No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Botulinum toxin for the treatment of neck lines and neck bands
Abstract
Rejuvenation of the aging neck with botulinum toxin injections is a minimally invasive, safe, and effective treatment modality with a very high patient satisfaction rate. Treatments are usually started early in the aging process of the neck to prevent further degenerative changes and are performed thereafter at 4- to 6-month intervals. It is the ideal alternative to rhytidectomy when the patient is too young for face-lift surgery or for patients unwilling to take recuperation time. Furthermore, botulinum toxin therapy can be used to correct jowl and platysmal band asymmetry occurring after suboptimal rhytidectomy. Botulinum exotoxin should not be used in pregnant or lactating women or in patients with a known sensitivity to human albumin or with a history of neuromuscular disorders.
... Various therapies are recommended for neck rejuvenation. [9][10][11][12][13][14][15][16][17][18] Ablative and nonablative laser treatments, microfocused ultrasound with visualization, radiofrequency, and plasma resurfacing are all effective at improving skin texture and neck laxity. [9][10][11]16,17 However, while they can tighten the skin, they do not reduce rhytides. ...
... [9][10][11]16,17 However, while they can tighten the skin, they do not reduce rhytides. Botulinum toxin type A injections effectively reduce platysmal bands, 15,18 but only marginally improve horizontal necklines. Skin excision, platysma plication, and liposuction can improve the neck contour, [12][13][14] but again, may have limited effects on horizontal necklines. ...
Horizontal neck wrinkles are a common aesthetic deficiency but limited treatment options exist and none have been studied with follow-ups of over 2 months.
Methods:
This dual-center, retrospective case series (Apr 2016-Jan 2017) included adult patients receiving CPM-HA to treat horizontal neck wrinkles. Patients were followed up for 40 weeks. CPM-HA treatment efficacy was evaluated through the Horizontal Neck Wrinkle Severity Scale and Global Aesthetic Improvement Scale (GAIS). Adverse events (AEs) and pain on injection, as assessed on the visual analogue scale, were documented.
Results:
Sixty-four lateral neck halves from 32 women (23-61 years) were analyzed. Significant improvement in wrinkle intensity, as assessed by Horizontal Neck Wrinkle Severity Scale, was observed from the second week onwards (1.352 ± 0.682, P<0.05). This improvement was sustained throughout the study duration and remained statistically significant at week 36 (1.423 ± 0.796, P<0.05). Patient GAIS (92.3%-100% through 36 weeks) and physician GAIS (100% through 24 weeks) were both excellent. Visual analogue scale scores revealed more pain associated with blunt cannula use (2.72 ± 1.71) than with sharp needle use (1.75 ± 1.39). AEs included erythema (62.5%), pruritus (43.7%), ecchymosis (43.7%), and localized swelling (25%).
Conclusions:
Subdermal injection of CPM-HA is safe and effective for treating horizontal neck wrinkles. Sustained improvement of wrinkle intensity up to 36 weeks and minimal AEs with no Tyndall effect were observed.
... H orizontal or transverse neck lines can occur at any age. 1 Neck lines may be associated with the deposition of submental and subplatysmal fat, and they are exacerbated by age-related decreases in elasticity and thickness of the skin of the neck, combined with gravity and the downward pull of the platysma muscle. [2][3][4] Horizontal neck lines may be treated with botulinum toxin Type A in cases where the lines are clearly caused by the activity of the platysma muscles, [3][4][5] although some groups report having little success with this approach. 6 Use of injectable filler for the treatment of horizontal neck lines has been reported in one case study 1 and in a prospective single-center study in combination with other therapies. ...
... 23 Kappa scores within the range of 0.0 to 0.20 indicate slight agreement, 0.21 to 0.40 indicate fair agreement, 0.41 to 0.60 indicate moderate agreement, 0.61 to 0.80 indicate substantial agreement, and 0.81 to 1.00 indicate almost perfect agreement. 24 Interrater agreement was measured by determining the intraclass correlation coefficient (ICC [2,1]) and 95% CIs calculated using the formula described by Shrout and Fleiss. 25 The a priori primary end point for the interrater agreement analysis was ICC (2,1) for the second rating session. ...
Background:
A validated scale is needed for objective and reproducible comparisons of horizontal neck lines before and after treatment in practice and clinical studies.
Objective:
To describe the development and validation of the 5-point photonumeric Allergan Transverse Neck Lines Scale.
Methods:
The Allergan Transverse Neck Lines Scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each scale grade. The clinical significance of a 1-point score difference was evaluated in a review of multiple image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject rating validation study (N = 297) completed during 2 sessions occurring 3 weeks apart.
Results:
A difference of ≥1 point on the scale was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 1.22 [1.09-1.35] for clinically different image pairs and 0.57 [0.42-0.72] for not clinically different pairs). Intrarater agreement between the 2 live-subject rating validation sessions was substantial (mean weighted kappa = 0.78). Interrater agreement was substantial during the second rating session (0.73, primary end point).
Conclusion:
The Allergan Transverse Neck Lines Scale is a validated and reliable scale for rating of severity of neck lines.
... Concurrently, platysma engages along with forehead muscles to lower eyebrows in displeasure. Botox temporarily paralyzes specific overacting muscles for tailored cosmetic outcomes (Brandt and Boker 2004). Understanding functional interplay aids in reconstruction after paralysis or trauma. ...
This chapter comprehensively reviews the chin soft tissue anatomy, highlighting its importance for maxillofacial surgeons. It begins with an overview of the anatomical landmarks and regions of the chin, followed by a discussion of the embryological development and developmental influences on chin morphology. The chapter then delves into the specifics of the cutaneous layers, subcutaneous tissues, and fat compartments, as well as the age-related changes in chin skin. The musculature of the mental region is described in detail, including the mentalis, depressor labii inferioris, depressor anguli oris, platysma, and orbicularis oris muscles, along with their functional anatomy and interactions with soft tissues. The neurovascular structures, including arterial supply, venous drainage, innervation, and lymphatic drainage, are also explored, emphasizing their clinical relevance in surgical procedures. The fascial and ligamentous structures, such as the superficial and deep fascial layers and mandibular ligaments, are discussed concerning their role in facial aesthetics. The chapter also covers anatomical variations and gender differences in soft tissue thickness, chin anatomy, and ethnic variations. The impact of aging on chin soft tissues, including changes in soft tissue composition, the impact of bone resorption, and soft tissue ptosis, is addressed, along with their surgical implications. Finally, the chapter concludes with clinical implications and surgical considerations, such as techniques for the chin area and potential complications associated with chin surgery. Understanding the anatomy of the chin’s soft tissues is crucial for maxillofacial surgeons to achieve optimal functional and aesthetic outcomes while minimizing complications.
