Platysmal Botulinum Toxin A Injections for Cosmetic Purposes

Introduction: Chemodenervation with botulinum toxin A is the cornerstone of minimally invasive upper facial rejuvenation. Although the safety and efficacy of botulinum toxin A in the upper face has been extensively documented, its efficacy in the platysma muscle for cosmetic enhancement remains controversial. The mimic muscle with the largest surface—the platysma—has complex actions and considerable natural variation. The platysma muscle contributes to different characteristics of aging of the décolleté and neck areas, as well as the inferior portion of the lower face.

Objectives: This study aims to (1) review the contribution of the platysma in the aging process, (2) to address the use of botulinum toxin A injections into the platysma muscle for rejuvenation, and (3) to illustrate its use in individual author examples.

Data Synthesis: The platysma contributes to different characteristics of aging aspects such as platysma bands, horizontal neck lines, décolleté wrinkles, upward turn of the corner of the mouth, and loss of jawline definition. A review on how to treat the platysma including indications, doses, points of injection, results, and complications is described in this article.

Conclusion: Most articles evaluated treatment of platysma bands successfully with botulinum toxin A mostly in two situations: (1) older patients who had prior surgery and (2) younger patients. More studies are necessary to clarify the efficacy of botulinum toxin A to improve jawline definition and to treat décolleté and horizontal necklace lines.