Platysma bands treatment with Botulinum Toxin
The ageing neck is an area that improvement is commonly requested in clinic. It can be quite challenging, and expectations can be high.
Ageing of the neck can present with submental fat, loss of definition of the mandibular border and neck angle, flaccidity and poor quality of the skin as well as horizontal lines and vertical bands of the platysma muscle.
These bands appear due to hyperkinetic activity of the platysma muscle and its interfaces as well as its connections with adjacent oral muscles combined with the function of the depressor anguli oris lead to marked bands and depressed oral commissures, which are also aspects commonly associated with ageing. Botulinum Toxin can relax these muscles and when properly injected give excellent outcomes for the patient.
The Nefertiti lift as it is sometimes called can be used on its own or in conjunction with other rejuvenating procedures. It is particularly helpful in younger patients with platysma muscle hyperactivity and retained skin elasticity.
Anatomy
The clavicle, acromion, and superficial fascia of the upper thorax are where the platysma muscle begins to develop. Its posterior fibres are inserted into the lateral orbicularis oris muscle, the depressor anguli oris, and the risorius muscles.
The platysma contracts and lowers the mouth’s angle. The medial region of the mandibular border’s periosteum is where the anterior fibres are implanted. The masseter, buccinator, and depressor anguli oris fibres connect to these ones. Masseter, risorius, and depressor anguli oris can all be directly accessed by superficial platysmal fibres. When muscles contract, it is mostly these anterior regions that are in charge of causing platysmal bands to develop.
The oblique line of the jaw is where the depressor anguli oris muscle originates. It is inserted into the inferior aspect of the mouth and connects to the nearby muscles. It reduces the mouth’s commissure, which leads to an expression of melancholy or annoyance. It contributes to the development of the mentolabial fold along with the mandibular ligament.
Technique
The injector administers three or four injection sites with approximately 5 U (Botox®and Xeomin®) or 15 U (Dysport®) in 0.1 ml saline solution each platysmal band as well as the jawline on both sides.
In some cases, more lateral wrinkles of the muscle are also treated with a few additional units of the toxin. The depressor anguli oris muscles are treated bilaterally with a single injection of approximately 2-5 U (Botox® and Xeomin®) or 6-15 U (Dysport®) in each muscle.
Pebble chin can be included in this technique. 5 units to the belly of the mentalis muscle will help relax a hyperactive chin.
Complications
| Complication | Number | Percentage |
|---|---|---|
| Ecchymosis/haematoma | 7 | 8.9% |
| Mild dysphagia | 4 | 5.2% |
| Neck weakness | 1 | 1.3% |
| Total | 12 | 15.4% |
If the treatment is too strong it may cause neck weakness on arising from bed or carrying out exercise.