What is the recommended dose of Botox (Botulinum toxin) for platysmal band release?

Botox Dosing for Platysmal Band Release

For mild to moderate platysmal bands, inject 15-20 units of onabotulinumtoxinA (Botox) per band, with a maximum total dose of 100 units, using a standardized injection technique that targets the medial border of each band at multiple points along its length. 1

Dose Recommendations by Severity

Mild to Moderate Bands (Type II-III)

• 15-20 units of onabotulinumtoxinA per band is the standard dose that achieves optimal efficacy with minimal complications 1
• Maximum total dose should not exceed 100 units across all bands 2
• This dosing achieved a 93.7% response rate at 2 weeks and 86% response rate at 3 months in systematic review data 1

Moderate to Severe Bands (Type III-IV)

• For abobotulinumtoxinA (Dysport), use 120-180 units total in a two-stage approach 3
• The higher 180-unit dose demonstrated superior grade improvement (≥2 grades) and longer duration of effect compared to 120 units 3
• Optional 90-unit touch-up can be performed if initial response is suboptimal 3

Injection Technique

The standardized approach involves:

• Inject along the medial border of each visible platysmal band 1
• Use multiple injection points spaced 1-2 cm apart along the length of each band 1
• Inject superficially into the platysma muscle itself, avoiding deeper structures 2
• For abobotulinumtoxinA, use the more concentrated on-label reconstitution (1.5 mL/300 units) to minimize volume and reduce diffusion risk 3

Critical Safety Considerations

Dysphagia risk exists even at conservative doses:

• Dysphagia has been reported with doses as low as 60 units of abobotulinumtoxinA (equivalent to 20 units onabotulinumtoxinA) 2
• The mechanism may involve diffusion to underlying deglutition muscles, larynx, or neck flexors 2
• Risk factors include injection technique errors, intravascular injection, or inadvertent deeper placement 2

Complication rates:

• Overall complication rate is 15.4%, with most being minor and self-limited 1
• Transient positional neck weakness can occur with higher doses but resolves spontaneously 3
• No cases of airway obstruction have been reported in aesthetic platysmal band treatment 4

Patient Selection Algorithm

Best candidates (Type II-III):

• Mild to moderate horizontal neck rhytids with thin to moderate platysma muscle bands 5
• Minimal to moderate skin laxity 5
• These patients achieve the highest satisfaction rates 5

Suboptimal candidates (Type IV):

• Severe skin laxity limits results regardless of muscle treatment 4, 5
• Botox does not provide any lifting effect of the lower face 4
• Surgical intervention should be considered for these patients 5

Duration and Retreatment

• All results are temporary, typically lasting 3-5 months 4, 1
• Repeat injections are necessary to maintain results 4
• Time to loss of effect is dose-dependent, with higher doses providing longer duration 3