... Conversely, the term "cosmetic" refers to practices or interventions that modify the physical appearance, specifically concerning prosthetic devices (Brown 2016). BoNT/A is a highly regarded aesthetic procedure that effectively improves facial attractiveness in various indications, including facial wrinkle reduction, eyebrow lifting, gummy smile reduction, jawline contouring, and neckband wrinkle reduction (Jaspers et al. 2011;Polo 2008;Brandt and Boker 2004;Wu 2010). ...
Hemifacial spasm (HFS) represents a challenging cranial movement disorder primarily affecting the facial nerve innervated muscles, with significant prevalence among Asians. Botulinum toxin type A (BoNT/A) injections, established as a primary therapeutic intervention since FDA approval, offer considerable effectiveness in alleviating spasms, albeit accompanied by challenges such as temporary effects and potential adverse events including facial asymmetry. This comprehensive review underscores the crucial need for harmonising neurological benefits and aesthetic outcomes in HFS management. The discussion delves into the interplay between facial aesthetics and neurological objectives in BoNT/A injections, emphasising precise techniques, dosages, and site considerations. Distinct aspects in neurological and aesthetic domains are also examined, including detailing the targeted muscles and injection methodologies for optimal therapeutic and aesthetic results. Importantly, evidence regarding various BoNT/A formulations, recommendations, and reconstitution guidelines in both neurology and aesthetics contexts are provided, along with a schematic approach outlining the stepwise process for BoNT/A injection in HFS treatment, addressing critical areas such as orbicularis oculi muscle sites, eyebrow correction strategies, mid- and lower-face considerations, contralateral injection sites, and post-injection follow-up and complication management. By highlighting the culmination of neurological efficacy and facial esthetics in BoNT/A treatment for HFS patients, this review proposes a holistic paradigm to achieve balanced symptomatic relief and natural aesthetic expression, ultimately enhancing quality of life for individuals grappling with HFS.
... Although there are other treatment options for the neck, HA filler remains the obvious choice for horizontal neck lines given the limited downtime, minimal side effects, ease of treatment, cost, and efficacy. Most other treatments require multiple sessions for modest improvements [1][2][3][4] or are too dangerous to perform on the neck, such as deep ablative full-field laser resurfacing. 5,6 Although HA for neck lines has gained popularity, the long-term safety and efficacy of HA fillers have only been studied extensively on certain areas on the face; long-term data regarding neck treatments is lacking. ...
BACKGROUND
The long-term efficacy and safety of hyaluronic acid fillers injected into the neck have yet to be analyzed in a prospective trial in the United States.
OBJECTIVE
Analyze the long-term efficacy and safety of a hyaluronic acid filler for static horizontal neck rhytids.
MATERIALS AND METHODS
Twenty-six subjects were enrolled in the study. Six subjects were randomized to receive saline and 20 subjects were randomized to receive HA RR. All subjects were randomized to use a cannula on 1 side and needle on the other with optional retreatment on day 30 and optional crossover treatment with different assignment on day 60. The subjects were graded using the Transverse Neck Line Scale, Canfield photography, and the Global Aesthetic Improvement Scale on day 360.
RESULTS
A significant improvement from baseline on day 360 was achieved on the Transverse Neck Line Scale according to the blind evaluator, subjects, and investigator without any delayed-onset or prolonged side effects. There was no significant difference in the average improvement from the short-term analysis on day 60 to the long-term analysis on day 360.
CONCLUSION
HA RR achieved significant long-term improvement in static horizontal neck rhytids without any long-term side effects.
... Multimodal approaches to treating neck and jawline aging have been published, and common treatments include surgical and nonsurgical methods. 6 Non-surgical treatments involve intense pulsed light (IPL) to improve mottled dyspigmentation, 8 microfocused ultrasound with visualization (MFU-V) to address mild to moderate laxity of the jawline or neck area, 9 thermistor-controlled subsurface monopolar radiofrequency (SMRF) to improve neck skin laxity, 10 botulinum toxin for the treatment of neck lines, 11 and cryolipolysis, a non-invasive method to treat submental fat, 8 as well as deoxycholic acid injection for submental fat reduction. 12 A combination of these treatments is typically needed for optimal results. ...
Background:
Aging of neck and jawline skin is caused by intrinsic and extrinsic factors and is evidenced by wrinkling, laxity, skin dyspigmentation, loss of the mandibular contour, accumulation of submental fat, density loss, and prominent platysma bands. Early intervention with topical cosmeceuticals, especially in younger subjects with "tech neck," can offer a solution and potentially mitigate aging of the neck and jawline.
Aim:
The objective of this prospective, open-label, single-center clinical study was to assess the efficacy and tolerability of a topical anti-aging neck treatment (TNT) in a cohort of Chinese women with mild to moderate signs of aging on the neck and jawline.
Subjects/methods:
This study was approved by an ethics committee and involved healthy Chinese subjects. Thirty-five female subjects, 25-50 years old, with mild to moderate signs of aging of the neck and jawline were recruited. Subjects applied the TNT to the neck and jawline twice daily for 84 days. Long-term efficacy and tolerability, clinical photography, bioinstrumentation, and a self-assessment questionnaire were performed at baseline and post-baseline.
Results:
The TNT significantly improved horizontal neck fold lines and neck skin elasticity, hydration, gloss/radiance, and skin tone evenness post-baseline. Clinical photography and ultrasound corroborated these findings. The product was well perceived and well tolerated by subjects.
