Riviera Medical Spa & Aesthetics Guide: Cosmetic Treatments, Laser Skin Care & Body Contouring in Santa Barbara

Neck Botox Demystified

Riviera Medical Spa Episode 11

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0:00 | 20:47

A “turkey neck” sounds like a skin problem, but the real culprit is often a thin muscle you’ve probably never heard of: the platisma. We walk through the physical mechanics of why those vertical neck cords show up, why they get more obvious when you clench your jaw, and why the old assumption “only surgery fixes this” misses what’s happening under the skin.

We use clear anatomy to explain neck Botox for platysmal bands, including the exact goal of microdosing along the bands to quiet the chemical signal that drives contraction. Then we unpack the Nefertiti lift, where weakening a downward-pulling muscle can create a subtle jawline lift by changing the balance of forces in the lower face and neck. If you’ve wondered how a 15 to 20 minute appointment can change neck contouring, we lay out the real timeline: onset in days, peak at about two weeks, and typical longevity of three to four months.

We also get honest about safety and limits. The neck isn’t an area for cookie-cutter injection patterns, and we explain why depth, dose, and placement protect swallowing and speech by keeping treatment in the superficial plane. Finally, we zoom out to the bigger plan: Botox addresses muscle, energy devices like RF microneedling and tightening tech can support skin, and surgery such as deep plane techniques may be the right answer when structure has truly descended. We close with a modern twist that’s hard to ignore: tech neck posture and whether our screens are training the platisma to age faster.

If this helped you see your neck differently, subscribe for more science-first aesthetic breakdowns, share the episode with a friend who’s curious about neck rejuvenation, and leave a quick review with your biggest takeaway.

For more information on surgical and non-surgical options for neck rejuvenation call the Riviera Medical Spa at Montecito Plastic Surgery at 805-969-9004.

Myth Of Scalpel Only Fixes

SPEAKER_01

So I mean most people think that erasing a turkey neck uh requires a scalpel, right? Like general anesthesia, weeks of recovery, the whole nine yards.

SPEAKER_00

Right. Yeah. It's that classic assumption.

SPEAKER_01

Aaron Ross Powell Exactly. We have this, you know, really ingrained idea that gravity can only be fought by uh by going in, making incisions, pulling things tight, basically rebuilding the house from the studs up.

SPEAKER_00

Yeah, which I mean, traditionally that was kind of the only way.

SPEAKER_01

Aaron Powell But the thing is, for a lot of people, the fix actually involves freezing this it's this bizarre floating sheet of muscle in just like 15 minutes.

SPEAKER_00

Yep. No surgery, zero downtime.

SPEAKER_01

It's wild. So welcome to today's deep dive. We're exploring the, well, the fascinating science and the actual physical mechanics of non-surgical neck rejuvenation.

SPEAKER_00

It's a game changer, really.

SPEAKER_01

Totally. Specifically, we're looking at Botox for the neck, and we're drawing on source material from the Riviera Medical Spa at Montecito Plastic Surgery, which is Dr. Adam Lowenstein's practice out in Santa Barbara, California.

SPEAKER_00

Great clinic, yeah. They have some really fantastic insights on this.

SPEAKER_01

They do. And our mission here is to really demystify one of the most requested, but honestly least understood aesthetic treatments out there right now.

SPEAKER_00

Absolutely. Because there is a lot of confusion.

SPEAKER_01

Aaron Ross Powell So much confusion. We want to give you, the listener, the ultimate cheat sheet so you know exactly what is happening anatomically, and we can separate the uh the medical facts from the cosmetic fiction. Okay, let's unpack this. Let's do it.

The Platisma Behind Turkey Neck

SPEAKER_01

Before we can even talk about the fix, we really have to establish what is physically changing in the neck during the aging process.

SPEAKER_00

Right.

SPEAKER_01

Like we need to introduce the main culprit today, which is the platisma muscle. Trevor Burrus, yeah.

SPEAKER_00

The platisma, it is well, it's a highly specialized piece of anatomy.

SPEAKER_01

Right.

SPEAKER_00

Because when most people think of a muscle, they picture something, you know, thick and dense, something anchored firmly between two joints.

SPEAKER_01

Trevor Burrus, Jr.: It's like a bicep or uh your calf muscle. Trevor Burrus, Jr.

