A Practical, Targeted Approach to the Treatment of the Platysma Muscle With Neuromodulator

BACKGROUND: The platysma contributes significantly to lower face and neck aging through downward pull, banding, and contour changes. Current botulinum toxin techniques vary widely in dosing and injection patterns, often relying on fixed anatomic approaches or higher doses that may increase adverse effects. This study evaluates a targeted, patient-specific approach designed to optimize outcomes while minimizing the dose. METHODS: A retrospective study was conducted in a single outpatient dermatology clinic over 6 months. Forty-four treatment-naive patients receiving first-time platysma treatment with onabotulinumtoxinA were included. Injection sites were determined using dynamic assessment to identify areas of maximal contraction and key insertion points. The total dose was limited to 30 units. Outcomes were assessed using blinded evaluator and patient-reported Global Aesthetic Improvement Scale scores, along with six-month treatment retention. RESULTS: The mean dose was 29.6 units. Most of the patients were rated as much improved by a blinded evaluator, with no cases of no change or worsening. Patient-reported outcomes showed high satisfaction, with nearly all reporting marked improvement. Retention at 6 months was 84%. No adverse events were observed. CONCLUSION: A targeted, low-dose approach to platysma treatment produced high satisfaction and favorable safety outcomes. These findings support an individualized strategy that optimizes efficacy while minimizing the dose and risk.