Conclusion:
This study demonstrated the TNT was effective against both extrinsic and intrinsic aging of the neck and jawline. The TNT provides a topical solution for Chinese women concerned with an aging appearance of the neck including "tech neck."
... With being aging, transverse wrinkles and platysma muscle bundle shaped belt gradually appeared in the neck, because of relaxation and contraction of the neck skin, elasticity reducing, gravity. 18 Transverse wrinkles in neck cause by loss of dermal matrix volume, in which collagen is in the majority, so injecting soft tissue fillers is the main idea to ameliorate the neck wrinkles. 19,20 Because of special anatomy, it is difficult to cure the neck wrinkles. ...
Objective:
To assess the effectiveness of injection of autologous keratin gel and fibroblast for neck aging as soft tissue filler.
Materials and methods:
Totally 30 volunteers received treatment of autologous keratin and fibroblast for neck wrinkles and 5 of them received hyaluronic acid (HA) treatment as control. Clinical features of the volunteers were collected at 1st, 3rd, 6th, 12th, and 24th months after treatment. The volunteers were independently assessed using Lemperle's methods at different time points.
Results:
The neck wrinkles ameliorated observably and no severe complications were reported after treatment. The effect and maintain time of autologous keratin and fibroblast were better than HA control.
Conclusion:
Autologous keratin and fibroblast as soft tissue filler is an effective treatment option for neck rejuvenation with long-term efficacy for reversing of skin aging.
... Platysma spasticity may be obvious from bands in the neck that deform the shape of the deep muscles and are worsened by fat that tends to accumulate in the subcutaneous plane. Successful treatment of platysmal bands may consist of the use of botulinum neurotoxin for mild bands, a myotomy, or cervical rhytidectomy [5][6][7][8][9][10]. Numerous procedures have been proposed for the treatment of the platysma, including muscle flaps, plications, resections, or composite flap translations. ...
Unlabelled:
Knowing the difficulties and limitations of surgery for rejuvenating the submental area during a cervicofacial rhytidectomy, we came up with the concept of the digastric corset, which is described in this article along with the surgical importance of the platysma, digastric and mylohyoid muscles based on anatomical dissections. A study of ten cadavers was conducted to describe precisely the limits of the submental area, the mandibular edge between the two Furnas ligaments, and the hyoid bone. Each anatomical item was dissected plane by plane: the skin, platysma, digastrics muscles, and mylohyoid muscle. The sliding of each muscle relative to the others was studied, photographed, and recorded. Feldman's corset technique was tested on two cadavers and a digastric corset was performed on eight cadavers. After suprahyoid fat lipectomy, we suture the digastric retaining ligaments to the mylohyoid muscles using a running suture, like a corset, then the platysma muscles are put aside on the median line followed by lateral platysma suspension. The different steps are presented and the results of 20 patients who underwent this procedure are presented after 1 year of follow-up. This study showed that the technique of a digastric corset anchored on the mylohyoid allows for one-step reconstruction of the floor of the mouth and a well-defined anterior cervical angle, a sign of a youthful-looking neck. This technique is indicated for difficult necks, when lateral repositioning of the platysma alone gives insufficient results.
Level of evidence iv:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
... Along with a desire to look younger is an even stronger desire to look "natural" and it is this fact that drives plastic surgeons to reinvent many of the traditional techniques for facial rejuvenation. Although photos in the media often show faces that appear surgically altered and unnatural, this can be readily avoided by utilizing hybrid surgical techniques supplemented by other non-surgical modalities such as Botox injections 1,2 and the use of various injectable fillers. ...
The premium that our society has placed on youthful appearance has driven an ever increasing number of patients to seek facial rejuvenation. As the demand for these procedures has increased so has the expectation that these procedures can be performed more safely while ultimately delivering a more natural appearance than has historically been possible. More focused (and often times less invasive) procedures have been developed to better serve the needs of our patients.
... Each band is grasped individually and held firmly between the thumb and index fingers. Injections are placed directly into the platysmal band at 1.0-to 1.5-cm intervals along the band, starting at the jawline and descending all the way to the clavicular border (32). Adverse reactions include neck weakness (manifested by difficulty lifting the head off a pillow from the decubital position), dysphonia and difficulty swallowing (18). ...
The purpose of this review is to update cosmetic dermatologists and surgeons on the latest information about botulinum toxin injections for the treatment of the face and neck and to provide a practical guide to effective and safe technique. We review indications, recommended doses and dilutions, storage recommendations and injection techniques.
Background
Botulinum toxin is widely used in aesthetic medicine, with numerous studies examining its efficacy and safety.
Objectives
This bibliometric analysis aims to describe research trends and assess the methodological quality of the highest-impact botulinum toxin research in aesthetic applications.
Methods
The authors of this study identified the 100 most-cited publications on botulinum toxin in aesthetics using Web of Science, covering all available journal years (from inception to October 2024). The Oxford Centre for Evidence-Based Medicine Level of Evidence (LOE) was used to assess the methodological quality of each study.
Results
The authors identified 1728 articles on the aesthetic uses of botulinum toxin, with the top 100 most-cited articles spanning from 1994 to 2021. The United States dominated the research landscape with 50 articles, followed by Canada (15). The University of California (United States) and the University of British Columbia (Canada) emerged as the top contributing institutions. Among journals, Dermatologic Surgery led in publication count, followed by Plastic and Reconstructive Surgery and Aesthetics Surgery Journal. Notably, Professors Jean Carruthers and Alastair Carruthers from Canada were the leading researchers, topping both publication count and citation metrics. Notably, more than half of the studies were classified as LOE 5 (Expert Opinion/Narrative Review).
Conclusions
This bibliometric analysis reveals a paucity of high-quality studies in the field of botulinum toxin in aesthetic medicine, with research predominantly concentrated in western countries. These findings highlight the need for more rigorous, evidence-based studies and increased global collaboration to advance the understanding and application of botulinum toxin in aesthetics.
