The 'Nefertiti lift': a new technique for specific re-contouring of the jawline.
Abstract
Botulinum toxin type A (BoNTA) is now used extensively for rejuvenation of the forehead, glabellar and periocular regions and there is increasing focus on treatment of the lower face. Although there is well-documented evidence for the efficacy of botulinum toxin in the correction of platysmal bands, little work has been done to explore its potential role in rejuvenation of the jawline. To date, effects in this area have been reported as a consequence of platysmal banding treatment and are inconsistent. Hesitancy to explore treatment may be due to evidence of a greater, more durable response to the toxin in the lower facial muscles as well as reports of increased potential migration and subsequent side effects. This paper describes a new technique using BoNTA (Vistabel); Allergan, Irvine, CA, USA) to drape the skin of the jawline contour and provide the visual effect of a 'mini lift'. Experience with 130 patients with doses of BoNTA up to 20 U is described. Patient satisfaction is extremely high and the specificity of dosing and technique has led to a low incidence of adverse effects. The 'Nefertiti lift' is a minimally invasive, effective and acceptable alternative for those patients seeking an effective way to push back surgery.
[Botulinum toxin injection techniques in the lower third and middle of the face, the neck and the décolleté: the "Nefertiti lift"].
Abstract
Although correction of the dynamic wrinkles of the upper part of the face is the major indication for botulinum toxin, there are also many possibilities for the middle and lower thirds of the face and neck. However, these injections are more delicate and require an experienced operator who has excellent knowledge of the muscles of these regions, their functions, the antagonist actions exercised on other muscles, particularly in terms of the complex equilibrium of the mouth. An excessive dose, an inappropriate injection point, or a centering mistake can all easily be responsible for undesirable side effects. However, the results obtained, often with lower doses than in the superior part of the face, can be highly satisfactory, notably in erasing bunny lines, improvement of marionette lines, peau d'orange chin, attenuation of peribuccal lines, melomental folds, correction of a gummy smile, and facial asymmetries. In the neck it is possible to reduce platysmal bands, horizontal lines, and diagonal lines of the neck and décolleté. The face contours can also be improved by the Nefertiti lift. In the mid and lower regions of the face, botulinum toxin is often a complement to other esthetic techniques, particularly filling procedures.
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