Platysma and the Nefertiti Lift®

19 Platysma and the Nefertiti Lift®






Introduction


Botulinum toxin type A (BoNT-A) is now extensively used for the upper face to correct wrinkling of the glabella, forehead, and periocular regions thereby promoting rejuvenation and postponing the need for surgical intervention. A more youthful and attractive appearance is achieved when fillers are combined with BoNT-A to smooth rhytides and eradicate deep folds in the upper and mid face, but the lower face and neck should not be ignored or there could be a risk of creating an aesthetic imbalance.


As clinicians gain experience and confidence with BoNT-A, they should consider treating areas of the lower face and neck. It is becoming commonplace to treat the depressor anguli oris, orbicularis oris, chin, masseter, and platysma. These indications have the main objective of ‘lifting’ lower face features, sharpening the jawline, and thus creating the clinical effect of a ‘mini-lift’.


Brandt & Bellman were the first to document their clinical use of BoNT-A for the aging neck. The aging process causes rhytides to appear on the neck and the skin to become increasingly slack. The authors observed that these effects diminished and appearance improved when BoNT-A was injected directly into the platysma muscle. They also noted an improvement in platysma bands that procured ‘an overall tightening of the neck and recontouring of the jawline’ even though their primary objective was not to improve facial contouring. High doses (50–100 units onabotulinum toxin A) were used, with some patients receiving as many as 200 units in one session. When 50–200 units were employed, adverse events such as muscle soreness, neck discomfort, mild neck weakness, and headaches were reported by patients. This rather expensive high-dose regimen translated into non-specific aesthetic improvements and an important array of possible unwanted side effects.


In this chapter we discuss how to use BoNT-A to treat vertical platysma bands and horizontal neck folds, and then we will focus on the ‘the Nefertiti Lift®’ – a ‘low-dose’ technique described in 2007 that restores a sharper and more defined jawline while lifting the corners of the mouth.



Mar 12, 2016 | Posted by in General Surgery | Comments Off on Platysma and the Nefertiti Lift®

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