at different locations among males and females\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage8.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7755090/v1/ac601b3983450e115cb8427b.jpeg"},{"id":93733145,"identity":"53a779dd-0027-4881-a1f3-c28306689a70","added_by":"auto","created_at":"2025-10-17 02:39:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5140948,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7755090/v1/64051690-7b87-447d-82d9-e3136f06adf5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Platysma Thickness Change with Age: A Retrospective MRI Study","fulltext":[{"header":"Background and Significance","content":"\u003cp\u003eThe platysma is a thin, sheet-like voluntary muscle innervated by the facial nerve. It originates broadly from the fascia of the upper thorax, including the clavicle, acromial region, and the pectoralis major and deltoid muscles. Its fibers course superiorly and medially in a rostral-caudal direction, inserting into the mandible, cheek skin, commissure of the mouth, orbicularis oris, and in some cases as high as the orbicularis oculi. Notably, the muscle has only a small bony insertion on the anterior third of the mandible [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAnatomically, the platysma exhibits several variations. In 75% of individuals, its medial fibers interdigitate below the chin for 1 to 2 cm; in 15%, this interdigitation extends to the thyroid cartilage; and in 10%, no interdigitation occurs. The muscle's striated fibers can vary significantly in thickness depending on age, gender, and nutritional status. In elderly or malnourished individuals, it may be indistinct from overlying adipose tissue. Deep to the platysma lie the sternocleidomastoid and digastric muscles laterally, and the strap muscles medially, covering the larynx and thyroid [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePlatysma fiber arrangement and decussation patterns vary among individuals, influencing neck aesthetics and aging [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].Contraction of the platysma elevates the neck, accentuates platysmal bands, lowers midfacial tissues, and contributes to facial expressions such as surprise, horror, or disgust. It also assists in mandibular depression, thereby altering neck shape and contour. Physiologic variants include partial or complete absence, unusual termination points, or extension into facial musculature such as the zygomaticus or orbicularis oris [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePlatysma bands are among the earliest visible signs of neck aging, often becoming apparent after the age of 55 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Prior studies have identified shortening and thinning of the platysma as the predominant age-related changes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, the etiology of these bands remains debated. While some researchers attribute them to progressive skin laxity and muscle atrophy [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], others emphasize the role of hyperkinetic platysmal activity, suggesting that muscle changes precede and influence skin draping [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA more refined understanding of platysma aging is vital, as it informs surgical and nonsurgical rejuvenation strategies. Surgical techniques that preserve the cervical branch of the facial nerve during subplatysmal procedures have been described to reduce morbidity and improve outcomes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Current treatments may either aim to tighten lax tissues or target muscular hyperactivity. However, imaging studies exploring the structural integrity of the platysma with age remain scarce. This study aims to fill this gap by radiologically assessing platysma thickness changes with age and gender.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eStudy design, settings, and eligibility criteria\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective observational study was conducted at Lebanese American University Medical Centers\u0026mdash;Rizk Hospital and Saint John Hospital. MRI neck scans from 2009 to 2023 were reviewed. Inclusion criteria included patients aged 18 years and older who underwent neck MRI for various clinical indications. Only scans with appropriate imaging protocol\u0026mdash;axial T1-weighted sequences with sufficient resolution and no significant motion artifacts\u0026mdash;were included to ensure reliable platysma measurements. Exclusion criteria encompassed prior neck radiation, surgeries involving subplatysmal dissection, previous neck or lower face botulinum toxin injections, FNA through the platysma, vocal cord pathology, poor-quality MRI scans with motion artifacts or missing slices at key measurement levels, and cases with abnormal neck anatomy such as congenital malformations or mass lesions impacting the platysma.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthical approval\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board (IRB) of the Lebanese American University. Patient confidentiality was maintained in accordance with institutional and ethical guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMeasurements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePlatysma thickness was measured at six preset anatomical sites on axial MRI: suprahyoid level, infrahyoid level, hyoid level, angle of mandible, 4 cm below the angle of mandible, and the most inferior aspect of the orbicularis oris, bilaterally. All measurements were performed by two trained investigators using a standardized protocol. Interobserver agreement was assessed on a random subset of 20 MRIs to ensure reliability. A separate key sheet linking patient MRNs to study-specific IDs was maintained by the principal investigator and stored securely. Only de-identified datasets were used for analysis, and access was restricted to approved study personnel.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical analysis\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were performed to summarize participants\u0026rsquo; demographic characteristics and platysma thickness values at different anatomical levels. Continuous variables were expressed as mean \u0026plusmn; standard deviation or median and interquartile range, and categorical variables as frequencies and percentages. Normality was assessed using the Shapiro-Wilk test and complemented by visual inspection of histograms and Q-Q plots.