This article is more than 5 years old. Information may no longer be current.

Botulinum toxin A shows efficacy in treating upper platysma area of lower face

Botulinum toxin A was effective at treating the upper platysma muscle area, showing that the area of the lower face can be safely modulated by neuromodulators, according to study results published in Dermatologic Surgery.

Ada R. T. de Almeida, MD, of the dermatologic clinic at Hospital do Servidor Pứblico Municipal de São Paulo, Brazil, and colleagues conducted a retrospective, open-label study of 161 patients (median age, 57.5 years; 142 women) who had loss of lower face contour, and/or lower face and upper neck wrinkles and lines, during lower face animation.  Patients who had neuromodulator treatments in the previous 120 days or who were planning in the upcoming month to have any procedure to improve lower face contour were ineligible for the study.

The researchers treated the lower face as a whole unit, with two sites of the mentalis muscle intramuscularly injected. This was followed by two horizontal lines of superficial botulinum toxin A above and below the mandible, including a total dose of 16 Botox (onabotulinumtoxinA, Allergan) per side. Xeomin (incobotulinumtoxinA, Merz Aesthetics) and Dysport (abobotulinumtoxinA, Ipsen) also were used in the study.

Photographs taken at rest and during motion were taken before injection and after treatment.

Three findings showing improvement included enhancement of lower facial contour; relaxation, and in some cases disappearance, of high horizontal parallel lines and wrinkles located below the lateral mandibular border; and relaxation and effacement of the lower vertical deep smile lines, located just behind the oral commissures. The third finding was most surprising, the researchers reported.

Adverse events include a heaviness sensation after treatment described by one patient and very mild unilateral reduction in the lower lip retraction in two other patients.

“The upper platysma muscle plays a relevant role in the functional anatomy of the lower face, acting as a major depressor that can be modulated by neuromodulators,” the researchers concluded. “When addressed in combination with other lower facial muscles as a whole complex, enhancement of lower facial contour and relaxation of dynamic wrinkles of the lower face will be achieved.” – by Bruce Thiel

Disclosure: De Almeida reports having been a consultant to Allergan and Merz and having participated in clinical trials for Allergan and Galderma. Please see the study for a full listing of the other researchers’ relevant financial disclosures.