Botulinum Toxin Treatment for Mild to Moderate Platysma Bands: A Systematic Review of Efficacy, Safety, and Injection Technique

Abstract

Background

Platysma bands are characteristic of an aging neck. Resection and plication of the platysma muscle is the basis of treatment. Yet, unfavorable surgical outcomes and improved understanding of platysma band etiology has shifted treatment towards nonsurgical rejuvenation.

Objective

Assesses efficacy, injection techniques, and complications associated with botulinum toxin injection for the treatment of platysma bands.

Methods

A systematic literature search was performed to identify articles reporting botulinum toxin injections for platysma bands in neck rejuvenation. The search included published articles in three electronic databases—Ovid MEDLINE, EMBASE, and the Cochrane Library—between January 1985 and December 2017.

Results

Three studies met the inclusion criteria, with a total of 78 patients undergoing botulinum toxin injection for platysma bands. Incobotulinumtoxin A (Xeomin®) was used in 62.3% (n=45/78) of patients, with 38.4% (n=30/78) having abobotulinumtoxin A (Dysport®). Efficacy was assessed using Merz platysma score scale (mean score and response rate-% patients responding to injections by at least one score). A mean score improvement of 2.0 points, with a response rate of 93.7% was observed after 14±2 days. At three months, mean score improvement was 1.2 points with response rate 86%. Patient-reported metrics demonstrated an improvement in 71/78 (91%) of subjects. There was a standard injection technique between studies, with a maximum 20IU of incobotulinumtoxin A and 5 U abobotulinumtoxin A used per band. Complications were reported in 12/78 (15.4%) patients, with none requiring further invention.

Conclusions

Botulinum toxin is highly effective treatment for isolated platysma bands. A safe injection technique is described and recommended for clinical practice.