Patient Selection

5.13.5 Technique

Kinetic and hyperkinetic patients who contract the platysmal bands actively when speaking are best. Please be aware that BNT-A is not treatment for horizontal neck lines. Here other methods might be more appropriate, such as the combination of biodegradable injectable fillers and ablative procedures.

Patients must be in a sitting position as this is the best position to contract the platysma bands actively. Treatment follows the course of the contracted platysmal bands. BNT-A is injected every 1-2 cm. Grasping the band with the non-injecting hand might be helpful while injecting very superficially (intradermally) in the contracted muscle (Fig. 5.102).

Table 5.14. Overview of the muscles responsible for the platysmal bands

Table 5.14. Overview of the muscles responsible for the platysmal bands

Muscle

Action

Synergists Antagonists

Platysma

Shows vertical bands

M. depressor anguli oris M. levator anguli oris

Anterior fibers: assist

mandibular depression

Intermediate fibers: pars

labialis - depress the

lower lip

Posterior fibers: pars

modiolaris - depress the

buccal angle

The pharynx region should be avoided as in rare cases dysphagia and dysphonia have been reported after BNT-A.

Treatment of the platysmal bands

• Sitting position of the patient

• Contraction of the bands by having the patient grimace

• Four to eight injection points per band, approximately 1 cm from each other (the number of injection points depends on the length of the bands) (Fig. 5.102)

• Injection technique: very superficially (intradermally) in the contracted muscular band

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