Platysma Bands/ Nefertiti Lift
Despite advances in nonsurgical rejuvenation of the face, the aging neck remains a challenge to the aesthetic surgeon. Lipodystrophy, horizontal rhytides, thinning of the skin and subcutaneous tissues, underlying skeletal changes, blunting of the cervicomental angle, and tissue laxity are just a few of the components of the aging neck. Although many of these components require surgical techniques to address, there remains a role for nonsurgical rejuvenation of the aging neck with botulinum toxins. Static rhytides and lipodystrophy are not amenable to treatment with BTA, but vertical platysma banding and horizontal rhytides can be improved with chemodenervation. Furthermore, patients seeking improved contour and definition of the jawline have been successfully treated with chemodenervation of the lower face and neck.
The platysma is a broad, thin muscle that originates in the deltopectoral fascia and extends cephalad to insert along the inferior border of the mandible and the superficial musculoaponeurotic system of the lower face. These insertions make the platysma a powerful depressor of the lower face and mandible. Although classically depicted as a distinct muscle on either side of the anterior neck, fibres often decussate across the midline.
In patients looking to soften the appearance of their platysma bands but are not candidates for—or do not desire—a platysmaplasty, BTA injection to the platysma bands is a safe and effective procedure. Furthermore, techniques are available for those seeking improved contour of the mandibular border. The patient is asked to contract the platysma muscle, which can often be elicited by asking them to show the examiner their bottom teeth. This contraction allows the examiner to grasp each band between the thumb and index finger of the nondominant hand. Direct injections into the bands in 3 to 5 sites, at 2-cm intervals along the muscle are suggested. A significant variability in dosing has been reported in the literature, with consensus recommendations averaging 30 to 40 U of Botox and varying based on number of bands and muscle mass. On general, 2 Units of Botox per injection point is recommended, ensuring that the needle is not inserted too deep (about half a standard Botox needle on average) Care must be taken to inject specifically into the bands, in the deep dermal layer, as diffusion of toxin to the strap muscles or deeper muscles of the neck can cause dysphagia, dysphonia, dysarthria, or life-threatening breathing difficulties. The complications, although rare can be minimised by keeping the dose to less than 50 units per session. Toxin can also be used to sharpen the mandibular contour to elongate the appearance of the neck. This technique, the Nefertiti lift, is named for an Egyptian queen with a jawline considered to be ideal. Injections are directed into the platysma along the mandible and posterior platysma bands to better define the mandible-neck junction.
2 units of Botox per injection point.