\u003c/p\u003e\n\u003cp\u003eAssociations between platysma thickness and age (both as a continuous and categorical variable) and gender were examined using the appropriate statistical tests. These included Spearman correlation coefficients for continuous age, independent samples T-tests for gender, and ANOVA or Kruskal-Wallis tests for age categories (18\u0026ndash;39, 40\u0026ndash;59, 60\u0026ndash;79, 80\u0026ndash;99), depending on data distribution. Multivariable generalized linear models using a gamma distribution were constructed for each anatomical level due to skewed data, allowing simultaneous evaluation of age and gender as independent predictors of platysma thickness. Results from these models were reported as adjusted \u0026beta; coefficients with 95% confidence intervals.\u003c/p\u003e\n\u003cp\u003eAn alpha level of 0.05 was used to determine statistical significance. All analyses were conducted using IBM SPSS Statistics for Windows, Version 29 (IBM Corp., Armonk, NY).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eParticipants’ characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA total of 200 patients were included, evenly distributed across four age groups (18–39, 40–59, 60–79, 80–99), with a mean age ± SD of 58 ± 23 years. The sample consisted of 49% males and 51% females\u0026nbsp;(Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eBivariate associations between age, gender and maximum thickness of platysma\u0026nbsp;\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePlatysma thickness progressively declined with age at all measured sites. The steepest reductions were observed at the hyoid and infrahyoid levels(). The associations between continuous age and platysma thickness across all anatomical locations are detailed in \u003cstrong\u003eTable 2\u003c/strong\u003e. The correlation coefficients demonstrated significant negative associations (p \u0026lt; 0.001), with the strongest effects noted at the left hyoid (ρ = -0.53) and left infrahyoid (ρ = -0.46) levels.\u003c/p\u003e\n\u003cp\u003eComparisons of platysma thickness by age category (18–39, 40–59, 60–79, 80–99) are shown in \u003cstrong\u003eTable 3\u003c/strong\u003e. Differences in platysma thickness were most prominent between the youngest and oldest age groups across all anatomical sites except the angle of the mandible. These findings highlight a consistent stepwise decline with increasing age.\u003c/p\u003e\n\u003cp\u003eThe association between gender and platysma thickness is outlined in \u003cstrong\u003eTable 4\u003c/strong\u003e. Males exhibited significantly thicker platysma at all measured points (p \u0026lt; 0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eMultivariable analysis for the Maximum thickness of platysma at different locations\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFurthermore, multivariable regression models at each anatomical level showed that both increasing age and female gender were independently associated with reduced platysma thickness. These models simultaneously adjusted for all included variables simultaneously \u003cstrong\u003e(Table 5)\u003c/strong\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study presents the first MRI-based evaluation of age-related platysma changes across multiple neck levels, confirming a clear trend of muscular thinning with age. These findings support the theory that structural degeneration of the platysma contributes to visible neck aging, especially in the anterior cervical region.\u003c/p\u003e\n\u003cp\u003eThe most notable changes occurred at the hyoid and infrahyoid levels, regions critical for neck contour and the formation of platysmal bands. This aligns with theories suggesting that platysma changes precede or act independently of skin laxity in producing visible neck aging.\u003c/p\u003e\n\u003cp\u003eAnalyzing by age categories further clarified this trend: each advancing group demonstrated statistically thinner platysma compared to the younger one. This incremental decline in muscle thickness suggests a progressive degenerative process, which carries important clinical implications. From an aesthetic perspective, the stepwise atrophy of the platysma with age contributes significantly to the loss of cervicomental definition and the appearance of platysmal banding [1,5]. These observations underscore the value of incorporating age-based anatomical changes into personalized rejuvenation strategies, guiding the choice between dynamic treatments in earlier stages and structural reinforcement or surgical interventions in more advanced aging. Clinically, this implies that the degree of platysma thinning could be used as a radiologic marker for the progression of neck aging. Patients in the younger cohorts may benefit from dynamic treatments targeting muscular hyperactivity, while those in older groups may require structural lifting or reinforcement due to significant muscle atrophy.\u003c/p\u003e\n\u003cp\u003eGender-based differences were also significant. Males consistently exhibited greater muscle thickness, which may contribute to delayed or less pronounced neck aging. These findings suggest that sex-specific strategies might be warranted in both aesthetic assessment and treatment planning.\u003c/p\u003e\n\u003cp\u003eFurthermore, our results are consistent with previous anatomical and aesthetic studies supporting the use of botulinum toxin injections to manage platysmal hyperactivity in the aging neck [7]. However, the application of botulinum toxin in this region requires nuanced understanding of the underlying anatomy and muscular changes. With increasing age and progressive platysma atrophy, injections should be administered superficially within the muscle layer to avoid diffusion into deeper structures such as the laryngopharyngeal muscles. Improper technique or deeper injections risk impairing swallowing and phonation, with reported complications including dysphagia and aspiration. Ensuring a safe plane of injection, particularly in patients with already thinned platysma, is therefore critical. Several authors have advocated for conservative dosing and superficial intramuscular placement to mitigate these risks, especially in elderly patients [7].