SPEAKER_00

Exactly, like a bicep. But the platisma operates on a totally different mechanical principle. Yeah. It's a broad, incredibly thin sheet of muscle that just stretches from your collarbone all the way up over your jawline.

SPEAKER_01

Wow, just sitting right there under the skin.

SPEAKER_00

Right beneath the skin of the neck. Super superficially.

SPEAKER_01

Aaron Powell, and unlike skeletal muscles that, you know, rely on firm bony attachments to keep their tension, the platisma is essentially just a floating fascial layer.

SPEAKER_00

Aaron Powell Yeah, floating is a good word for it.

SPEAKER_01

Which explains why it behaves so unpredictably as we get older and that soft tissue degenerates. Because I mean, without that skeletal anchor, its structure is just inherently vulnerable, right?

SPEAKER_00

What's fascinating here is that because it lacks those firm, bony anchors, its behavior over time is uh entirely dictated by soft tissue dynamics.

SPEAKER_01

Aaron Powell Not a fixed skeletal structure.

SPEAKER_00

Exactly. I mean, consider the sheer volume of movement it endures over decades. Trevor Burrus, Jr.

SPEAKER_01

Just from daily life.

SPEAKER_00

Yeah. Talking, chewing, grimacing, expressing emotion, that muscle is literally constantly contracting.

SPEAKER_01

Trevor Burrus, Jr.: So it's basically doing a marathon every single day. It creates this compound effect. So as the tissue loses its structural integrity over the years, the two vertical edges of this muscle sheet, they actually separate.

SPEAKER_00

They part ways.

SPEAKER_01

Yeah, they part ways and begin to pull forward. And, you know, think of it like an old backyard hammock.

SPEAKER_00

Oh, that's a great analogy.

SPEAKER_01

Yeah, like when a hammock is brand new, the fabric is pulled taut, it's perfectly smooth. But over time, as the tension loosens and the material just stretches from people using it, those thick, heavy support ropes running through the middle of the fabric, they start to pop out.

SPEAKER_00

They become hyper-visible.

SPEAKER_01

Exactly. The fabric itself is sagging, sure, but it's the tight ripes protruding through it that actually catch your eye.

SPEAKER_00

That is exactly it. Those protruding ropes in your hammock are the perfect visual for what patients are seeing on their necks.

SPEAKER_01

Right.

SPEAKER_00

They form these ropey vertical lines running up and down the neck, which are formerly known as platismal bands.

SPEAKER_01

So most people just call it a turkey neck.

SPEAKER_00

Right. Colloquially, it's a turkey neck, which is honestly it's a term that really misrepresents the anatomy. The vital takeaway here is that these bands are fundamentally a muscle-driven pattern.

SPEAKER_01

They aren't just redundant, sagging skin.

SPEAKER_00

No, not at all.

SPEAKER_01

Yeah.

SPEAKER_00

It is overactive muscle edges protruding through thinning skin. And any patient can actually test this dynamically themselves.

SPEAKER_01

Wait, really? How?

SPEAKER_00

By just standing in front of a mirror and clenching the jaw hard or, you know, making a severe grimace.

SPEAKER_01

Oh, I'm doing it right now.

SPEAKER_00

See. Those vertical bands will immediately pop out and become sharply defined. And then upon relaxing, they just soften or recede. Because if the issue were exclusively loose skin, clenching the jaw wouldn't alter the structural appearance so drastically.

SPEAKER_01

Right. The skin would just sit there. Okay, so if the core issue is overactive muscle edges protruding forward, the logical solution isn't to just like cut the skin away.

How Neck Botox Actually Works

SPEAKER_00

Exactly.

SPEAKER_01

The solution requires a targeted approach to actually calm that specific muscle down, which of course leads us directly to Botox. The active ingredient being botulinum toxin, which is the exact same neuromodulator used for uh softening forehead lines and crow's feet. Right.

SPEAKER_00

The biochemical mechanism is absolutely identical, but the application in the neck is highly specialized.

SPEAKER_01

How so?

SPEAKER_00

Well, when an expert injector places these precise microdoses of Botox directly along those visible platismal bands, the toxin targets the neuromuscular junction.

SPEAKER_01

Okay.

SPEAKER_00

It temporarily blocks the release of acyl choline, which is the neurotransmitter responsible for telling that muscle to contract.

