As cosmetic uses of botulinum A exotoxin for wrinkle reduction in the aging face has become prevalent, attention has been drawn to its uses in improving laxity in the neck as well.
Vectors of Neck Aging
While neck skin is subject to the same extrinsic aging factors as facial skin, (heredity, sun exposure, weight changes, ect.) anatomical neck aging can occur earlier and present more harshly in some individuals, due to underlying muscular tension vectors.
The platysma muscle originates in the front of the chest, over the clavicle bone and stretches like a handkerchief over the neck until it continues as the superficial musculoaponeurotic system (SMAS) over the jawline.
In time gravity causes the platysma to loosen on the sides of the neck and fall toward the middle of the neck. In addition, its central band or bands can thicken, or contract. This may represent a compensatory hypertrophy from supporting deeper neck structures, or it may be due to anatomical shortening of the cervical spine with age. It is possible that even gravity causes this central thickening as well. The thickened central muscle band(s) give a characteristic “turkey-waddle” appearance, which is extremely distressing to most affected individuals. Using the platysma to accentuate facial expression can exacerbate this problem in susceptible individuals. Most botulinum exotoxin injection techniques address only these “banding” issues of neck aging.
An earlier change seen more frequently is progressive laxity of the skin in its attachment to the platysma causing the development of multiple horizontal wrinkles and a dimpled “chicken-skin” appearance in the mid and lower neck. It is this facet of neck aging which our technique addresses.
I utilize a “combination” technique, whereby two to four platysmal bands are treated as above, with a total dose of 20-30 U of botulinum toxin, while an additional 10-20 U are injected at 2.0-3.0 cm intervals (3-5 U per injection) along horizontal rhytides. At this lower dosing, there have been no reported adverse side effects.
Botox Cosmetic® and/or Dysport® can improve both facets early neck aging. I inject both into the actual platysmal bands/ “turkey-waddle” to soften/relax their thickened/contracted appearance. I also inject more superficially, into the skin of the mid and lower “loose” skin of the neck to improve the dimpling or “chicken-skin” appearance which can occur in this area. Together, these two Botox Cosmetic®/Dysport® injection techniques can simulate a “pre-neck lift” in appropriate individuals, without any recovery time or surgical risk. Many of my patients are already taking advantage of my expertise in this procedure. In conjunction with the procedure, I often inject along both sides of the jawline, so that the muscles of the lower cheek take charge and lift jawline laxity as well. If you are concerned with sagging of your neck or jawline (especially in your profile photos) or the “double chin” appearance of your central neck, visit us to see if these techniques can help you delay, or even PREVENT a surgical neck lift!
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