Level of Evidence: 4 (Therapeutic)
Background
The emergence of horizontal neck wrinkles is increasingly becoming a focal point for both cosmetic professionals and clients. Various treatment approaches must be considered to address this issue effectively, owing to its diverse underlying causes. The study explores the potential of utilizing the Endolift laser in conjunction with nanofat injection as a viable treatment option.
Methods
Twenty patients with horizontal neck wrinkles involved in the study. Ten patients underwent treatment with a combination of Endolift laser and nanofat injection and 10 patients treated with nanofat injection alone. The participants were monitored for 6 months post‐treatment. Biometric measurements were utilized to assess outcomes, including changes in volume, depth, and area of the wrinkles, skin elasticity, as well as the diameter and density of the epidermis and dermis in the treated area. Skin improvement was evaluated by two independent dermatologists, who compared before and after photos in a blinded manner. Patient satisfaction levels were also documented.
Results
The Visioface analysis showed a notable decrease in neck wrinkle depth and area in both groups. However, the group receiving the combination treatment of Endolift laser and nanofat exhibited a significantly greater improvement compared to the group treated with nanofat alone. Skin ultrasonography results demonstrated an increase in thickness and density of the dermis and epidermis in both groups. Particularly, the group treated with Endolift laser‐nanofat displayed significant enhancements in dermis and epidermis density and thickness when contrasted with the nanofat‐only group. Analysis with Cutometer revealed a marked enhancement in skin elasticity in the Endolift‐nanofat treated group in comparison to the nanofat‐only treated group. Furthermore, in the Endolift‐nanofat treated group, a substantial majority (90%) of patients exhibited improvement. Patient evaluations highlighted significant distinctions between the two groups, with 95% of patients in the Endolift‐nanofat treated group demonstrating enhancement.
Conclusion
Both methods notably enhance horizontal neck wrinkles; nevertheless, the combination of endolift laser and nanofat seems to be more efficient for treating horizontal neck wrinkles.
Botulinum neurotoxin type A (BoNT/A) smooths out wrinkles in the upper face by relaxing the underlying muscles and thereby creating a more refreshed, alert appearance. The effects of BoNT/A on the lower face typically have a different purpose in addition to the above and is used to rejuvenate the face through lengthening the upper lip (gummy smile), smoothing the chin, reversing a downturned mouth, softening upper and/or lower lip lines, or relaxing neck bands. Although the effects are temporary, lasting approximately 3–4 months, consistent use can lead to longer-term benefits such as enhanced muscle memory and prevention of additional lines.
Treatment of the lower face and neck with BoNT/A is off-label and is considered an advanced technique. These areas can pose a challenge to the practitioner because of the function and complexity of the musculature in the lower face. It is recommended the novice injector become comfortable with injecting the upper face before delving into treating the lower face for these reasons. Patients who have lines, dimples, or other issues caused from muscle contraction or tension are candidates for neurotoxin treatment, and this chapter will discuss lower face treatment indications for BoNT/A.
Understanding facial structure and anatomy is invaluable for aesthetic practitioners to create an enhanced, more youthful look. Knowledge of facial anatomy is crucial to the art and science of aesthetic practice. Facial muscles, subcutaneous fat, bone, and skin all contribute to the shape and composition of the face.
Unnatural expression and facial shapes are avoided by understanding specific facial muscle function and effects of volume loss. Appropriate use of available modalities to rejuvenate facial features is an important aspect of aesthetic practice. Botulinum toxin/A (BoNT/A), dermal filler, and other technologies and treatments are examples of modalities used for facial rejuvenation.
Generally, the face tends to have similar aging processes across ethnicities. Over time, bone structure and underlying tissue changes contribute to the appearance of the face. Awareness of these changes will assist the practitioner in attaining the most desired outcome for patients.
Background:
Hyaluronic acid (HA) fillers have been studied extensively on the face; however, their safety and efficacy on the neck has not yet been evaluated in a prospective trial in the United States.
Objective:
Analyze the efficacy and safety of a HA filler for static horizontal neck rhytides using either a cannula or needle.
Materials and methods:
Twenty-six subjects were randomized to receive up to 1 mL of the HA filler Restylane Refyne (HARR, n = 20) or saline (n = 6) using a cannula on one side and a needle on the other with optional repeat treatment. Subjects were graded using the Transverse Neck Line Scale, Canfield photography, and the Global Aesthetic Improvement Scale.
Results:
A significant improvement 30 days after the last treatment was achieved on the Transverse Neck Line Scale when comparing HARR with saline according to the blind evaluator, subjects, and investigator without any significant side effects. In addition, the blind evaluator, subjects, and investigator rated the side of the neck injected with a needle as having significantly greater improvement than the cannula.
Conclusion:
The hyaluronic acid filler, Restylane Refyne, achieved significant improvement in static horizontal neck rhytides using either a cannula or needle without any serious side effects, although the needle was more effective.
Percebe-se que atualmente a busca de profissionais por profissionais que realizam harmonização facial está crescendo cada vez mais e consequentemente o uso da toxina botulínica também, o que está levando a ser um tema bastante presente nos estudos e pesquisas entre os dentistas, mas um fator interessante que percebemos é que existe uma escassez em produções no seu uso em gestantes e a partir disto decidimos realizar uma pesquisa que tem como objetivo avaliar os estudos em relação ao uso da toxina botulínica em gestantes e lactantes, para isso decidimos fazer uma revisão de literatura, onde dentre os artigos encontrados, foram utilizados 30 artigos que tinham um caráter mais relevante para a produção desta pesquisa, o que nos fez perceber que devido a toxina botulínica ser um dos materiais mais usados, é necessário que exista um maior acervo de produções acadêmicas na sua aplicação em mulheres grávidas e lactantes, afim de evitar possíveis danos a mãe e ao feto.
Background
The aged and unattractive appearance of the neck has a profound impact on the overall youthfulness and attractiveness of the face. Neck wrinkles are one of the manifestations of neck skin aging. Botulinum toxin type A (BTX-A) represents an effective means for aesthetic neck rejuvenation as novel facial rejuvenation technologies are progressively developed.
