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Botox injections are the most common form of chemical neuromodulation of the face. Decreasing undesired facial expressions has become a mainstay of modern aesthetic facial management. Every conceivable undesired facial expression can be treated with usually satisfying effects.

But decreasing adverse muscle activity can also extend down into the neck. The hyperactive platysma muscle that results in vertical muscle bands and resultant horizontal neck wrinkles can also be treated by Botox injections. Known as the ‘Nefertiti Lift’, the platysmal bands and the lower border of the jaw are injected. While this use of Botox is widely practiced and marketed, no clinical study has ever evaluated its effectiveness.

In the July 2017 issue of the journal of Plastic and Reconstructive Surgery, an articlee was published entitled ‘Botulinum Toxin for Neck Rejuvenation: Assessing Efficacy ands Redefining Patient Selection’.  In this clinical study the authors injected thirty (30) patients along the jawline and into the platysmas bands. An average of 125 units was used per patient. Results were assessed by static and dynamic pictures. Their findings showed that platysmas bands at rest and with maximal tension were significantly improved. Over 90% of investigators and patients alike rated their results as improved and satisfying. The patients who had the best results were younger patients with good skin elasticity.

While there is only one known image of the Egyptian Queen  Nefertiti, her beauty is defined by her distinct jawline and facial proportion. The use of the term ‘Nefertiti Lift’ is a marketing name and is not a surgical lift but an injectable approach to contouring the jawline and neck. By precisely placing Botox injections along the jawline and neck, the platysmas muscles are weakened that pull down on the jawline. This allows the tissues to redraw up tighter along the jawline. The effectiveness of this muscle release works best in thinner and younger patients where the definition of the jawline can be better appreciated and revealed. By combining many other facial techniques (injectable fillers, laser resurfacing, chemical peels etc) enhanced versions of the Nefertiti Lift have been touted.

Marketing issues aside, the Nefertiti Lift is based on sound anatomic principles of chemodenervation of sections of the platysma muscle. It is no surprise that is most effective in thinner patients with good skin elasticity. Thus, patient selection is critical. I have found that it works best when combined with other skin tightening procedures such as laser resurfacing and chemical peels of the rest of the face.

Dr. Barry Eppley

Indianapolis, Indiana

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