What is the recommended treatment for platysmal bands using Botox (botulinum toxin)?

Botulinum Toxin Treatment for Platysmal Bands

Botulinum toxin A injection is the recommended first-line treatment for platysmal bands, with typical dosing of 10-20 units of onabotulinumtoxin A per band using a standardized injection technique to achieve temporary improvement lasting 3-6 months. 1

Treatment Protocol for Platysmal Bands

Dosing Guidelines

• OnabotulinumtoxinA (Botox): 10-20 units per band
• AbobotulinumtoxinA (Dysport): 30-60 units per band (using 3:1 conversion ratio) 2, 1
• IncobotulinumtoxinA (Xeomin): 10-20 units per band 1

Injection Technique

1. Patient positioning: Seated upright with neck slightly extended
2. Band identification: Ask patient to contract platysma by grimacing or tightening the neck
3. Marking: Identify and mark visible bands while muscles are contracted
4. Injection points: Space injections 1-2 cm apart along each band
5. Injection depth: Superficial intramuscular injection directly into the platysmal band
6. Total dose: Typically 40-60 units total for all bands (onabotulinumtoxinA) 3, 4, 1

Efficacy and Outcomes

• Response rate: 93.7% of patients show improvement within 14 days 1
• Duration of effect: 3-6 months (86% response rate at 3 months) 1
• Patient satisfaction: 91% of patients report improvement 1
• Limitations: Results are temporary and limited by skin redundancy 3

Safety Considerations and Complications

Common Side Effects (15.4% of patients) 1

• Pain at injection site
• Bruising/ecchymosis
• Hematoma formation

Serious but Rare Complications

• Dysphagia: Can occur even with low doses (reported with as little as 20 units equivalent of onabotulinumtoxinA) 2
• Neck weakness: Temporary difficulty holding head upright
• Asymmetry: Uneven results requiring touch-up

Risk Mitigation Strategies

1. Avoid excessive dosing: Stay below 100 units total (onabotulinumtoxinA) 2
2. Proper technique: Superficial injections to avoid diffusion to deeper structures
3. Cooling: Apply ice before and after injection to minimize bruising 5
4. Aspiration: Before injection to avoid intravascular administration
5. Patient selection: Assess skin laxity and band thickness to determine candidacy

Patient Selection Algorithm

1. Ideal candidates: Patients with visible platysmal bands but minimal skin laxity (Type I-II)
2. Good candidates: Moderate bands with moderate skin laxity (Type III)
3. Limited benefit: Severe skin laxity with redundant skin (Type IV) 4
4. Contraindications: Neuromuscular disorders, pregnancy, infection at injection site

Treatment Expectations

• Improvement in visible banding when neck is at rest and during animation
• No significant lifting of lower face or neck 3
• Temporary results requiring repeat treatments
• Progressive improvement with serial treatments

Follow-up Care

• Assess results at 2 weeks post-treatment
• Touch-up injections if asymmetry is present
• Maintenance treatments every 3-6 months
• Consider combination with other modalities for skin laxity

By following this protocol, clinicians can safely and effectively treat platysmal bands with botulinum toxin, providing significant aesthetic improvement with minimal risk of complications.