Objectives
The objective of this article was to review the pertinent clinical literature for descriptions of BTX-A treatments and evaluations of their efficacy and safety for neck wrinkles.
Methods
The Web of Science, PubMed, EMBASE, Cochrane Library, and SCOPUS databases were searched from inception to April 30, 2020, for the existing literature, which are presented along with the authors’ experience with neck wrinkles.
Results
Overall, 112 women between 24 and 65 years of age were included, with 3 studies of monotherapy and 2 studies of multimodal combination therapy. BTX-A has been reported in combination with other approaches, including intensity focused ultrasound, cohesive polydensified matrix hyaluronic acid, and microfocused ultrasound. Only one of the three reports on monotherapy had less than a 50% satisfaction and improvement rate. Overall, BTX-A attained high patient satisfaction without serious and persistent side effects, notwithstanding the relatively limited sample size.
Conclusions
The existing research cannot strongly prove its aesthetic effect in neck wrinkles. However, BTX-A is probably an effective technology in response to the growing demand for neck wrinkle treatment, whether it is single treatment or combined treatment.
Understanding facial structure and anatomy is invaluable for aesthetic practitioners to create an enhanced, more youthful look. Knowledge of facial anatomy is crucial to the art and science of aesthetic practice. Facial muscles, subcutaneous fat, bone, and skin all contribute to the shape and composition of the face.
Botulinum neurotoxin type A (BoNT/A) smooths out wrinkles in the upper face by relaxing the underlying muscles and thereby creating a more refreshed, alert appearance. The effects of BoNT/A on the lower face typically have a different purpose in addition to the above and is used to rejuvenate the face through lengthening the upper lip (gummy smile), smoothing the chin, reversing a down-turned mouth, softening upper and/or lower lip lines, or relaxing neck bands. Although the effects are temporary, lasting approximately 3–4 months, consistent use can lead to longer term benefits such as enhanced muscle memory and prevention of additional lines.
Introduction
Neck skin aging is of particular interest to skin scientists and dermatologists because of the increasing demand for neck wrinkle improvement. This study aimed to determine the neck aging features of Chinese women and to investigate the clinical alterations and mechanical, topographical, and biophysical properties of neck skin.
Methods
A total of 450 Chinese women (age range: 16‐66 years) were clinically examined and graded by the same dermatologist using standardized photographs. The skin properties were assessed by noninvasive skin measuring devices.
Results
The results showed that different neck aging signs, including the horizontal neck fold, neck sagging, hollowing of emaciated neck, platysmal bands, and neck texture, appeared in different ages, and all of them worsened age‐dependently since they manifested. The skin elasticity markedly changed before the onset of most of the aging signs and showed a negative correlation with both age and the severity of these signs. Transepidermal water loss (TEWL) was positively correlated with age, whereas hydration and pH were not significantly correlated with age. We also found that wrinkles (SEw) and average roughness (Ra) were significantly correlated with age. SEw, smoothness, the average depth of roughness (Rz), TEWL, and erythema index were significantly and positively correlated with the severity of the horizontal neck fold, neck sagging, hollowing of emaciated neck, and platysmal bands.
Conclusion
This is the first study to emphasize that age causes diverse changes in Chinese women's neck skin. The changes in skin elasticity may effectively predict neck aging before the onset of most of the neck aging signs.
Background:
There is an increasing trend shifting the esthetic focus downward from the face with a significant number of new treatments aimed at the aging neck. Hyaluronic acid (HA) filler injection is widely performed into the horizontal neck lines in Korea, but there are few reports assessing its effectiveness.
Objective:
We aimed to evaluate the efficacy and safety of HA filler injection in the treatment of horizontal neck lines.
Patients and methods:
A retrospective chart review was performed on cases of horizontal neck lines treated with HA fillers. A total of 28 neck halves from 14 patients with Fitzpatrick skin types IV-V were included. All participants underwent a single treatment session with a 0.3 cc insulin syringe (31G×8 mm needle). Wrinkle assessment was conducted at baseline and 2 months after treatment. Two blinded physicians evaluated the improvement using a 5-point Global Aesthetic Improvement Scale (GAIS) (5-very much improved, 4-much improved, 3-improved, 2-no change, 1-worse) by comparing the pretreatment and post-treatment photographs. A questionnaire was used to evaluate patient satisfaction and the incidence of adverse reactions.
Results:
Among the 28 neck halves, 35.7% were treated with the linear threading technique (LTT) and 64.3% were treated with the vertical technique (VT). The average amount of filler injection per side was 1.01±0.13 cc. The GAIS score of the horizontal neck lines measured at the 2-month follow-up after filler injection was 4.04±0.79 (overall); the GAIS score of the horizontal neck lines was 3.60±0.70 with the LTT and 4.27±0.75 with the VT (P=.027). Complications, such as skin irregularity and accentuation of neck lines, were observed, but they were transient.
Conclusion:
Our preliminary study results indicate that HA filler injection with a 0.3 cc insulin syringe could be a safe and effective treatment option for horizontal neck lines.
In 2013, 13.4 million minimally invasive cosmetic procedures were performed in the USA, over 60 % of which were injectables such as botulinum toxin (BTX) and dermal fillers [1]. Botulinum toxin procedures alone accounted for almost 1.5 billion dollars spent on cosmetic procedures [2]. These types of aesthetic procedures are gaining popularity because of their relatively quick effects but shorter procedure and recovery time compared to incisional surgery. The overall complication rate of such procedures is low; however, knowledge of both complications and treatments are vital to a safe and successful cosmetic practice.
Botulinum toxin type A (BTX-A) is now extensively employed for cosmetic concerns. Upper face rejuvenation, including glabella frown lines and crow's feet lines, received FDA approval for cosmetic uses. However, other off-label uses for lower face conditions have been employed for texture and contouring purposes, including masseter hypertrophy and vertical banding of the neck. BTX-A for rejuvenation of the aging neck is an effective and popular treatment with high patient satisfaction rates. Alleviating the aging appearance of the neck by BTX-A is the result of denervation of hyperkinetic platysma. Concerning an extensive area of treatment and the relationship of treated muscles with other nearby muscles, dermatologists should be aware of potential adverse effects of the BTX-A injection. We herein present a case of dysphagia following botulinum toxin injection for the treatment of platysma bands.
