Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Anatomical Guidelines and Technical Tips for Neck Aesthetics with Botulinum Toxin

  • Hyewon Hu (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry) ;
  • Soo-Bin Kim (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry) ;
  • Jovian Wan (Asia Pacific Aesthetic Academy) ;
  • Lisa Kwin Wah Chan (EverKeen Medical Centre) ;
  • Alvin Kar Wai Lee (EverKeen Medical Centre) ;
  • Olena Sydorchuk (Wlabel) ;
  • Arash Jalali (One Clinic MD) ;
  • Mariana Cesar Correa (Clinic Dr Mariana Correa) ;
  • Jong-Seo Kim (Kimjongseo Plastic Surgery Clinic) ;
  • Kyu-Ho Yi (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry)
  • Received : 2024.04.17
  • Accepted : 2024.06.16
  • Published : 2024.09.15
Download PDF
⟨ Previous Next ⟩

Abstract

Botulinum toxin can be used for various purposes to enhance neck aesthetics, addressing concerns such as platysmal bands, optimizing the cervicomental angle, preventing worsening of horizontal neckline and decolletage lines during aging, submandibular gland hypertrophy, and hypertrophied superior trapezius muscle. Understanding the anatomy of muscles such as the trapezius, platysma, and submandibular gland is crucial for achieving desirable outcomes with botulinum toxin administration. Techniques for injecting botulinum toxin into these muscles are discussed, emphasizing safety and efficacy. Specific injection points and methods are detailed for treating platysmal bands, optimizing the cervicomental angle, addressing submandibular gland hypertrophy, and managing hypertrophied superior trapezius muscle. Careful consideration of anatomical landmarks and potential complications is essential for successful botulinum toxin injections in these areas.

