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Evaluation of the Microbotox Technique: An Algorithmic Approach for Lower Face and Neck Rejuvenation and a Crossover Clinical Trial

Awaida, Cyril J., M.D.; Jabbour, Samer F., M.D.; Rayess, Youssef A., M.D.; El Khoury, Joseph S., M.D.; Kechichian, Elio G., M.D.; Nasr, Marwan W., M.D.

Plastic and Reconstructive Surgery: September 2018 - Volume 142 - Issue 3 - p 640–649
doi: 10.1097/PRS.0000000000004695
Cosmetic: Original Articles
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Background: Microbotox consists of the injection of microdroplets of botulinum toxin into the dermis to improve the different lower face and neck aging components. No clinical trial has evaluated its effect on the different face and neck components and no study has compared it to the “Nefertiti lift” procedure.

Methods: In this crossover study, patients previously treated with the Nefertiti lift were injected using the microbotox technique. Using standardized preinjection and postinjection photographs, the jowls, marionette lines, oral commissures, neck volume, and platysmal bands at maximal contraction and at rest were assessed with validated photonumeric scales. In addition, the overall appearance of the lower face and neck was evaluated by the Investigators and Subjects Global Aesthetic Improvement Score. Pain and patient satisfaction rates were also evaluated.

Results: Twenty-five of the 30 patients previously treated with the Nefertiti technique were injected with a mean dose of 154 U using the microbotox technique. Platysmal bands with contraction, jowls, and neck volume reached a statistically significant improvement. The microbotox technique improved the jowls and the neck volume more than the Nefertiti technique, whereas the platysmal bands at rest and with contraction were more improved by the Nefertiti technique. One hundred percent of patients were satisfied with both techniques and rated themselves as improved.

Conclusions: The microbotox technique is a useful, simple, and safe procedure for lower face and neck rejuvenation. It is mainly effective in treating neck and lower face soft-tissue ptosis, in contrast to the Nefertiti technique, which is more effective on platysmal bands.


Beirut, Lebanon

From the Departments of Plastic and Reconstructive Surgery and Dermatology, Faculty of Medicine, Saint-Joseph University.

Received for publication October 5, 2017; accepted March 29, 2018.

This trial is registered under the name “Microbotox for Lower Face Rejuvenation,” registration number NCT03189082 (

Disclosure: The authors have no financial interest to declare in relation to the content of this article. No external funding was received.

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Cyril J. Awaida, M.D., Faculty of Medicine, Saint-Joseph University, Hotel Dieu de France Hospital, Bonjus Street, 1st Floor, Khoueiry Building, Fanar, Lebanon,

©2018American Society of Plastic Surgeons