Unlabelled:
Botulinum toxin is available as types A and B. These two different forms need different dosages and hence, the physician needs to be familiar with the formulations. A thorough knowledge of the anatomy and physiology of the muscles in the area to be injected is essential. INDICATIONS FOR BOTULINUM TOXIN: Dynamic wrinkles caused by persistent muscular contractions are the main aesthetic indications for the use of Botulinum toxin. These include forehead lines, glabellar lines, crow's feet, bunny lines, perioral wrinkles, and platysmal bands. Non-aesthetic indications include hyperhidrosis of the palms, soles and axillae. PHYSICIANS' QUALIFICATIONS: Any qualified dermatologist may practice the technique after receiving adequate training in the field. This may be obtained either during post-graduation or at any workshops dedicated to this subject.
Facility:
Botulinum toxin can be administered in the dermatologist's minor procedure room.
Preoperative counseling and informed consent:
Detailed counseling with respect to the treatment, desired effects, and longevity of the results should be discussed with the patient. The patient should be given brochures to study and adequate opportunity to seek information. A detailed consent form needs to be completed by the patient. The consent form should include the type of botulinum toxin, longevity expected and possible postoperative complications. Pre- and postoperative photography is recommended. Dosage depends on the area, muscle mass, gender and other factors outlined in these guidelines. It is recommended that beginners should focus on the basic indications in the upper third of the face and that they treat the middle and lower parts of the face only after garnering adequate experience.
The submental incision has traditionally been the standard method of access during anterior neck lifts. Visible scarring and/or tethering of the scar to underlying structures were possible untoward effects of such incision. Furthermore, difficult access to the neck structures through such a small incision necessitated strong skin traction, which was traumatic to the sensitive neck skin, leading to annoying bruising, rippling and sometimes puckering. Difficult hemostasis was an additional nuisance. Last but not least, access to deeper neck structures such as the investing fascia of the neck -which may need tightening during a neck lift-was a practical impossibility. For all such reasons, we sought to find an alternative access route, and to that purpose used the intra-oral approach in fifteen successive neck lifts. This novel route of access has several advantages: avoiding the submental incision with all its possible afore-mentioned potential risks, offering easier access to the platyzma. This enables more perfect plication and fixation to the hyoid, reducing traction and subsequent trauma to neck skin leading to practically negligible swelling, bruising, dimpling or puckering. Last but not least a more anatomic repair is achieved since lax investing fascia of the neck could be tightened, which is an additional reinforcement to the neck lift.We recommend this novel route of access for neck lift surgery, and introduce it as an additional tool that may add to the armature of the plastic surgeon.
The author of this article uses the pulsed ablative CO2 laser for resurfacing of the neck and face, based on the gold standard status of the CO2 laser and a novel post-treatment plan that greatly reduces adverse effects traditionally associated with fully ablative resurfacing. The croton oil peel is an inexpensive and effective modality for rejuvenating neck skin. The use of either technique as an adjunct to neck lift surgery, with or without facelift surgery, permits surgeons to fulfill the expectations of patients who want the skin of their face and neck to be homogeneous and more attractive.
Botulinum toxin (BoNTA) has become the modern generation's treatment of choice for facial aging. Advanced uses of neurotoxin have treated specific areas of the face, in addition to the glabella, which is the only site for injection approved by the Food and Drug Administration. This article suggests that BoNTA has replaced surgical procedures that treat oral commissures, mild brow ptosis and brow asymmetries, and hypertrophic orbicularis oculi muscles. It is becoming increasingly used for lip asymmetry, platysmal banding, and necklift, although it has not replaced traditional procedures for the correction of these areas.
The aging neck is accompanied by an increase in submental fat, platysmal banding, and redundant dyspigmented skin. Creating a more acute cervicomental angle, distinct mandibular border, homogeneous skin tone, and smoother texture helps to achieve a more youthful appearance. The aesthetic provider's armamentarium has long had surgical techniques in the highest regard, but a new wave of minimally invasive procedures looks to offer a nonsurgical approach to cervicomental rejuvenation. Selecting the appropriate procedure for appropriate patients that will effectively meet their aesthetic goals and expectations is the core of successful neck rejuvenation.
Background:
Marked platysmal bands in the neck are an unwelcome sign of aging. Botulinum neurotoxin type A has been used successfully to treat this indication, but there is a need for a validated tool for accurate assessment of dynamic platysmal bands to evaluate treatment efficacy objectively.
Objective:
To develop a scale for objective assessment of dynamic platysmal bands and to validate its use in the clinical setting.
Methods:
A new 5-point photonumeric assessment scale for platysmal bands was developed. Ten experts experienced in aesthetic dermatology used the scale to rate frontal and lateral neck photographs of 50 subjects in two separate validation cycles. Inter- and intrarater reliability of the scale was assessed.
Results:
The scale comprises five ratings of platysmal band severity ranging from 0 (no relevant prominence of platysmal bands) to 4 (very severe prominence of platysmal bands). Interrater reliability was "almost perfect," with intraclass correlation coefficients of 0.81 for the first validation cycle and 0.82 for the second. Mean intrarater reliability was also high (0.89), with Pearson correlation coefficients ranging between 0.87 and 0.91.
Conclusion:
The new 5-point dynamic platysmal band photonumeric assessment scale is a valuable tool for use in the aesthetic clinical setting.
Botulinum toxin (BT) represents one of the latest and most revolutionary treatments in facial rejuvenation. The cosmetic use of BT in the upper third of the face began in the late 1980s and gradually advanced to applications in the mid and lower face, neck and other areas of the body. Currently, more accurate techniques and the adjunctive use of BT allow physicians more precise applications, with significantly improved, more natural-looking results. Every year, the discoveries of many new clinical and cosmetic uses of BT continue to show the utility and versatility of this therapeutic modality, both in dermatology and in other specialized areas of medicine.
