What is the effect of neuromodulators like Botox (Botulinum Toxin) on platysmal bands?

Platysmal Bands and the Effect of Botulinum Toxin (Botox)

Botulinum toxin injections are highly effective for treating platysmal bands by causing flaccid muscular paralysis of the platysma muscle, resulting in temporary improvement of neck appearance with response rates over 90% and minimal side effects when properly administered. 1

What Are Platysmal Bands?

Platysmal bands are vertical bands in the neck that become more prominent with aging. They are formed by:

• Hypertrophic platysma muscle that becomes more visible with age
• Muscle flaccidity and skin laxity that occur over time
• Contraction of the platysma muscle during facial expressions

The severity of platysmal bands can be classified into four types based on:

• Horizontal neck rhytids (wrinkles)
• Thickness of platysma bands
• Degree of muscle flaccidity
• Amount of skin laxity 2

Mechanism of Botulinum Toxin on Platysmal Bands

Botulinum toxin works through:

1. Inhibition of acetylcholine release at the presynaptic neuromuscular junction 3
2. Induction of flaccid muscular paralysis in the targeted platysma muscle 3
3. Relaxation of the contracted platysma bands, reducing their visibility

Efficacy of Botulinum Toxin for Platysmal Bands

Research demonstrates:

• High response rates: 93.7% improvement after 14 days and 86% at 3 months 1
• Significant improvement: Mean score improvement of 2.0 points on the Merz platysma score scale initially, and 1.2 points at 3 months 1
• Patient satisfaction: 91% of patients report noticeable improvement 1
• Temporary results: All improvements are temporary, requiring repeat treatments 4

Injection Technique

Standard injection technique includes:

• Dosing: Maximum 20 IU of incobotulinumtoxinA or 5 U of abobotulinumtoxinA per band 1
• Technique: Direct injection into the platysma muscle bands
• Cooling: Cooling the skin before and after injection helps prevent pain, hematoma, and bruising 5
• Patient position: Keep patient upright for 3-4 hours post-injection to minimize complications 6

Potential Complications

While generally safe, potential complications include:

• Common minor effects: Pain, hematoma, ecchymosis, and bruising at injection sites 5
• Diffusion concerns: Botulinum toxin may spread beyond the injection site, particularly in the first 24-48 hours 6
• Dysphagia risk: Even low doses (equivalent to 20 units of onabotulinumtoxinA) can cause mild to moderate difficulty swallowing if the toxin diffuses to underlying deglutition muscles 7
• Respiratory complications: Rare but serious if respiratory muscles are affected 6
• No face lifting effect: While platysmal bands improve, there is no evidence of lifting of the lower face 4

Risk Management

To minimize complications:

• Use the minimum effective dose
• Apply precise injection technique
• Maintain proper patient positioning after treatment
• Have epinephrine and antihistamines available during administration (due to 1-2% risk of anaphylaxis) 6
• Be aware that results are limited by redundant skin 4

Patient Selection

Best candidates include:

• Patients with Type II (mild) and Type III (moderate) platysmal bands show the highest satisfaction rates 2
• The degree of muscle flaccidity and hypertrophy most influence success rates, not anatomic variations 2

Botulinum toxin offers an effective non-surgical alternative for platysmal band treatment with high satisfaction rates when properly administered, though patients should be informed of the temporary nature of results and potential risks.