Botulinum toxin A (Botox) has been used therapeutically in humans for over 20 years. Recently, plastic surgeons have started using it in a variety of aesthetic facial procedures to treat such conditions as an aging neck. Results from the following two studies involving the use of botulinum toxin A, are included in the February issue of Plastic and Reconstructive Surgery (Vol. 104, No. 76), the official journal of the American Society of Plastic Surgeons (ASPS).

Until recently, platysma (layer of muscle situated on each side of neck) banding was a problematic area of facial aging for which the only known treatment was surgical intervention involving some form of resurfacing. In one study, "Botulinum A Exotoxin for the Management of Platysma Bands," 1,500 patients were treated by three independent practices during a 36-month period to test the use of botulinum toxin A in treating the aging neck.

The majority of patients in the study had bilateral anterior (area from chin to notch in between collar bones or "turkey gobbler") muscle cords treated with Botox. The indications which qualified the patients for botulinum treatment included: platysma banding not warranting surgery (or patient did not desire surgery); residual platysma bands after facialplasty surgery; horizontal neck lines associated with platysma bands; and patients with medical contraindications or who were psychologically unprepared for surgery or who were deemed nonsurgical candidates for facialplasty. Eighty-four percent of patients were women, 16 percent were men, and the patients ranged in age from 30 to 77 years old. "Botulinum treatment for the aging neck has several advantages," according to Alan Matarasso, MD, a New York ASPS member and co-author of the study. "No preparation is required, the results are rapid, it is highly successful and predictable, does not require systematic anesthesia and patients experience little discomfort."

The best results appeared in patients with mild horizontal neck rhytids (lines), thin or mild flaccidity of the platysma bands, mild skin laxity or moderate horizontal neck rhytids, thick bands with moderate flaccidity of the platysma bands and moderate skin laxity; 98.5 percent had good-to-excellent results with 1.5 percent having fair results.

According to the study, botulinum, as an off-label use, is a safe and effective treatment for bands and rhytids caused by platysma muscle degeneration. Botulinum toxin A can be used in conjunction with surgery or performed on numerous areas of the face and neck simultaneously.

A second study on the use of botulinum toxin A in facial aesthetic procedures, "Nonsurgical Treatment of Platysmal Bands with Injection of Botulinum Toxin A," was conducted by Michael Kane, MD, who administered 50 separate treatments of platysmal bands between May of 1992 and August of 1998. Twenty-six separate patients were treated. Twenty-five of the patients were female and one was male. The average (mean) age of the women was 47 and the male patient was 50 years old. Each platysmal band was injected with between 5 and 20 units of botulinum toxin A. All of the patients had at least a small improvement in their platysmal bands.

According to the study, the procedure is most appropriate for older patients who are not good candidates for surgery, older patients who have previously had neck rejuvenation surgery and younger patients with strong, dynamic platysmal bands who are not yet surgical candidates. "Although most of the patients were very happy with their results, botulinum toxin A is not a replacement for surgery and definitely not a "face-lift in a bottle," says Michael Kane, MD, author of the study.

The American Society of Plastic Surgeons represents 97 percent of all physicians certified by the American Board of Plastic Surgery (ABPS). By choosing an ASPS member plastic surgeon certified by the ABPS, a patient can be assured that the physician has graduated from an accredited medical school and completed at least five years of additional residency training, usually three years in general surgery and two years of plastic surgery. Additionally a physician must also practice plastic surgery for two years and pass comprehensive written and oral examinations. Consumers may call the Plastic Surgery Information Service at 1-800-635-0635 or access the ASPS web site at www.plasticsurgery.org for informational brochures and names of qualified plastic surgeons in their areas.