Botox Study Evaluates Botulinum Toxin Injections for Treatment of the Aging Neck
LOS ANGELES, Calif (May 2, 1998) — Botulinum toxin injections have been widely used in the upper face to temporarily reduce expression-induced frown lines, horizontal forehead lines, and crows feet. Statistics compiled by the American Society for Aesthetic Plastic Surgery (ASAPS) reveal that more than 65,000 such procedures were performed in 1997. A clinical study was undertaken to evaluate the effectiveness of injections to reduce the horizontal neck creases and vertical cords in the neck under the chin (platysmal bands or "turkey gobbler" neck) caused by hyperactivity of the platysma muscle.
"Platysmal banding has been a problem for which the only treatment was surgery, and options for treating horizontal neck creases have been limited to resurfacing procedures, which were not particularly successful," notes New York City plastic surgeon Alan Matarasso, MD, who presented the report at the ASAPS annual meeting in Los Angeles.
In this study, approximately 1500 patients from three medical practices (Alan Matarasso, MD; Seth L. Matarasso, MD; and Fredric S. Brandt, MD and Betty Bellman, MD) were treated over a period of 27 months. Predominantly female (84%), patients ranged from 30 to 77 years of age. Indications for treatment included: early platysmal banding; residual platysmal banding following facelift; horizontal neck lines; and patients for whom surgery was contraindicated.
A classification system was devised to quantify and categorize the condition of the neck. Horizontal lines, platysmal bands, skin laxity, and fat beneath the skin and muscle were assessed, and the patients were placed in one of four classes ranging from mild (Type I) to severe (Type IV).
All of the procedures were performed in the physicians offices. Patients were placed in a seated position and were asked to forcefully grimace to isolate particular regions of the platysma muscle. Using a tiny needle, multiple injections were made into the muscle. Upon completion, gentle pressure was applied to the site, and patients were instructed to remain upright and not to manipulate the treatment site (no bending, massage or straining) for 3 to 4 hours to avoid extension of the toxin to adjacent muscle groups.
"The vast majority achieved very good to excellent results correlating with the degree of age-related neck degeneration," reports Matarasso. "Type III patients were most satisfied, followed closely by Type I and Type II."
Bruising and mild neck discomfort were the side effects infrequently observed in the study. Occasionally, local swelling and redness are other side effects that may occur after botulinum toxin injections. In some instances, an additional injection may be necessary for effectiveness of the toxin.
"The ultimate effect of botulinum toxin injections is a chemical denervation with temporary paralysis of the muscle," explains Matarasso. "The onset of action in the neck can be more rapid than in the upper face," he points out, "but still may range from hours after the injections to 14 days later." When muscular function begins to return at approximately 3 to 4 months, patients may elect to repeat the procedure to maintain the improved appearance of the neck.
Note: The botulinum toxin used for injections is one of six substances (exotoxins) produced by the bacteria Clostridium botulinum. It is the botulinum exotoxin type-A. The commonly used term, Botox, is actually one trade name for this preparation.
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.
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