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Platysma Chemical Denervation with Botox before Neck Lift

Prado, Arturo S. M.D.; Parada, Francisco M.D.; Andrades, Patricio M.D.; Fuentes, Patricio M.D.

Plastic and Reconstructive Surgery: August 2010 - Volume 126 - Issue 2 - p 79e-81e
doi: 10.1097/PRS.0b013e3181df6ed4

Plastic Surgery Division; Department of Surgery; Jose Joaquin Aguirre Clinical Hospital; University School of Medicine; Santiago, Chile

Correspondence to Dr. Prado, Division of Plastic Surgery, School of Medicine, Postgraduate School, University of Chile, Manquehue Norte 1701 ofic 210, Vitacura, Santiago, Metropolitana, Chile,

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An acute and juvenile neck contour is considered a foremost component in facial rejuvenation.1 A perfect lifting is frequently judged by other plastic surgeons by the results of the neck lift.

Aging of the neck is mostly attributable to the result of skin laxity; accumulation of fat; platysma ptosis, laxity, and redundancy; and sometimes prominent submandibular glands or digastric muscles.1,2

Neck lifts can be performed with or without simultaneous face lifting and can be approached with a simple skin lift, suturing the medial borders of the platysma muscle (corset fashion),2 transection of the platysma muscle, and division of both heavy medial platysmal bands with superolateral vector elevation of the muscle.

To prove our thesis that chemical denervation of the platysma muscles before surgery could partially paralyze and make the muscle more prone to traction and suture fixation, we recruited five female patients over a period of 8 months (from March to October of 2007), with ages ranging from 51 to 70 years, who consented and accepted preoperative unilateral transcutaneous injections of botulinum toxin type A (Botox; Allergan, Inc., Irvine, Calif.) in a necklace pattern across the ipsilateral platysma muscle, imitating transectional surgery. The other side was left untouched and served as control.

The ethical committee of the clinical hospital in which the patients were being treated approved this study before the recruitment phase. All of them were informed of the purpose of the study and gave informed signed consent. If after a short period of follow-up, asymmetry resulted, the patient would receive Botox of the nonpretreated side.

For the Botox technique, 7 days before surgery, the patients were injected with Botox. They were asked to grimace and project the mandible forward to identify and isolate the left platysma muscle before Botox injection that was performed with 50 units of exotoxin across the unilateral necklace lines.3 The right platysma muscle was left untouched.

For the neck-lift technique, all of the patients had moderate to severe skin laxity and significant lipodystrophy. Through a 4-cm submental incision, we proceeded to a direct preplatysmal defatting of the neck and advancement-plication of the medial and lateral platysma of both sides. A polydioxanone suspension suture was placed from 1 to 3 cm below the mandibular border in the submental platysma to the mastoid fascia. This suture defined the neck from the cheek, providing support for the submandibular gland.4

For the intraoperative study, a 5 × 1-cm rectangle of the central part of both platysma muscles (Fig. 1, above) was resected with scissors and anchored to a bimodal tension measurement device (USSC sutures; Tyco International, Inc., Princeton, N.J.) (Fig. 1, below) designed to evaluate tension suture resistance. The elongative force applied was the same for both samples. The chemodenervated platysma elongated more in all the cases compared with the normal platysma (untouched).

Fig. 1.

Fig. 1.

After this experience, we believe that segmentary platysmal chemical denervation with Botox facilitates contouring these muscles during surgery and also permits better manipulation and traction, with less antagonist-contracture muscle force that will last for at least 6 months after surgery (duration of Botox effect) and that could lead to better cosmetic results in difficult neck lift cases (Fig. 2).

Fig. 2.

Fig. 2.

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The authors have no financial interest to declare in relation to the content of this article.

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The patient provided written consent for the use of her images.

Arturo S. Prado, M.D.

Francisco Parada, M.D.

Patricio Andrades, M.D.

Patricio Fuentes, M.D.

Plastic Surgery Division

Department of Surgery

Jose Joaquin Aguirre Clinical Hospital

University School of Medicine

Santiago, Chile

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1. Feldman J, Joel J. Neck Lift. St. Louis, Mo: Quality Medical; 2006.
2. Feldman J. Corset platysmaplasty. Plast Reconstr Surg. 1990;85:333–343.
3. Kane MA. Nonsurgical treatment of platysmal bands with injection of botulinum toxin A. Plast Reconstr Surg. 2003;112(Suppl):115S–122S.
4. Rohrich RJ, Rios JL, Smith PD, Gutowski KA. Neck rejuvenation revisited. Plast Reconstr Surg. 2006;118:1251–1263.
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