Keywords

References

  1. Matarasso A, Matarasso SL, Brandt FS, Bellman B. Botulinum A exotoxin for the management of platysma bands. Plast Reconstr Surg 1999;103(02):645-652, discussion 653-655
  2. Barbarino SC, Wu AY, Morrow DM. Isolated neck-lifting procedure: isolated stork lift. Aesthetic Plast Surg 2013;37(02):205-209
  3. Yi KH, Lee HJ, Choi YJ, Lee K, Lee JH, Kim HJ. Anatomical guide for botulinum neurotoxin injection: application to cosmetic shoulder contouring, pain syndromes, and cervical dystonia. Clin Anat 2021;34(06):822-828
  4. Yi K-H, Lee J-H, Lee K, Hu HW, Lee HJ, Kim HJ. Anatomical proposal for botulinum neurotoxin injection targeting the platysma muscle for treating platysmal band and jawline lifting: a review. Toxins (Basel) 2022;14(12):868
  5. Yi KH, Lee HJ, Lee JH, et al. Sonoanatomy of the platysmal bands: what causes the platysmal band? Surg Radiol Anat 2023;45(11):1399-1404
  6. Bae JH, Youn KH, Hu KS, Lee JH, Tansatit T, Kim HJ. Clinical implications of the extension of platysmal fibers on the middle and lower face. Plast Reconstr Surg 2016;138(02):365-371
  7. Minelli L, Wilson JL, Bravo FG, et al. The functional anatomy and innervation of the platysma is segmental: implications for lower lip dysfunction, recurrent platysmal bands, and surgical rejuvenation. Aesthet Surg J 2023;43(10):1091-1105
  8. Kim HJ, Hu KS, Kang MK, Hwang K, Chung IH. Decussation patterns of the platysma in Koreans. Br J Plast Surg 2001;54(05):400-402
  9. Baur DA, Williams J, Alakaily X. The platysma myocutaneous flap. Oral Maxillofac Surg Clin North Am 2014;26(03):381-387
  10. Daane SP, Owsley JQ. Incidence of cervical branch injury with "marginal mandibular nerve pseudo-paralysis" in patients undergoing face lift. Plast Reconstr Surg 2003;111(07):2414-2418
  11. Trevidic P, Sykes J, Criollo-Lamilla G. Anatomy of the lower face and botulinum toxin injections. Plast Reconstr Surg 2015;136(5 Suppl):84S-91S
  12. Connell BF, Shamoun JM. The significance of digastric muscle contouring for rejuvenation of the submental area of the face. Plast Reconstr Surg 1997;99(06):1586-1590
  13. McKinney P. The management of platysma bands. Plast Reconstr Surg 1996;98(06):999-1006
  14. Rohrich RJ, Pessa JE. The subplatysmal supramylohyoid fat. Plast Reconstr Surg 2010;126(02):589-595
  15. Trevidic P, Criollo-Lamilla G. Platysma bands: is a change needed in the surgical paradigm? Plast Reconstr Surg 2017;139(01):41-47
  16. Lee JH, Park YG, Park ES. A prospective observational study of the effectiveness and safety of botulinum toxin in the horizontal neck lines. Aesthetic Plast Surg 2018;42(05):1370-1378
  17. Sugrue CM, Kelly JL,McInerney N. Botulinum toxin treatment formild to moderate platysma bands: a systematic review of efficacy, safety, and injection technique. Aesthet Surg J 2019;39(02):201-206
  18. de Almeida ART, Romiti A, Carruthers JDA. The facial platysma and its underappreciated role in lower face dynamics and contour. Dermatol Surg 2017;43(08):1042-1049
  19. Matarasso A, Matarasso SL. Botulinum A exotoxin for the management of platysma bands. Plast Reconstr Surg 2003;112(5 Suppl):138S-140S
  20. Prager W, Bee EK, Havermann I, Zschocke I. Incobotulinum toxinA for the treatment of platysmal bands: a single-arm, prospective proof-of-concept clinical study. Dermatol Surg 2015;41(Suppl 1):S88-S92
  21. Rohrich RJ, Savetsky IL, Cohen JM, Avashia YJ. Effective treatment of platysma bands with neurotoxin. Plast Reconstr Surg Glob Open 2020;8(06):e2812
  22. Petracca M, Guidubaldi A, Ricciardi L, et al. Botulinum Toxin A and B in sialorrhea: long-term data and literature overview. Toxicon 2015;107(Pt A):129-140
  23. Armstrong MA, Turturro MA. Salivary gland emergencies. Emerg Med Clin North Am 2013;31(02):481-499
  24. Ono K, Morimoto Y, Inoue H, Masuda W, Tanaka T, Inenaga K. Relationship of the unstimulated whole saliva flow rate and salivary gland size estimated by magnetic resonance image in healthy young humans. Arch Oral Biol 2006;51(04):345-349
  25. Scott J. Age, sex and contralateral differences in the volumes of human submandibular salivary glands. Arch Oral Biol 1975;20(12):885-887
  26. Choi DY, Bae H, Bae JH, Kim HJ, Hu KS. Effective locations for injecting botulinum toxin into the mentalis muscle; cadaveric and ultrasonographic study. Toxins (Basel) 2021;13(02):13
  27. Lee JH, Lee BN, Kwon SO, Chung RH, Han SH. Anatomical localization of submandibular gland for botulinum toxin injection. Surg Radiol Anat 2010;32(10):945-949