In minute doses, purified BTX-A injected into facial muscles causes temporary chemodenervation. Partial or complete paralysis
of selected muscles of facial expression reduces hyperdynamic wrinkles, improves the position or shape of the brow and mouth,
and even contours the face. There are discussions on the mechanisms of action of botulinum toxin, clinical effects, anatomy,
indications, facial assessment, and general techniques.
Onabotulinumtoxin A has been used for many years in the aging face treatment. A survey was organized to identify current practices in France.
To develop consensual recommendations for treating aging lower face and neck with onabotulinumtoxin A.
Fifty-seven participants to six regional surveys reviewed practices and techniques for each individual treatment indication. From conference summaries and data from a questionnaire, consensual recommendations were developed.
General considerations, key treatment rules, injection specifics (dose, site, and techniques), associated procedures/treatments, and procedure follow-up were defined by indication, i.e., nasolabial angle, nasal tip repositioning, dilated nostrils, lips and perioral area, Marionette lines and depressor anguli oris, gingival smile, risorius and zygomatic perioral muscles, masseters, chin, and platysma. For the consensus participants, current onabotulinumtoxin A use is a global preventive and corrective treatment. Overall, judicious treatment of multiple sites and adjunctive modalities, such as fillers, peels, and laser, leads to satisfactory results with a youthful, harmonious, animated, and natural-looking face.
Years of experience using onabotulinumtoxin A result in sophisticated treatment approaches, more specific targeted injections, and better understanding of lower facial and neck aging, leading to satisfying therapeutic results for patients and clinicians.
Neck wrinkles are common, troublesome aesthetic deformities for which a limited number of treatments exist. Although previous study has demonstrated the safety and efficacy of subdermal minimal surgery technology in treatment of acne scarring, this technology has never been applied to treatment of wrinkles.
To evaluate the efficacy and safety of subdermal minimal surgery technology in the treatment of horizontal neck wrinkles.
All 12 enrolled participants were Koreans (Fitzpatrick skin types II-IV) with horizontal neck wrinkles. Participants underwent up to four sessions of treatment with subdermal minimal surgery technology at 4-week intervals. Wrinkle assessments were conducted at baseline and 2 months after the final treatment session. Participants and physicians evaluated improvement using pre- and post-treatment photographs.
All participants completed the study. Improvement of wrinkling by at least 50% was observed at 6 months (2 months after the final treatment session) in more than half of the participants, as determined according to physician and participant evaluation.
Findings from this preliminary study demonstrate that use of subdermal minimal surgery technology results in an effective decrease of the appearance of neck wrinkles.
Botulinum toxin A has a wide variety of clinical applications in medical and dermatologic sciences. Nowadays, researchers introduce some other indications for botulinum toxin in cosmetic and especially noncosmetic aspects of dermatology such as medical rhinoplasty, hypertrophic scar, chemical brow lift, supraciliary wrinkles, pompholix, eccrine angiomatosis, Hailey-Hailey, dermatochalasis, lichen simplex, nosthalgia parestetica, and granulosis rubra nasi. In this general overview of the use of botulinum toxin in dermatology, an extensive literature search was carried out to updates of all dermatology-oriented experiments and clinical trials on the mentioned aspect of botulinum toxin.
Aesthetic improvement of the neck and cervicomental angle remains one of the most challenging aspects of surgical facial rejuvenation. Individuals may become dissatisfied with the appearance of their neck because of changes in skin quality, submental fat, and muscle tone or anatomic position related to aging, weight gain, weight loss, sun damage, and other causes. To achieve the patient's desired result, surgeons use various techniques, either in isolation or in combination. Careful preoperative evaluation of the patient's anatomy dictates the most appropriate procedure, ranging from laser skin resurfacing to sub-superficial muscular aponeurotic system (sub-SMAS) rhytidectomy with an extended platysmaplasty. This article reviews the techniques that are available and the decision-making process in choosing the appropriate technique for the individual patient.
In dermatology, botulinum toxin is now most often used to reduce dynamic facial creases and treat primary focal hyperhidrosis. The exemplary safety record of this medication is such that after nearly 2 decades, it is not known to have any long-term adverse events. Transient adverse events, such as mild injection pain, are typically minor and spontaneously remitting. Headache, nausea and flu-like symptoms, lid and brow ptosis after upper face injection, lower face asymmetry after perioral injection, and fine motor impairment after palmar injection are uncommon to rare. Understanding of anatomic landmarks and site-specific precautions can further mitigate the incidence of unwanted effects. Patients who do experience uncommon, transient effects can be reassured that these are not dangerous and will resolve completely without intervention.
The differences between intrinsic aging and photoaging are reviewed. The various model systems currently employed for the studies of aging and photoaging are discussed. Findings on age associated decrements in receptor/ligand mediated signaling as well as changes during cellular senescence in the expression of nuclear transcription factors are described. The role of telomere shortening and oxidative damage in the aging process is explained. At the cellular level, genetic and behavioral differences between aging and photoaging are illustrated with particular emphasis on changes in the structure and function of the tumor suppressor gene p53.
Cutaneous aging is a complex biological phenomenon consisting of two distinct components, (a) the intrinsic, genetically determined degenerative aging processes and (b) extrinsic aging due to exposure to the environment, also known as "photoaging". These two processes are superimposed in the sun-exposed areas of skin, with profound effects on the biology of cellular and structural elements of the skin. This overview summarizes our current understanding of the mechanisms of innate versus extrinsic aging with emphasis on connective tissue alterations, primarily collagen and the elastic fiber network. We also introduce a novel transgenic mouse model, expressing a human elastin promoter-reporter gene construct, suitable for studies on biology and preventive pharmacology of the cutaneous aging.
