19 Platysma and the Nefertiti Lift®
Summary and Key Features
• The platysma acts as a major depressor in the lower face
• Anterior and posterior platysma bands can be treated with a total of 10–30 units of onabotulinum toxin A (BoNT-A) in women and with a total of 10–40 units in men (3–5 injection sites per band)
• The Nefertiti Lift® uses BoNT-A to redefine and sharpen the jawline whilst helping to lift the corners of the mouth. Dosage is 15–20 units onabotulinum toxin A per side injected intradermally
• Complications such as dysphagia and dysphonia can be avoided if injections are intradermal, there is no excessive toxin migration, and the total dose per session does not exceed 40 units
• Asymmetric smile, a rare adverse event associated with the Nefertiti Lift®, can be prevented through precise dosing (maximum dose of 20 units onabotulinum toxin A or equivalent per side, per session) and accurate intradermal injection
• Poor candidates for the Nefertiti Lift® include: patients with excessive submental fat, heavy jowls, or poor downward pull of the platysma with no prominent posterior platysma band
• Excellent candidates for the Nefertiti Lift® include: patients with prominent posterior platysma band and disappearing jawline with platysma contraction
The platysma: anatomy and dynamic aesthetic clinical implications
The platysma is a large, flat cutaneous muscle stretching from the upper décolleté to the mid cheek. It originates inferiorly from the pectoralis and deltoid fascia. The fibers ascend upwards and at the mandible some fibers insert directly into bone under the mandible, its only bony insertion. The other fibers blend into the modiolus, the depressor anguli oris, the lower lip, the depressor labialis inferioris and mostly continue to ascend above the mandible where they blend into the SMAS (superficial muscular aponoretic system). In the midline of the neck the platysma is absent except when the fibers from each side decussate (intertwine) with the other side under the chin (Fig. 19.1).
Injection techniques for the neck
Vertical bands
After asking the patient to contract their platysma the practitioner should hold the band to be injected between the thumb and index finger. Deep intradermal injections of 2.5–5 units should be injected equidistantly in 3–7 sites per band. A maximum of 30 units for women and 40 units for men should be respected per session (Fig. 19.2).