SPEAKER_01

So it basically just mutes the chemical signal commanding the muscle to pull.

SPEAKER_00

Precisely. And deprived of that chemical signal, the muscle just stops pulling forward with such aggressive force.

SPEAKER_01

Makes sense.

SPEAKER_00

As it relaxes, the vertical bands lay flat against the underlying tissue, and the entire contour of the neck becomes noticeably smoother.

unknown

Wow.

SPEAKER_00

And because the platisma is such a thin superficial sheet of tissue, achieving this requires, well, surprisingly small doses compared to bulkier muscle groups.

SPEAKER_01

Right, you're not treating a massive bicep here.

SPEAKER_00

Exactly.

The Nefertiti Lift Logic

SPEAKER_01

And this precise application actually leads to a technique highlighted in the Riviera medical spa sources called the Nefertiti lift.

SPEAKER_00

Yes, named for the ancient Egyptian queen.

SPEAKER_01

Right, with that notoriously sharp, elegant jawline. And looking at the anatomy, the mechanics of this are just brilliant.

SPEAKER_00

They really are.

SPEAKER_01

Because the platisma runs from the collarbone up over the jawline. And since it's anchored below, and whenever it contracts, it actively pulls downward on the lower face.

SPEAKER_00

It's a huge depressor muscle.

SPEAKER_01

So the nephritidi lift involves placing Botox strategically along the jawline and the upper part of the platisma to neutralize it.

SPEAKER_00

So wait, by paralyzing a muscle that pulls down, you actually achieve a lift.

SPEAKER_01

I know. It sounds counterintuitive.

SPEAKER_00

That's crazy.

SPEAKER_01

But that is the principle of dynamic opposition.

SPEAKER_00

Okay, explain that.

SPEAKER_01

The musculature in the face and neck operates in this constant tug of war. Elevators pull up, creating that youthful appearance while depressors pull down.

SPEAKER_00

Right.

SPEAKER_01

And the plotisma is a very powerful depressor. As we age, it often becomes hypertonic.

SPEAKER_00

Yes. It gets tighter and stronger at baseline, and it's constantly yanking the jawline downward, exacerbating the appearance of jowls.

SPEAKER_01

Oh, wow.

SPEAKER_00

So strategically weakening that downward vector with Botox creates a subtle but very distinct lifting effect along the jawline. It results in a much cleaner demarcation between where the jaw ends and the neck begins.

Safety Depends On Anatomy

SPEAKER_01

So from an anatomical standpoint, I mean, that makes perfect sense, but I have to ask, deliberately injecting a paralytic toxin into a muscle that spans the throat.

SPEAKER_00

I know where you're going with this.

SPEAKER_01

It definitely invites some obvious safety questions. I mean, the neck houses the structures we literally need to swallow, speak, and breathe.

SPEAKER_00

Crucial functions, yes.

SPEAKER_01

So if the goal is to freeze the musculature in that area, it seems like there's a really fine line between, you know, smoothing a cosmetic band and impairing critical daily functions.

SPEAKER_00

That is the exact reason why a deep understanding of anatomical planes is non-negotiable for anyone performing this procedure.

SPEAKER_01

You can't just wing it.

SPEAKER_00

Absolutely not. But to clarify the safety profile, when properly dosed and accurately placed, there is no impairment of function.

SPEAKER_01

Okay, that's good to hear.

SPEAKER_00

Because the platisma is a strictly superficial muscle. The critical muscles responsible for the heavy lifting of swallowing, like the pharyngeal constrictors, and the muscles controlling the vocal cords, they sit much deeper in the neck.

SPEAKER_01

Separated by other tissue.

SPEAKER_00

Yes, separated by layers of deep cervical fascia. The injection only targets that thin outer envelope. So patients maintain completely normal head movement, swallowing, and speech.

What The Visit Feels Like

SPEAKER_01

Okay, so let's map out the actual patient experience in the chair. According to the Riviera Guide, this doesn't actually require clearing your schedule for the day.

SPEAKER_00

No, not at all.

SPEAKER_01

It's a very fast process.

SPEAKER_00

The clinical encounter is remarkably efficient, usually taking no more than 15 to 20 minutes tops.

SPEAKER_01

Wow.

