What is the typical starting dose of Dysport (abobotulinumtoxinA) for the platysma muscle and for a Nefertiti lift?

Dysport Dosing for Platysma Muscle and Nefertiti Lift

For platysma bands, use 120-180 units of Dysport total, distributed across the visible bands using a two-stage injection technique with concentrated reconstitution (1.5 mL/300 units), with an optional 90-unit touch-up at 6 weeks if needed. 1

Dosing Protocol for Platysma Bands

Initial Treatment Doses

• 120 units of Dysport achieves 100% responder rate (grade 1-2 improvement) at 1 month during maximal contraction 1
• 180 units of Dysport achieves 90% responder rate with superior outcomes: more subjects achieve ≥2 grade improvement and longer duration of effect compared to 120 units 1
• The higher 180-unit dose provides better efficacy for moderate-to-severe platysmal banding without major adverse reactions when using concentrated reconstitution 1

Injection Technique Considerations

• Use the on-label concentration of 1.5 mL per 300 units (rather than more dilute preparations) to reduce injection volume and minimize spread to adjacent muscles like the deglutition muscles and larynx 1
• Employ a standardized two-stage injection technique: initial treatment followed by optional 90-unit touch-up at week 6 for non-responders 1
• Distribute the dose across clinically identified platysma bands based on the pattern of muscle contraction 1

Conversion to Other Botulinum Toxin Products

AbobotulinumtoxinA (Dysport) to OnabotulinumtoxinA (Botox) Conversion

• The conversion ratio is approximately 3:1 (Dysport:Botox) 2
• Therefore, 120-180 units of Dysport equals approximately 40-60 units of Botox
• Maximum recommended Botox dose for platysma has traditionally been 100 units to avoid diffusion complications 2

IncobotulinumtoxinA Dosing

• When using incobotulinumtoxin A, the maximum recommended dose is 20 IU per band 3
• This product was used in 62.3% of patients in systematic review data, demonstrating mean score improvement of 2.0 points at 2 weeks with 93.7% response rate 3

Safety Profile and Adverse Events

Common Side Effects

• Adverse events occur in approximately 15.4% of patients treated for platysma bands, with none requiring intervention in systematic review data 3
• Transient positional neck weakness can occur even with higher doses (180 units) but resolves spontaneously 1
• Mild to moderate dysphagia has been reported even with very low doses (60 units Dysport, equivalent to 20 units Botox), likely due to diffusion, injection technique, or intravascular injection 2

Risk Mitigation Strategies

• Using concentrated reconstitution (1.5 mL/300 units rather than more dilute preparations) reduces the risk of toxin spread to underlying deglutition muscles, larynx, and neck flexors 1
• Avoid injecting too deeply or too medially to prevent involvement of swallowing musculature 2
• Counsel patients about the possibility of dysphagia and neck weakness, even with conservative dosing 2

Duration of Effect and Retreatment

• Response duration varies but typically requires retreatment every 3-4 months based on clinical assessment 3
• At 3 months post-injection, mean score improvement of 1.2 points persists with 86% response rate 3
• The 180-unit dose demonstrates longer time to loss of grade 1-2 response compared to 120 units 1
• Patient-reported improvement occurs in 91% of subjects across multiple studies 3

Clinical Pitfalls to Avoid

• Do not use overly dilute preparations as this increases injection volume and risk of diffusion to adjacent structures 1
• Be aware that even "low" doses can cause dysphagia - the 60-unit Dysport case report demonstrates that no dose is completely without risk 2
• Do not assume non-response at 4 weeks is permanent - consider touch-up dosing at 6 weeks rather than immediate high-dose retreatment 1