Weakening the Platysmal with Botox good or bad for skin/facial and neck tone and texture?

Question

I have read contradicting research/information about the Platysmal muscles and whether it needs to be strengthened or relaxed in order to improve over facial/skin tone/appearance—complete opposite info. My story: I went to a highly recommended injector to inquir about Dao and Platysmal Botox for lifting of the midface. I now feel that instead of a lift, I have less volume in lower face—and my neck (that I had no issues with before) now has loose skin and exaggerated banding. Why is Botox used?

James M. Economides, MD, FACS · Answer

I understand your frustration, especially when you were seeking improvement but now feel less volume and changes in your neck appearance. Let's break this down:

1. Why Botox Is Used for the Platysma and DAO:
Platysmal Botox: The platysma is a thin sheet of muscle in the neck that can contribute to banding or sagging when it contracts or becomes overactive. Botox is sometimes used in this area to relax the platysmal bands, softening the neck and jawline appearance. However, over-relaxation can sometimes lead to undesired effects, such as exaggerated banding or looseness if the muscle is weakened too much.
Depressor Anguli Oris (DAO) Botox: Botox is used in the DAO muscles to relax them and prevent downward pulling at the corners of the mouth, helping to achieve a more lifted midface. However, if overdone, it can create an imbalance, leading to a "heavier" or more hollow appearance in the lower face.
2. Potential Reasons for Your Results:
Volume Loss in the Lower Face: Botox affects muscle movement, not volume. However, if the muscles responsible for providing support and lift (like the platysma and DAO) are overly relaxed, they can fail to hold facial structures in place, leading to a perceived loss of volume or a "droopy" look in the lower face.
Exaggerated Neck Banding: It's possible that by relaxing the platysmal muscles too much, they no longer provide the structure needed for a smooth neck, resulting in looser skin or more visible banding that wasn’t a problem before.
3. Strengthening vs. Relaxing the Platysma:
Relaxing with Botox: The rationale behind using Botox in the platysma is to reduce the muscle's downward pull on the jawline and neck, which can help achieve a smoother, more defined neck area in some cases. However, in some patients, this may exacerbate banding or skin looseness.
Strengthening: On the other hand, some theories suggest that strengthening the platysma through facial exercises could help with toning and firming the lower face and neck over time. This approach may help some individuals achieve better support for their skin, though the effectiveness varies.

Anna Chacon, MD, FAAD · Answer

Thank you for your question and for sharing your experience. The use of Botox in the platysmal muscles can be a bit complex, and it's understandable to have concerns about the outcomes. Here’s a detailed explanation:

Botox and the Platysmal Muscles:
Botox, or botulinum toxin, is often used to relax muscles, which can help in reducing the appearance of wrinkles and fine lines. When it comes to the platysmal muscles in the neck, Botox can be used for different purposes:

Reducing Neck Bands: By relaxing the platysmal bands, Botox can smooth out the appearance of vertical neck lines or bands.
Nefertiti Lift: This technique involves injecting Botox into the platysmal bands and the DAO (depressor anguli oris) muscles to provide a lifting effect to the jawline and reduce jowls.
Potential Effects:
While Botox can be effective for these purposes, there are some considerations:

Loss of Volume: Some patients may experience a perceived loss of volume in the lower face as the muscles relax and the skin may appear less taut.
Loose Skin: Relaxing the platysmal muscles can sometimes lead to a temporary increase in the appearance of loose skin or exaggerated banding, especially if there is pre-existing skin laxity.
Why is Botox Used?
Botox is used in these areas to:

Smooth Wrinkles: By relaxing the muscles that cause dynamic wrinkles.
Lift and Contour: To provide a subtle lift and contour to the jawline and neck area.
Your Experience:
It sounds like you may have experienced some of the less desirable effects, such as increased skin laxity and banding. This can happen if the underlying skin structure is not robust enough to support the relaxed muscles, or if there is significant pre-existing laxity.

Recommendations:
Consult with Your Injector: Discuss your concerns with the injector who performed the procedure. They can provide insights into why these changes occurred and what can be done to address them.
Consider Additional Treatments: Depending on your specific case, treatments like skin tightening procedures, fillers, or even surgical options might be recommended to improve the tone and texture of your skin and address any loose skin.
In summary, while Botox can be beneficial for relaxing the platysmal muscles and improving facial aesthetics, it is essential to have a thorough consultation with an experienced injector to understand the potential outcomes and tailor the treatment to your specific needs.

Best regards,

Philip S. Schoenfeld, MD, FACS · Answer

I suspect that you have received contradictory information on this topic for good reason.  In short, injecting the DAO will help slightly with marionette lines.  Platysma injections are very effective for platysma banding but no matter how many injectors tell you about the Nefertiti neck lift with Botox or any other neurotoxin, I would challenge them to show you any identifiable lift.  The idea that the mid face would elevate with Botox is completely factitious.  Your injector is being as honest as they can with the information they were led to believe is the truth.  If you relax the platysma muscle, you will get more neck laxity, not lift.

Zoran Potparic, MD · Answer

It is ok to use Botox in highly elective places but it would be hard to find the purpose in midface lift. Your selection of provider may have to do something with your result? Better luck next time.

Stephen Prendiville, MD · Answer

Based on your question, it seems that you have high expectations from a procedure that is, at best, very subtle. Botox can lift the corners of the mouth in a very slight fashion, but does not lift the midface.  Furthermore, Botox will not have any demonstrable effect on facial volume.

Camille Cash, MD · Answer

Botox and similar neuromodulators work by affecting the injected muscle's ability to contract.  Injecting the platysmal bands can soften their appearance.  If you are wanting more of a lift you can consider options such as FaceTite or a thread lift.  I've included a video I hope you find helpful.

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