SPEAKER_00

And honestly, the most critical phase of the appointment actually occurs before a single needle is even uncapped. The evaluation. Right. The provider will ask the patient to perform those dynamic movements we talked about, clenching the jaw, grimacing, making really exaggerated expressions.

SPEAKER_01

So they are basically mapping the specific topography of the active bands.

SPEAKER_00

Exactly. They have to see exactly where that individual's platisma is hyperactive. Because anatomy varies wildly from person to person.

SPEAKER_01

Right. No two necks are the same.

SPEAKER_00

So once the precise injection sites are mapped out, the administration involves incredibly fine needles. It just feels like a series of very light, quick pinches.

SPEAKER_01

Do they numb you?

SPEAKER_00

Copical anesthetic is always an option, but the discomfort is so minimal that most patients actually decline it. And the downtime is practically non existent.

SPEAKER_01

Aaron Powell

Results Timeline And Longevity

SPEAKER_01

But the timeline for results does require a little patience, though. Like you don't walk out of the clinic with a perfectly smooth neck that same afternoon.

SPEAKER_00

No, definitely not.

SPEAKER_01

The onset usually takes three to seven days as the neurotoxin binds to the receptors, right? And then the peak aesthetic result settles in around the two-week mark.

SPEAKER_00

That's correct. And the longevity is a bit different from facial injections, too.

SPEAKER_01

Oh, really? How so?

SPEAKER_00

Well, because the platisma is so delicate and thin, the clinical effects tend to metabolize slightly faster than they do in a thicker muscle, like the frontalis in your forehead.

SPEAKER_01

Okay, so how long does it last?

SPEAKER_00

A neck treatment typically maintains its effect for about three to four months.

SPEAKER_01

Here's where it gets really interesting, though. The source material notes that a patient isn't necessarily locked into that exact three-month cycle forever. Right. By maintaining a highly consistent schedule of treatments, you can actually like actively train the muscle over time, altering its baseline behavior.

SPEAKER_00

Yes, it is a process of induced atrophy.

SPEAKER_01

Induced atrophy. Okay.

SPEAKER_00

Basically, if you consistently use a neuromodulator to prevent a muscle from contracting forcefully over a long period, the muscle fibers physically adapt to that lack of use. They shrink. They weaken slightly and lose their overall bulk. But crucially, the muscle loses its resting tension.

SPEAKER_01

Oh, I see.

SPEAKER_00

So over several cycles, patients frequently observe that the muscle simply forgets how to pull with such aggressive force, which often allows them to comfortably extend the intervals between their maintenance sessions.

SPEAKER_01

That is fascinating.

When Technique Goes Wrong

SPEAKER_01

But okay, if understanding the anatomy is what prevents freezing the wrong muscle, then incorrect technique must carry some pretty significant consequences.

SPEAKER_00

It absolutely does.

SPEAKER_01

Like, if a provider treats Botox like just another commodity rather than a precise medical intervention, the margin for error in the neck seems quite narrow.

SPEAKER_00

It is very narrow. The risks are directly tied to technique and anatomical knowledge.

SPEAKER_01

Right.

SPEAKER_00

If an inexperienced injector places the needle too deep, or they penetrate the fascial planes, or use an excessively high dose, or even injects too close to the midline of the neck, the toxin can diffuse into those deeper constrictor muscles we mentioned earlier.

SPEAKER_01

It breaches that safety barrier.

SPEAKER_00

Exactly. And when diffusion occurs into the deeper structures, it can induce temporary dysphagia, difficulty swallowing, or just a general neck weakness. And while the effect is always temporary, it resolves as the neurotoxin naturally metabolizes, it is an incredibly distressing experience for the patient.

SPEAKER_01

Oh, I can imagine. That sounds terrifying.

SPEAKER_00

It really underscores why cookie cutter, one-size-fits-all injection templates are completely inappropriate for the neck.

SPEAKER_01

Right.

SPEAKER_00

The depth and placement must be customized to the unique anatomy of the individual sitting in the chair.

SPEAKER_01

And that need for precise anatomical diagnosis brings up another really crucial limitation. Because if diagnosing the exact depth of the muscle is essential for safety, diagnosing the nature of the cosmetic problem is essential for efficacy.

SPEAKER_00

100%.

Who Botox Helps And Who It Cannot

SPEAKER_01

Botox has very rigid boundaries. It only blocks the chemical signal for muscle contraction. It does nothing else.

