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Posted: 6/28/2013

Editor's Note:
Botulinum neurotoxin type A products for aesthetic use are approved by the US Food and Drug Administration for the temporary improvement in the appearance of moderate to severe glabellar lines associated with procerus and corrugator muscle activity in adult patients younger than 65 years of age. Other uses are off label.


How are neurotoxins used to treat platysmal bands?

Response From James Spencer, MD
Professor of Clinical Dermatology,
Mount Sinai School of Medicine,
New York, New York;
Private Practice, Spencer Dermatology,
St. Petersburg, Florida

The platysma is a broad, sheet-like muscle extending from the collarbone, across the neck, and onto the cheeks. As we age, the muscle splits in the midline, creating bands. Neurotoxins can weaken the muscle in the area of the bands while leaving the upper portion intact. The upper portion is then unopposed and "pulls" up, improving the bands.

Recent consensus publications specify recommended dosing for the platysmal bands ranging from 30 units (of onabotulinumtoxinA) to as high as 60 units (expressed as dosage for the entire treatment, to be divided among all injection points).[1,2] Consensus guidance for the use of abobotulinumtoxinA suggests a dosing range of 30 to 120 units for the platysma (again, divided among all injection points).[3] Lower dosing is recommended for less-experienced injectors and for patients new to this treatment area. For any injector, use of the lowest effective dose is recommended to minimize the risk of adverse effects. Overdosing in this area can have significant adverse effects on patient quality of life, including neck weakness and difficulty swallowing. Patients should return for reassessment approximately 2 weeks following treatment, at which time they can receive additional injections if the initial result was not satisfactory.

When I inject the platysma, I have the patient activate the muscle to visualize the banding. For vertical platysmal banding, I grasp the band with my index finger and thumb and inject 2 to 5 units of onabotulinumtoxinA every 1 to 2 cm along the length of the band, with a maximum of 50 units injected in a single session.

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