I was recently asked to present a lecture at The Aesthetic Show 2019 titled “Neck and Jawline Rejuvenation using Neurotoxins”. This blog post is based on the talk I gave on July 11 in Las Vegas.
Why Treat the Neck with Botox
As a field, we are good at treating the face using nonsurgical treatments such as Botox, fillers, lasers and skincare. However, I believe that a focus just on the face can lead to a new problem. That is a disproportionately youthful looking face that directly contrast with an adjacent aging but untreated neck. In other words, even though the face looks great, the neck the neck does not. In the past, surgery was the only good treatment option for the lower face and neck. However, today, botulinum toxins like Botox, Dysport, Xeomin and now Jeuveau can be safely used on the lower face and neck with high rates of patient satisfaction.
Common Signs of an Aging Neck
Before discussing treatment techniques, it is important to understand signs of aging on the neck. Common signs of neck aging are listed below.
- skin laxity
- vertical (platysmal) bands
- horizontal wrinkles
- loss of jawline definition
- crepey skin
The platysma muscle plays a major role in the aging neck. When the platysma contracts it creates horizontal neck lines but it also pulls down on the lower face resulting in more apparent jowls and loss of jawline definition. The upper part of the platysma also contributes to lower vertical smile lines.
How to Treat the Aging Neck Using Botox - Two Different Treatment Options
Two common techniques for treating the neck with Botox (and Dysport) are MicroBotox and Nefertiti Lift. MicroBotox was first described by Dr. Wu. It involves multiple (150-200) injections of hyperdilute Botox to the dermis of the skin. The intent of this treatment is not to completely paralyze the platysma but to weaken the superficial fibers of the muscle thought to be responsible for fine lines and wrinkles. This in turn also helps smooth and tighten the skin on the neck and decrease the pulling effect of the muscle on the attached skin. I typically use 120-180 units of Dysport for the entire neck. This is equal to 40-60 units of Botox using a 3:1 conversion.
Dr. Levy introduced the concept of the Nefertiti Lift in 2007. The technique involves placing Botox or Dysport along the jawline and into each platysmal band. The injections are placed subcutaneously and the Dysport is the typical concentration we use in the upper face and not the hyperdilute mixture used for MicroBotox. I typically use 120-150 units of Dysport for this treatment.
Nefertiti Lift versus MicroBotox
So there are two different techniques for treating the neck with neurotoxin. Which one is better? Both techniques have high patient satisfaction rates. Each one targets a different component of the aging lower face and neck. MicroBotox produces a skin tightening effect, improves lower face and upper neck contour and enhances skin texture. The Nefertiti Lift improves platysmal bands, both at rest and contraction.
If a patient is concerned with platysmal bands but has minimal if any skin laxity, then I will treat with the Nefertiti Lift. If the patient has skin laxity, jowling and textural changes then I will treat with MicroBotox. If they have skin laxity, jowling, skin changes AND platysmal bands, then I will treat with MicroBotox and schedule a two week followup appointment at which time any remaining platysmal bands can be treated.
What Other Treatments Help with the Aging Neck?
It’s also important to remember that in addition to MicroBotox and Nefertiti Lift, there are other options for treating the neck. Kybella can be used to reduce submental (below the chin) fat and jowl fat. Fillers can be used to improve chin and jawline definition as well as horizontal neck lines (“TechNeck”). Lasers, IPL, fractionated radiofrequency and microneedling also help improve the quality of the neck skin. Retinol, antioxidants, and sun protection will help prevent further damage to the neck and optimize the results of the office based treatments mentioned above.