\u003c/p\u003e\n\u003cp\u003eIn patients with significant age-related thinning or degenerative changes in the platysma, botulinum toxin injections may be insufficient. In such cases, deeper structural interventions such as platysmaplasty or neck lifts are more appropriate, as they address the underlying muscular laxity and volume loss. As the platysma thins with age, cervical platysmal bands often recur after traditional facelift procedures, where the platysma is simply tightened and anchored to the mastoid fascia. The recurrent laxity may be attributed to the inability of the aging, thinned platysma to maintain tension with this method. To address this, resection of central redundant platysma combined with double or triple imbrication techniques and central tightening closure has been proposed to yield more durable and aesthetically satisfying outcomes in cervical contouring [8].\u003c/p\u003e\n\u003cp\u003eIntegrating imaging-based platysma assessment into treatment algorithms can refine decision-making, ensuring that interventions align with each patient\u0026rsquo;s anatomical aging profile and aesthetic goals. This imaging-based approach may guide the threshold for transitioning from minimally invasive to surgical interventions depending on measurable muscle atrophy and structural integrity. Importantly, multivariable analysis confirmed that age and gender exert independent and simultaneous effects on platysma thickness, reinforcing the need to consider both variables when developing individualized treatment plans.\u003c/p\u003e\n\u003cp\u003eClinically, the data support a shift in paradigms\u0026mdash;beyond skin-focused approaches, practitioners should consider underlying platysma integrity when planning rejuvenation. Younger patients with hypertrophic or hyperactive platysma may benefit more from neurotoxins, while older patients with significant atrophy might require structural lifting.\u003c/p\u003e\n\u003cp\u003eThe clinical relevance of our findings extends across several specialties. Surgeons may use these data to better predict which patients are likely to benefit from more durable surgical approaches such as central platysma imbrication or resection, particularly in older individuals with significantly thinned platysma. Relying solely on lateral platysma fixation may not provide lasting results in such cases. Dermatologists, who often manage early neck aging non-surgically, can utilize platysma thickness data to determine candidacy for neuromodulators or energy-based treatments. Thicker, more hyperactive platysma muscles in younger patients may respond well to botulinum toxin, while thinner muscles in older patients may show diminished returns. Radiologists can contribute meaningfully by incorporating platysma thickness assessment into structured reports, especially when evaluating patients undergoing pre-aesthetic or reconstructive consultation. Routine reporting may offer valuable objective data for multidisciplinary planning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study offers several strengths, including a large sample size spanning a wide age range, standardized radiological measurements across six anatomical levels, and multivariable analysis adjusting for age and gender. To our knowledge, it is among the first to quantitatively evaluate platysma thickness using axial MRI across a full adult lifespan. However, its retrospective nature introduces potential selection bias, and functional correlates such as electromyography or muscle tone assessment were not included. Additionally, MRI scan protocols may have varied slightly across institutions and over the years. Despite these limitations, our findings provide a valuable framework for integrating objective muscle metrics into aesthetic evaluation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePlatysma thickness declines significantly with age, especially at the hyoid and infrahyoid levels. These findings enhance our understanding of neck aging and may refine both surgical and nonsurgical rejuvenation strategies. Multivariable analysis confirmed that age and gender have independent and cumulative impacts on platysma morphology. Future research should integrate functional muscle assessments to further optimize patient-specific treatment protocols.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare that they have no competing financial or non-financial interests related to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors received no financial support for the research, authorship, or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;This study was approved by the Institutional Review Board (IRB) of the Lebanese American University Medical Center\u0026ndash;Rizk Hospital. All procedures were conducted in accordance with the ethical standards of the institutional research committee and with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The requirement for informed consent was waived due to the retrospective nature of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable, as no patient-identifiable data are included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Keyrouz: Project development, Data collection, Data analysis, Manuscript writing\u003cbr\u003e\u0026nbsp;Ziade: Project development, Manuscript editing\u003cbr\u003e\u0026nbsp;Harb: Data collection, Manuscript writing\u003cbr\u003e\u0026nbsp;Swaidan: Data collection\u003cbr\u003e\u0026nbsp;Saade: Project development, Supervision, Manuscript editing\u003cbr\u003e\u0026nbsp;Semaan: Data collection, Data analysis\u003cbr\u003e\u0026nbsp;El Khoury: Data collection, Data analysis\u003cbr\u003e\u0026nbsp;Akiki: Data analysis, Manuscript editing\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTr\u0026eacute;vidic, Patrick, and Gisella Criollo-Lamilla. \u0026ldquo;Platysma Bands: Is a Change Needed in the Surgical Paradigm?.\u0026rdquo; \u003cem\u003ePlastic and reconstructive surgery\u003c/em\u003e vol. 139,1 (2017): 41-47. doi:10.1097/PRS.0000000000002894\u003c/li\u003e\n\u003cli\u003eHwang, Kun et al. \u0026ldquo;Anatomy of the Platysma Muscle.\u0026rdquo; \u003cem\u003eThe Journal of craniofacial surgery\u003c/em\u003e vol. 28,2 (2017): 539-542. doi:10.1097/SCS.0000000000003318\u003c/li\u003e\n\u003cli\u003eGordon, Neil A, and Stewart I Adam. \u0026ldquo;The deep-plane approach to neck rejuvenation.\u0026rdquo; \u003cem\u003eFacial plastic surgery clinics of North America\u003c/em\u003e vol. 22,2 (2014): 269-84. doi:10.1016/j.fsc.2014.01.003\u003c/li\u003e\n\u003cli\u003eThomas, J Regan, and Tatiana K Dixon. \u0026ldquo;Preoperative evaluation of the aging neck patient.