Anatomical Guidelines and Technical Tips for Neck Aesthetics with Botulinum Toxin

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: beautiful neck; botulinum toxin; neck aesthetics; platysma muscle; submandibular gland; trapezius muscle.

Fig. 1

The figure exhibits an illustrative representation elucidating the cervicomental angle, highlighting characteristics emblematic of an ideal neck contour. The illustration showcases a distinct delineation of the mandibular border, shaping an angle falling within the spectrum of 105 to 120 degrees.

Fig. 2

This figure illustrates the potential applications of botulinum toxin administration, which may encompass addressing various conditions including submandibular gland hypertrophy, platysmal bands, hypertrophied superior trapezius muscle, optimization of the cervicomental angle, and prevention of the exacerbation of horizontal neckline and decolletage line during the aging process.

Fig. 3

The figure depicts the origin of the platysma muscle from the fascial structure of the pectoralis major and anterior deltoid muscles. It extends downward toward the lower face integrating smoothly with the superficial musculoaponeurotic system.

Fig. 4

The image presents a panoramic view of ultrasonography, showcasing a longitudinal image captured from the midpoint of the mandibular border.

Fig. 5

The figure displays a panoramic view of ultrasonography, illustrating a horizontal image obtained from the midpoint between the mandibular border and clavicle.

Fig. 6

The illustration of the phenomenon where the platysma muscle contracts, resulting in a wider cervicomental angle and contributing to neck sagging. Upon injection of botulinum toxin into the platysma muscle, relaxation occurs, leading to the creation of a more curved neckline when viewed laterally.

Fig. 7

The figure demonstrates the injection technique for botulinum toxin, where 2 units (U) are administered per point. Five points are injected along each band, with a spacing of approximately 2 cm between each injection site. A total of 40 units are utilized for both the anterior and posterior bands. To prevent paralysis of swallowing muscles and potential dysphagia, as well as to avoid affecting the sternocleidomastoid muscle, intradermal or subdermal injection is recommended. CL, clavicular line; MB, mandibular border.

Fig. 8

The figure illustrates the option for additional injections in the middle portion of the platysma muscle, apart from the platysmal band injection points. One ( A ) to two ( B ) more vertical lines can be targeted for injection, with each point receiving 2 units (U) of botulinum toxin. The total units administered may range from 60 to 80 units depending on individual patient factors. An intradermal or subdermal injection is recommended for these additional injections. CL, clavicular line; MB, mandibular border.

Fig. 9

The figure depicts the case of a 45-year-old woman who underwent two cycles of botulinum toxin injections for jawline lifting and alleviation of the horizontal neckline. The injections were administered at a 3-month interval between each cycle. The photographs show the before ( A ) and after ( B ) treatment outcomes from a 45-degree viewing angle.

Fig. 10

The figure demonstrates the technique for jawline lifting using botulinum neurotoxin injections. Two units (U) are administered per point, totaling 20 U of botulinum neurotoxin per side. The injections are performed in two lines, spaced at a distance of two finger widths. One line is positioned directly above the mandibular lower border (MB), while the other line is placed below the line connecting the cheilion (Ch) and ear lobule (EL).

Fig. 11

The figure presents the case of a 36-year-old woman undergoing botulinum toxin treatment for horizontal neckline alleviation and cervicomental angle optimization. The treatment involved a single session of botulinum toxin injection. The photographs depict the before ( A ) and 3 months after ( B ) outcomes of the botulinum toxin treatment from a lateral view.

Fig. 12

The figure illustrates the bulky appearance of the jawline resulting from hypertrophy of the submandibular gland ( A ). Additionally, it includes a dissected image ( B ) showing the lower border of the mandible in cadaveric dissection, where the platysma muscle and cervical fascia have been removed.

Fig. 13

The figure depicts the ideal injection points for the submandibular gland. These points are located where a vertical line intersects the lateral canthus and aligns approximately 2 cm away from the inferior border of the mandible. This location is considered optimal for injection as there are no facial arteries or veins running over it, minimizing the risk of complications.

Fig. 14

The figure presents an ultrasonographic observation of the superior trapezius muscle. The depth from the epidermis to the rib measures approximately 2 cm in this instance. Therefore, a needle length of 0.5 inch would be appropriate for targeting the trapezius muscle.

Fig. 15

The figure outlines the recommended approach for administering botulinum toxin injections to the upper trapezius muscle. Injection should be targeted at each arborized section, with particular emphasis on the most arborized pattern located lateral to the contour of the neckline. Imaginary lines drawn from the frontal view, aligning with the lateral contour of the neckline and clavicular border, aid in identifying the injection sites. The authors suggest injecting in the medial half to avoid potential damage to the accessory spinal nerve, which enters at this point (highlighted in green). A total of 10 units of letibotulinum toxin are used, with each injection point receiving 10 units.

Fig. 16

The figure illustrates the case of a 34-year-old woman presenting with a chief complaint of hypertrophied trapezius. She underwent one session of botulinum toxin therapy. Panel ( A ) displays the condition before the treatment, while panel ( B ) shows the outcome 3 months after the treatment.