Botulinum A exotoxin for the management of platysma bands

Injections of botulinum A exotoxin are successfully used to treat neuromusc ular disorders and to improve hyperkinetic muscles and dynamic rhytids of t he upper face. Using these principles, we extended its use to the treatment of the aging neck (hypertrophic platysma muscle bands). A classification s ystem (I to IV) based on horizontal neck rhytids, platysma bands, and skin laxity was devised to categorize the degree of deformity and serve as a gui deline for suggested dosages of botulinum. The results correlated with the degree of age-related neck degeneration. Type II (mild horizontal neck rhyt ids; thin, mild platysma muscle flaccidity; and mild skin laxity) and III ( moderate horizontal neck rhytids; thick, moderate platysma muscle flaccidit y; and moderate skin laxity) patients were the most satisfied, followed clo sely by types I and IV. A total of 1500 patients were treated by three inde pendent practices. The majority of them achieved good-to-excellent results, as evaluated by both the physician and patient. The degree of muscle flacc idity and hypertrophy were the factors that most influenced success rates, not the anatomic variations in muscle configuration.