SPEAKER_00

Right, no magic wand.

SPEAKER_01

So this means a lot of patients in their, say, late 40s or 50s must walk into a clinic demanding a quick Botox fix for a heavily sagging neck, only to be told they are literally sitting in the wrong chair.

SPEAKER_00

If we connect this to the bigger picture, this is actually the most common point of friction in aesthetic medicine.

SPEAKER_01

Misalign expectations.

SPEAKER_00

Exactly. Patients frequently misdiagnose the mechanical cause of their own aging. A patient might look in the mirror, pull back severely sun-damaged, loose, creepy skin, or point to a significant accumulation of cemental fat, you know, under the chin, and expect a neuromodulator to resolve it.

SPEAKER_01

But Botox can't do that.

SPEAKER_00

Botox physically cannot correct skin laxity or dissolve adipose tissue. It only relaxes muscle.

SPEAKER_01

So the ideal candidate profile is actually quite specific. It's generally someone in their 30s to early 50s showing early to moderate signs of aging. Their skin retains good elasticity and turger, but they just have these dynamic muscle bands popping out when they speak or animate.

SPEAKER_00

Right. They are presenting with a primary muscle issue, not a primary skin or structural issue.

SPEAKER_01

Makes sense.

SPEAKER_00

Conversely, a poor candidate for this specific intervention is someone seeking permanent correction of heavy jowls, deep fat deposits, or advanced redundant tissue that has just lost all its recoil.

SPEAKER_01

So the source material from Riviera Medical Spa actually distills this into a really great foundational rule for aesthetic patients. Botox addresses the muscle, energy devices address the skin. Surgery addresses the underlying structure.

SPEAKER_00

That's the golden rule, really.

SPEAKER_01

But aging is rarely an isolated variable, right?

Devices Plus Surgery As A Plan

SPEAKER_01

Like a patient presenting with platismal banding likely also has some degree of collagen depletion in the skin, or maybe some early descent of the deeper facial structures.

SPEAKER_00

Usually, yes. It's a combination.

SPEAKER_01

So a comprehensive practice like Dr. Lowenstein's operates with an entire toolkit. Because a single modality just can't address a multi-layered problem.

SPEAKER_00

That multimodal approach is the current gold standard. Because different technologies act on entirely different biological pathways, combining them yields a really synergistic result.

SPEAKER_01

Right.

SPEAKER_00

Let's look at the skin level interventions, for example.

SPEAKER_01

If the tissue is significantly loose, generating new collagen won't provide enough mechanical contraction, right?

SPEAKER_00

True.

SPEAKER_01

That is where a more intensive device like Renuvian or J Plasma enters the picture.

SPEAKER_00

Yeah, Renuvian operates on completely different physics.

SPEAKER_01

How so?

SPEAKER_00

It is a minimally invasive procedure where a wand is introduced just beneath the skin, and the device passes helium gas over a radio frequency electrode, creating this stream of cold plasma.

SPEAKER_01

Cold plasma under the skin.

SPEAKER_00

Yeah. And when this plasma energy hits the fibrous septae, the connective tissue network under the skin, it rapidly heats those fibers to 85 degrees Celsius and cools them back down in a fraction of a second.

SPEAKER_01

Wow. So it's instantly shrink wrapping the connective tissue.

SPEAKER_00

It's exactly shrink wrapping. The rapid heating and cooling cause the collagen fibers to immediately contract, offering dramatic tissue tightening for moderate laxity, but without the extensive incisions of a traditional surgical lift.

SPEAKER_01

But there is downtime with this one.

SPEAKER_00

It does require some downtime, typically a few days to two weeks, but the structural contraction can last for years.

SPEAKER_01

And for surface texture, the actual quality and tone of the skin itself, they use Vivas RF microneedling.

SPEAKER_00

Yes, Vivas is excellent for that.

SPEAKER_01

Which combines the physical microinjuries of traditional microneedling with radio frequency heat. So the needles physically break up old disorganized collagen on the surface while the radio frequency energy flows down the needles to remodel the deeper dermis. That's a brilliant combination. And conveniently, that can be done in the exact same clinical visit as the Botox injections.

SPEAKER_00

Yeah. You can address the hyperactive muscle pulling and the degraded surface skin quality simultaneously.