  28. So JI, Song DH, Park JH, et al. Accuracy of ultrasound-guided and non-ultrasound-guided botulinum toxin injection into cadaver salivary glands. Ann Rehabil Med 2017;41(01):51-57
  29. Yi KH, Kim SB, Hu H, An HS, Hidajat IJ, Lim TS, Kim HJ. Ultrasonographic study of the submandibular gland for botulinum neurotoxin injection. Dermatol Surg. 2024 May 7. Epub ahead of print
  30. Seo KK. Botulinum Toxin for Asians. Springer; 2017
  31. Han KH, Joo YH, Moon SE, Kim KH. Botulinum toxin A treatment for contouring of the lower leg. J Dermatolog Treat 2006;17(04):250-254
  32. Oh WJ, Kwon TR, Oh CT, Kim YS, Kim BJ. Clinical application of botulinum toxin a for calf hypertrophy followed by 3-dimensional computed tomography. Plast Reconstr Surg Glob Open 2018;6(02):e1071
  33. Yi K-H, Lee H-J, Seo KK, Kim HJ. Intramuscular neural arborization of the latissimus dorsi muscle: application of botulinum neurotoxin injection in flap reconstruction. Toxins (Basel) 2022;14(02):107
  34. Yi K-H, Lee K-L, Lee J-H, et al. Elucidating intramuscular neural distribution of the quadratus lumborum muscle to propose an optimal trigger point injection for myofascial pain syndrome 2022
  35. Yi KH, Lee HJ, Lee JH, Seo KK, Kim HJ. Application of botulinum neurotoxin injections in TRAM flap for breast reconstruction: intramuscular neural arborization of the rectus abdominis muscle. Toxins (Basel) 2021;13(04):13
  36. Yi KH, Lee HJ, Seo KK, Kim HJ. Botulinum neurotoxin injection guidelines regarding flap surgeries in breast reconstruction. J Plast Reconstr Aesthet Surg 2022;75(01):503-505
  37. Yi KH, Lee JH, Kim HJ. Intramuscular neural distribution of the serratus anterior muscle: regarding botulinum neurotoxin injection for treating myofascial pain syndrome. Toxins (Basel) 2022;14(04):14
  38. Jeong SY, Park KY, Seok J, Ko EJ, Kim TY, Kim BJ. Botulinum toxin injection for contouring shoulder. J Eur Acad Dermatol Venereol 2017;31(01):e46-e47
  39. Kohan EJ, Wirth GA. Anatomy of the neck. Clin Plast Surg 2014;41(01):1-6
  40. Zhou RR, Wu HL, Zhang XD, et al. Efficacy and safety of botulinum toxin type a injection in patients with bilateral trapezius hypertrophy. Aesthetic Plast Surg 2018;42(06):1664-1671
  41. Bae JH, Lee JS, Choi DY, Suhk J, Kim ST. Accessory nerve distribution for aesthetic botulinum toxin injections into the upper trapezius muscle: anatomical study and clinical trial: reproducible BoNT injection sites for upper trapezius. Surg Radiol Anat 2018;40(11):1253-1259
  42. Kleine BU, Schumann NP, Bradl I, Grieshaber R, Scholle HC. Surface EMG of shoulder and back muscles and posture analysis in secretaries typing at visual display units. Int Arch Occup Environ Health 1999;72(06):387-394
  43. Mirbagheri SS, Rahmani-Rasa A, Farmani F, Amini P, Nikoo MR. Evaluating Kyphosis and Lordosis in students by using a flexible ruler and their relationship with severity and frequency of thoracic and lumbar pain. Asian Spine J 2015;9(03):416-422
  44. Snijders CJ, Hermans PF, Niesing R, Jan Kleinrensink G, Pool-Goudzwaard A. Effects of slouching and muscle contraction on the strain of the iliolumbar ligament. Man Ther 2008;13(04):325-333
  45. Caneiro JP, O'Sullivan P, Burnett A, et al. The influence of different sitting postures on head/neck posture and muscle activity. Man Ther 2010;15(01):54-60
  46. Dodick D, Blumenfeld A, Silberstein SD. Botulinum neurotoxin for the treatment of migraine and other primary headache disorders. Clin Dermatol 2004;22(01):76-81
  47. Dodick DW, Turkel CC, DeGryse RE, et al;PREEMPT Chronic Migraine Study Group. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache 2010;50(06):921-936
  48. Alter KE, Wilson NA. Botulinum Neurotoxin Injection Manual. 2015
  49. Singh D, Choudhary A, Garg A. Flexible and robust piezoelectric polymer nanocomposites based energy harvesters. ACS Appl Mater Interfaces 2018;10(03):2793-2800
  50. Ramirez-Castaneda J, Jankovic J, Comella C, Dashtipour K, Fernandez HH, Mari Z. Diffusion, spread, and migration of botulinum toxin. Mov Disord 2013;28(13):1775-1783
  51. Ahiskalioglu EO, Alici HA, Dostbil A, Celik M, Ahiskalioglu A, Aksoy M. Pneumothorax after trigger point injection: a case report and review of literature. J Back Musculoskeletal Rehabil 2016;29(04):895-897
  52. Chandawarkar RY, Cervino AL, Pennington GA. Management of iatrogenic injury to the spinal accessory nerve. Plast Reconstr Surg 2003;111(02):611-617, discussion 618-619