Skin cancer incidence is clearly linked to UV irradiation and increases exponentially with age. We studied the rate of removal of thymine dimers and (6-4) photoproducts in UV-irradiated human dermal fibroblasts derived from donors of different ages. There was a significant decrease with aging in the repair rates of both thymine dimers and (6-4) photoproducts (P<0.001). In addition, there was an age-associated decrease in the protein levels of ERCC3, PCNA, RPA, XPA, and p53 that participate in nucleotide excision repair. Moreover, the mRNA levels of XPA, ERCC3, and PCNA were significantly reduced with aging, suggesting that these decreases are often regulated at the mRNA level. Furthermore, with age induction of p53 after UV irradiation was significantly reduced. Taken together, our data suggest that the age-associated decrease in the repair of UV-induced DNA damage results at least in part from decreased levels of proteins that participate in the repair process.
The anatomical basis for some common anterior neck deformities, the key to which is the presence or absence of decussation of the platysma muscles at the midline, is described. A plea is made to be specific in describing these deformities, and to approach corrective surgery anatomically.
Clinically detectable, age-associated cutaneous changes result from two independent processes: chronologic aging and actinic irradiation. Several lines of evidence suggest that these two processes have different biologic, biochemical, and molecular mechanisms. This review summarizes the current understanding of age-associated alterations in the biochemistry and molecular biology of the extracellular matrix.
Cutaneous aging represents a complex situation in which at least two independent factors--innate aging and solar exposure--contribute to the development of degenerative changes in the dermis. The biochemical and ultrastructural evidence reviewed in this article indicates that reduced collagen deposition, as a result of diminished collagen biosynthesis and reduced proliferative capacity of the fibroblasts, could explain the development of dermal atrophy and would relate to poor wound healing in the elderly. At the same time, perturbations in the supramolecular organization of the elastic fiber network lead to alterations in the mechanical properties of the skin, as manifested by loose and sagging skin with reduced resilience and elasticity.
We measured serum antibodies to botulinum toxin (ABT) in 96 patients with focal dystonia who had been treated with type A botulinum toxin. The frequency of detectable ABT was 3% (three patients). Patients with ABT had received more than 50 ng of botulinum toxin, and the shortest time between two injections was significantly less than in patients without ABT. The clinical evolution of the three patients was heterogeneous: one had decreased effectiveness with repeated injections, another had persistent improvement, and the third never responded to toxin injections.
The use of botulinum toxin for facial rhytides has become more popular. In the past, plastic surgery was the only choice for rejuvenation of the aging neck. We discuss the cosmetic use of botulinum toxin for the rejuvenation of the neck and review the anatomy.
We will review the four age-related neck degeneration categories and discuss how to inject botulinum A exotoxin into the platysmal neck bands.
We will discuss how botulinum can tighten neck jowls, eliminate horizontal neck rhytides, and improve skin laxity.
Botulinum A exotoxin is a safe, effective, alternative treatment for rejuvenation of the aging neck and lower face. Patients are uniformly satisfied and complications are minimal.
The popularity of submental suctioning, platysmaplasty neck lifts, and now Botulinum A exotoxin injections into the neck has increased dramatically. A detailed working knowledge of clinical platysma and lip depressor muscle anatomy is of paramount importance to successfully anesthetize and block the treated areas, to avoid injury to important vessels, nerves, and deeper cervical structures, and to optimally treat the problem areas. A simple, user-friendly knowledge can be obtained by remembering simple mnemonics relating to (1) specific target areas, (2) anatomic relationships, and (3) topographic clinical landmarks.
The superficial musculoaponeurotic system (SMAS) platysma rotation flap with platysmal transection from the deep surface has been the author's face-lift technique to correct jowls, submental laxity, and platysma bands since 1982. An outcome study of 10 consecutive face-lift operations is presented to demonstrate the efficacy of correction of lower face and neck aging and the duration of the improvement. Reappearance of platysma bands has been the earliest and most frequent sign of recurrent aging changes. A technique for directly dealing with platysma bands in the submental and cervicomental location is described, and follow-up results up to 3 years are shown.
Since the 1970s, surgical procedures on platysma muscle, aiming to achieve better results in face lifting, became popular and turned out to be an important surgical step for the plastic surgeon. Many plastic surgeons have contributed to the topic throughout these years, as several articles on the subject have been published. Articles dealing with platysma muscle still bring great interest among plastic surgeons. My concern with platysma muscle began in the mid-1970s and since then has grown continuously. I have steadily been studying the importance of the platysma muscle in the surgeries for facial rejuvenation, involving its anatomy, the techniques proposed, the results obtained, the recommendations for the best surgical procedure for each patient, and the complications. My experience and studies regarding platysma muscle, and the contributions I have brought into this field, are thoroughly described and discussed in this article.
There is increasing evidence that longwave ultraviolet (UV) radiation (UVA; 320-400 nm) plays an important role in the pathogenesis of photodermatoses such as polymorphous light eruption as well as photoaging. In order to fully understand these detrimental effects it is critical to analyze the photobiological and molecular mechanisms by which UVA radiation affects the function of human skin cells. In this review, our current knowledge about the signal transduction pathway involved in UVA radiation-induced expression of proinflammatory genes relevant to the pathogenesis of polymorphous light eruption will be summarized. In addition, recent studies on the role of mitochondrial DNA mutations in UVA radiation-induced photoaging of human skin will be discussed. For both biological endpoints the UVA radiation-induced generation of singlet oxygen within human skin appears to be of critical importance. These studies are of enormous clinical relevance because they indicate that prevention of the generation of singlet oxygen or inhibition of singlet oxygen-induced signaling pathways may prove to be critical for effective protection of human skin against UVA radiation-induced damage.
We have used blunt liposuction for removing excess fat from the neck and jowls since 1983 with generally good results and few complications. Under local anesthesia with Valium and ketamine sedation and the use of the super-wet technique, and by using special precautions to avoid the complications of prominent platysmal bands, wrinkling of the neck, and salivary gland prominence, carefully performed liposuction to the neck and jowls has been shown to be a safe and dependable procedure with good results, and may delay or obviate the need for a facelift.
The major forces responsible for facial aging include gravity, soft tissue maturation, skeletal remodeling, muscular facial activity, and solar changes. This article discusses the anatomy and pathophysiology of facial aging by defining the affects of the aging process on the skeletal structure, skin, and musculature. How these changes affect the upper, mid, and lower thirds of the aging face is then examined.