SPEAKER_01

So to bring this back to the earlier concept, you are basically looking at a home renovation.

SPEAKER_00

Okay, I like this analogy.

SPEAKER_01

Botox addresses the act of wear and tear on the hinges, stopping the doors from slamming. Ultherapy, Renuvian, and Vivace, they repair and upgrade the drywall. But if the actual foundation of the house is sinking, no amount of drywall repair or hinge oil is going to stabilize the structure. Right. You have to rebuild the foundation.

SPEAKER_00

And that foundation repair is surgery.

SPEAKER_01

Surgery, yeah.

SPEAKER_00

For advanced structural descent, Dr. Lowenstein performs the deep plane facelift and his proprietary deep frame facelift.

SPEAKER_01

Right.

SPEAKER_00

And these surgical techniques don't just pull skin, they go and reposition the deeper retaining ligaments of the face and neck.

SPEAKER_01

They actually restore the foundational architecture to its youthful position.

SPEAKER_00

Exactly. And we have to be exceedingly clear here. Botox is a phenomenal complementary tool, but it is not an interchangeable substitute for surgery when structural repositioning is truly required.

SPEAKER_01

But they do work beautifully in tandem over a patient's lifespan.

SPEAKER_00

Oh yeah. Absolutely.

SPEAKER_01

Like a patient might utilize Botox in their 40s to manage the muscle banding and then eventually transition to a deep frame facelift later in life.

SPEAKER_00

Yep.

SPEAKER_01

And then post surgery, they return to Botox to prevent the platisma from actively pulling against their new lifted surgical results.

SPEAKER_00

Aaron Powell It really represents a continuum of care. The treatments protect and enhance one another.

SPEAKER_01

So what does this all mean for you, the listener? I mean, it means that understanding the specific anatomy of your neck really transforms you from a confused consumer into a highly empowered patient.

SPEAKER_00

Empowered is the key word.

SPEAKER_01

You now know that those ropey vertical bands aren't just, you know, an inevitable symptom of gravity requiring a surgical suite. They are the result of a unique, floating muscle that can often be calmed down in a 15-minute appointment.

SPEAKER_00

Exactly.

SPEAKER_01

But you also recognize the biological boundaries of that treatment, and that achieving a truly natural, comprehensive result usually requires addressing the muscle, the skin, and the structure in harmony.

SPEAKER_00

Because when you understand those underlying mechanisms, you can make highly informed strategic decisions about your own care.

SPEAKER_01

Absolutely.

SPEAKER_00

But

Tech Neck And Final Takeaway

SPEAKER_00

before we conclude, you know, reviewing this source material about the platisma and how decades of repetitive motion exacerbate these muscle bands. It prompts an observation about our current daily habits.

SPEAKER_01

Oh, where are you going with this?

SPEAKER_00

This raises an important question. We discussed how regular neuromodulator treatments can train the platisma muscle to relax by preventing forceful contraction, right?

SPEAKER_01

Right.

SPEAKER_00

But consider the intense physical training we are currently putting our cervical anatomy through every single day with our devices. Think about technec.

SPEAKER_01

Oh man. The posture we hold while staring down at our phones.

SPEAKER_00

Yeah, exactly. We spend hours daily with our heads tilted downward, just staring at screens.

SPEAKER_01

I'm guilty of it.

SPEAKER_00

We all are. But this unnatural, sustained posture places immense, continuous strain on the platisma and the surrounding cervical musculature. If lifelong repetitive expression causes these bands to hypertrophy, separate, and pull forward, we have to ask how much our modern digital posture is actively accelerating this precise aging mechanism.

SPEAKER_01

Oh wow. It really makes you wonder if the platismal banding of the future is going to be driven far more by our screen time than by our actual genetics.

SPEAKER_00

It is entirely plausible that we are systematically training our neck muscles to age prematurely. It's certainly something for you to think about the next time you catch yourself tensing your jaw and staring down while scrolling through your feed.

SPEAKER_01

I am consciously fixing my posture as you say that. Well, we began this deep dive discussing the assumption of major architectural construction, the idea that you just have to rebuild the neck with a scalpel. Right. But as we've explored today, sometimes you don't need a wrecking ball. Sometimes you just need to know exactly which biological wire to unplug to let the whole system relax.