\u0026rdquo; \u003cem\u003eFacial plastic surgery clinics of North America\u003c/em\u003e vol. 22,2 (2014): 171-6. doi:10.1016/j.fsc.2014.01.004\u003c/li\u003e\n\u003cli\u003eCardoso de Castro, C. \u0026ldquo;The changing role of platysma in face lifting.\u0026rdquo; \u003cem\u003ePlastic and reconstructive surgery\u003c/em\u003e vol. 105,2 (2000): 764-75; discussion 776-7. doi:10.1097/00006534-200002000-00047\u003c/li\u003e\n\u003cli\u003eRighini, C A et al. \u0026ldquo;An original submandibular approach technique sparing the cervical branch of the facial nerve.\u0026rdquo; \u003cem\u003eEuropean annals of otorhinolaryngology, head and neck diseases\u003c/em\u003e vol. 131,2 (2014): 143-6. doi:10.1016/j.anorl.2013.04.003\u003c/li\u003e\n\u003cli\u003eTr\u0026eacute;vidic, Patrick et al. \u0026ldquo;Anatomy of the Lower Face and Botulinum Toxin Injections.\u0026rdquo; \u003cem\u003ePlastic and reconstructive surgery\u003c/em\u003e vol. 136,5 Suppl (2015): 84S-91S. doi:10.1097/PRS.0000000000001787\u003c/li\u003e\n\u003cli\u003eCitarella, Enzo Rivera et al. \u0026ldquo;Triple suture for neck contouring: 14 years of experience.\u0026rdquo; \u003cem\u003eAesthetic surgery journal\u003c/em\u003e vol. 30,3 (2010): 311-9. doi:10.1177/1090820X10374096\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Participants\u0026rsquo; characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=200\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58 \u0026plusmn; 23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedian (Q1; Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59 (39; 81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMin \u0026ndash; Max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18 - 99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge categories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18 \u0026ndash; 39; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40 \u0026ndash; 59; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60 \u0026ndash;79; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e80 \u0026ndash; 99; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e98 (49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e102 (51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eMaximum thickness of platysma\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuprahyoid level \u0026ndash; right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.56 \u0026plusmn; 0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedian (Q1; Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.5 (1.3; 1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMin \u0026ndash; Max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.5 \u0026ndash; 3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuprahyoid level - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.60 \u0026plusmn; 0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedian (Q1; Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.5 (1.3; 1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMin \u0026ndash; Max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.5 \u0026ndash; 4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfrahyoid level - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.52 \u0026plusmn; 0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedian (Q1; Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.4 (1.2; 1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMin \u0026ndash; Max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.6 \u0026ndash; 3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfrahyoid level - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.60 \u0026plusmn; 0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedian (Q1; Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.5 (1.22; 1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMin \u0026ndash; Max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.7 - 5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHyoid level - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.81 \u0026plusmn; 0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedian (Q1; Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.7 (1.4; 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMin \u0026ndash; Max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 - 4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHyoid level - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.85 \u0026plusmn; 0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedian (Q1; Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.7 (1.4; 2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMin \u0026ndash; Max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 \u0026ndash; 5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAngle of mandible - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.20 \u0026plusmn; 0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedian (Q1; Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.2 (1; 1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMin \u0026ndash; Max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.5 \u0026ndash; 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAngle of mandible - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.23 \u0026plusmn; 0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedian (Q1; Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.2 (1; 1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMin \u0026ndash; Max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.5 \u0026ndash; 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 cm below angle of mandible - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.43 \u0026plusmn; 0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedian (Q1; Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.3 (1.1; 1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMin \u0026ndash; Max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.6 \u0026ndash; 3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 cm below angle of mandible - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.48 \u0026plusmn; 0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedian (Q1; Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.4 (1.1; 1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMin \u0026ndash; Max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.5 \u0026ndash; 3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMost inferior aspect of orbicularis oris - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.67 \u0026plusmn; 0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedian (Q1; Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.6 (1.3; 1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMin \u0026ndash; Max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.8 \u0026ndash; 4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMost inferior aspect of orbicularis oris - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.72 \u0026plusmn; 0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedian (Q1; Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.6 (1.3; 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMin \u0026ndash; Max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.8 \u0026ndash; 5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMin. Minimum; Max. Maximum\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAssociation between age and Maximum thickness of platysma at different locations\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Association between age and Maximum thickness of platysma\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpearman correlation coefficient \u0026rho;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuprahyoid level \u0026ndash; right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuprahyoid level - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfrahyoid level - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfrahyoid level - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHyoid level - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHyoid level - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAngle of mandible - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAngle of mandible - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 cm below angle of mandible - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 cm below angle of mandible - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMost inferior aspect of orbicularis oris - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMost inferior aspect of orbicularis oris - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAssociation between age categories and Maximum thickness of platysma at different locations\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Association between age categories and maximum thickness of platysma\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e18-39\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e40-59\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e60-79\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e80+\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuprahyoid level \u0026ndash; right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.80 \u0026plusmn; 0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.58 \u0026plusmn; 0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.46 \u0026plusmn; 0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e1.39 \u0026plusmn; 0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuprahyoid level - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.89 \u0026plusmn; 0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.55 \u0026plusmn; 0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.52 \u0026plusmn; 0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e1.43 \u0026plusmn; 0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfrahyoid level - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.78 \u0026plusmn; 0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.61 \u0026plusmn; 0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.36 \u0026plusmn; 0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e1.35 \u0026plusmn; 0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfrahyoid level - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.94 \u0026plusmn; 0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.70 \u0026plusmn; 0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.40 \u0026plusmn; 0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e1.37 \u0026plusmn; 0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003csup\u003e#\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHyoid level - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.18 \u0026plusmn; 0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.91 \u0026plusmn; 0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.65 \u0026plusmn; 0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e1.52 \u0026plusmn; 0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003csup\u003e##\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHyoid level - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.31 \u0026plusmn; 0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.93 \u0026plusmn; 0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.67 \u0026plusmn; 0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e1.49 \u0026plusmn; 0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003csup\u003e###\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAngle of mandible - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.27 \u0026plusmn; 0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.21 \u0026plusmn; 0.25\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.16 \u0026plusmn; 0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e1.17 \u0026plusmn; 0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAngle of mandible - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.35 \u0026plusmn; 0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.24 \u0026plusmn; 0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.15 \u0026plusmn; 0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e1.2 \u0026plusmn; 0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 cm below angle of mandible - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.56 \u0026plusmn; 0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.55 \u0026plusmn; 0.48\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.27 \u0026plusmn; 0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e1.32 \u0026plusmn; 0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003csup\u003e\u0026amp;\u0026amp;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 cm below angle of mandible - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.68 \u0026plusmn; 0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.58 \u0026plusmn; 0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.31 \u0026plusmn; 0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e1.35 \u0026plusmn; 0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003csup\u003e\u0026amp;\u0026amp;\u0026amp;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMost inferior aspect of orbicularis oris - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.89 \u0026plusmn; 0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.89 \u0026plusmn; 0.50\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.49 \u0026plusmn; 0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e1.42 \u0026plusmn; 0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003csup\u003e$\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMost inferior aspect of orbicularis oris - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.97 \u0026plusmn; 0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.92 \u0026plusmn; 0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.53 \u0026plusmn; 0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e1.46 \u0026plusmn; 0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003csup\u003e$$\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePost-hoc analysis using Tukey test\u003c/p\u003e\n\u003cp\u003e*P =0.002 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;; P\u0026lt;0.001 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;80-99\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e**P=0.003 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;40-59\u0026rdquo;; P=0.001 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;; P\u0026lt;0.001 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;80-99\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e***P\u0026lt;0.001 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;; P\u0026lt;0.001 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;80-99\u0026rdquo;; P=0.03 for \u0026ldquo;40-59\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;; P=0.02 for \u0026ldquo;60-79\u0026rdquo; and \u0026ldquo;80-99\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e#\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003eP\u0026lt;0.001 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;; P\u0026lt;0.001 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;80-99\u0026rdquo;; P=0.01 for \u0026ldquo;40-59\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;; P=0.004 for \u0026ldquo;40-59\u0026rdquo; and \u0026ldquo;80-99\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e##\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003eP=0.04 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;40-59\u0026rdquo;; P \u0026lt;0.001 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;; P\u0026lt;0.001 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;80-99\u0026rdquo;; P=0.001 for \u0026ldquo;40-59\u0026rdquo; and \u0026ldquo;80-99\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e###\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003eP=0.004 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;40-59\u0026rdquo;; P \u0026lt;0.001 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;; P\u0026lt;0.001 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;80-99\u0026rdquo;; P\u0026lt;0.001 for \u0026ldquo;40-59\u0026rdquo; and \u0026ldquo;80-99\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/strong\u003e P =0.005 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e\u0026amp;\u0026amp;\u003c/sup\u003e\u003c/strong\u003eP =0.01 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;; P=0.02 for \u0026ldquo;40-59\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e\u0026amp;\u0026amp;\u0026amp;\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003eP\u0026lt;0.001 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;; P=0.002 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;80-99\u0026rdquo;; P=0.02 for \u0026ldquo;40-59\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e$\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003eP =0.001 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;; P\u0026lt;0.001 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;80-99\u0026rdquo;; P\u0026lt;0.001 for \u0026ldquo;40-59\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;; P\u0026lt;0.001 for \u0026ldquo;40-59\u0026rdquo; and \u0026ldquo;80-99\u0026rdquo;;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e$$\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003eP \u0026lt;0.001 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;; P\u0026lt;0.001 for \u0026ldquo;18-39\u0026rdquo; and \u0026ldquo;80-99\u0026rdquo;; P=0.002 for \u0026ldquo;40-59\u0026rdquo; and \u0026ldquo;60-79\u0026rdquo;; P\u0026lt;0.001 for \u0026ldquo;40-59\u0026rdquo; and \u0026ldquo;80-99\u0026rdquo;;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAssociation between gender and Maximum thickness of platysma at different locations\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Association between gender and Maximum thickness of platysma\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuprahyoid level \u0026ndash; right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.73 \u0026plusmn; 0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.39 \u0026plusmn; 0.37\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuprahyoid level - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.82 \u0026plusmn; 0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.38 \u0026plusmn; 0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfrahyoid level - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.64 \u0026plusmn; 0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.41 \u0026plusmn; 0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfrahyoid level - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.75 \u0026plusmn; 0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.46 \u0026plusmn; 0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHyoid level - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.99 \u0026plusmn; 0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.65 \u0026plusmn; 0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHyoid level - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.08 \u0026plusmn; 0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.63 \u0026plusmn; 0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAngle of mandible - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.27 \u0026plusmn; 0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.14 \u0026plusmn; 0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAngle of mandible - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.31 \u0026plusmn; 0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.16 \u0026plusmn; 0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 cm below angle of mandible - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.61 \u0026plusmn; 0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.25 \u0026plusmn; 0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 cm below angle of mandible - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.70 \u0026plusmn; 0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.27 \u0026plusmn; 0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMost inferior aspect of orbicularis oris - right\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.78 \u0026plusmn; 0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.57 \u0026plusmn; 0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMost inferior aspect of orbicularis oris - left\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.85 \u0026plusmn; 0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.60 \u0026plusmn; 0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMultivariable analysis for the Maximum thickness of platysma at different locations\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted \u0026beta; (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eModel 1. Suprahyoid level \u0026ndash; right as dependent variable\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMale vs. Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.21 (0.13; 0.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e40 - 59 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.09 (-0.19; 0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e60 - 79 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.17 (-0.27; -0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e80 - 99 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.24 (-0.34; -0.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eModel 2. Suprahyoid level \u0026ndash; left as dependent variable\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMale vs. Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.26 (0.19; 0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e40 - 59 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.15 (-0.25; -0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e60 - 79 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.17 (-0.27; -0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e80 - 99 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.25 (-0.35; -0.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eModel 3. Infrahyoid level \u0026ndash; right as dependent variable\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMale vs. Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.14 (0.07; 0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e40 - 59 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.07 (-0.18; 0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e60 - 79 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.25 (-0.35; -0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e80 - 99 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.27 (-0.37; -0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eModel 4. Infrahyoid level - left as dependent variable\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMale vs. Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.17 (0.09; 0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e40 - 59 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.11 (-0.21; -0.008)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e60 - 79 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.30 (-0.40; -0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e80 - 99 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.34 (-0.44; -0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eModel 5. Hyoid level - right as dependent variable\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMale vs. Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.17 (0.10; 0.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e40 - 59 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.10 (-0.19; -0.005)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e60 - 79 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.25 (-0.34; -0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e80 - 99 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.35 (-0.44; -0.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eModel 6. Hyoid level \u0026ndash; left\u0026nbsp;as dependent variable\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMale vs. Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.22 (0.15; 0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e40 - 59 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.14 (-0.23; -0.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e60 - 79 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.29 (-0.38; -0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e80 - 99 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.42 (-0.51; -0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eModel 7. Angle of mandible - right as dependent variable\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMale vs. Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.11 (0.05; 0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e40 - 59 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.03 (-0.12; 0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e60 - 79 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.08 (-0.17; 0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e80 - 99 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.07 (-0.16; 0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eModel 8. Angle of mandible - left as dependent variable\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMale vs. Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.11 (0.04; 0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e40 - 59 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.07 (-0.16; 0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e60 - 79 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.15 (-0.24; -0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e80 - 99 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.11 (-0.20; -0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eModel 9. 4 cm below angle of mandible - right as dependent variable\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMale vs. Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.25 (0.17; 0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e40 - 59 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.03 (-0.08; 0.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e60 - 79 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.17 (-0.28; -0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e80 - 99 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.14 (-0.25; -0.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eModel 10. 4 cm below angle of mandible \u0026ndash; left\u0026nbsp;as dependent variable\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMale vs. Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.28 (0.21; 0.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e40 - 59 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.02 (-0.12; 0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e60 - 79 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.21 (-0.31; -0.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e80 - 99 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.20 (-0.30; -0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eModel 11. Most inferior aspect of orbicularis oris - right as dependent variable\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMale vs. Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.12 (0.05; 0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e40 - 59 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.03 (-0.07; 0.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e60 - 79 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.21 (-0.32; -0.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e80 - 99 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.27 (-0.38; -0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eModel 12. Most inferior aspect of orbicularis oris \u0026ndash; left\u0026nbsp;as dependent variable\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMale vs. Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.14 (0.07; 0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e40 - 59 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.001 (-0.10; 0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e60 - 79 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.23 (-0.33; -0.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e80 - 99 vs. 18 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.28 (-0.38; -0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"surgical-and-radiologic-anatomy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sara","sideBox":"Learn more about [Surgical and Radiologic Anatomy](http://link.springer.com/journal/276)","snPcode":"276","submissionUrl":"https://submission.nature.com/new-submission/276/3","title":"Surgical and Radiologic Anatomy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Platysma muscle, Neck aging, Magnetic resonance imaging, Muscle atrophy, Gender differences, Aesthetic surgery","lastPublishedDoi":"10.21203/rs.3.rs-7755090/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7755090/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003ePlatysma bands are among the earliest visible signs of neck aging, yet the mechanisms underlying their development remain debated. This study aimed to evaluate age-related changes in platysma thickness using axial MRI, with attention to the modifying effects of gender.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective review of 200 MRI neck scans from patients aged 18\u0026ndash;99 years was conducted at two tertiary centers. Platysma thickness was measured bilaterally at six anatomical levels using standardized radiological protocols. Associations with age and gender were assessed through correlation analysis, group comparisons, and multivariable generalized linear models.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003ePlatysma thickness demonstrated a progressive, statistically significant decline with advancing age across all measured sites (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), most pronounced at the hyoid and infrahyoid levels. Males consistently exhibited greater muscle thickness than females (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), a difference that persisted after adjustment for age. Multivariable regression confirmed that both increasing age and female gender were independently associated with reduced platysma thickness.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study provides MRI-based evidence of age-related platysma atrophy, particularly in regions critical for neck contour. These findings suggest that structural muscle degeneration contributes substantially to neck aging and support incorporating imaging metrics into individualized aesthetic assessment and treatment planning. Consideration of both age and gender may enhance the precision of surgical and nonsurgical rejuvenation strategies.\u003c/p\u003e","manuscriptTitle":"Platysma Thickness Change with Age: A Retrospective MRI Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 02:15:37","doi":"10.21203/rs.3.rs-7755090/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-20T13:53:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-06T22:01:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83907073414336824447858463373520132800","date":"2025-10-05T13:59:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-05T08:31:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-02T11:30:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-02T07:42:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Surgical and Radiologic Anatomy","date":"2025-09-30T22:05:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"surgical-and-radiologic-anatomy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sara","sideBox":"Learn more about [Surgical and Radiologic Anatomy](http://link.springer.com/journal/276)","snPcode":"276","submissionUrl":"https://submission.nature.com/new-submission/276/3","title":"Surgical and Radiologic Anatomy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3ea0a451-4f96-4bdd-b1ff-a5251f8095ba","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-28T09:23:45+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-17 02:15:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7755090","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7755090","identity":"rs-7755090","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}