The role of the platysma in lower facial and cervical aging: muscular rebalancing with botulinum toxin type A

Abstract

Introduction

The platysma muscle plays a fundamental role in the aging process of the lower third of the face and neck. Its hyperactivity contributes to the loss of mandibular definition, the appearance of vertical cervical bands, and the downward pull of the oral commissures.

Repeated contraction of the platysma exerts an “anti-lifting” effect by pulling facial tissues inferiorly, thereby aggravating cervical and mandibular laxity. Selective relaxation of this muscle through botulinum toxin injections can restore the balance between the elevator and depressor muscles of the face

Objective

To demonstrate the importance of the platysma muscle in lower facial and cervical aging and to highlight the benefits of its relaxation using Botulinum Toxin Type A.

Material and Methods

A clinical case report was conducted involving female patients presenting with signs of lower facial and cervical aging associated with platysma hyperactivity. Clinical assessment included facial analysis and standardized photographic documentation at rest and during maximal platysma contraction. Botulinum Toxin Type A (Vistabel®, Allergan) was reconstituted with 2 mL of saline solution (100 U/2 mL) and administered using a 30G needle. The treatment protocol included injections into the depressor anguli oris, upper platysma along the mandibular border, and visible cervical platysmal bands. Clinical outcomes were evaluated through comparison of pre- and post-treatment photographs and assessment of mandibular definition, cervical bands, oral commissure position, and dynamic neck wrinkles.

Clinical Case Description

Female patients presented with visible platysmal bands, loss of jawline definition, dynamic cervical rhytids, and downward displacement of the oral commissures. Clinical examination revealed marked platysma activity contributing to inferior traction of the lower facial tissues. Standardized photographs obtained during maximal muscle contraction demonstrated the combined action of the platysma and depressor anguli oris muscles. Following treatment with Botulinum Toxin Type A according to the established protocol, patients demonstrated improvement in jawline contour, reduction of cervical bands and neck wrinkles, attenuation of oral commissure depression, and an overall lifting effect of the lower third of the face. No significant adverse effects were reported. Discussion

Cervical and mandibular aging results not only from cutaneous laxity but also from platysma hyperactivity.

The concept of the Nefertiti Lift is based on the selective weakening of the platysma and lower facial depressor muscles, promoting improvement of the jawline and cervical rejuvenation.

Conclusion

The platysma plays a central role in the aging of the lower third of the face and neck.

Selective relaxation of this muscle with Botulinum Toxin Type A represents a minimally invasive, effective, and safe approach for improving jawline definition, reducing cervical bands, softening dynamic wrinkles, and minimizing the downward pull of the oral commissures.