Indications for Neurotoxins: Lower Face and Neck

Botulinum neurotoxin type A (BoNT/A) smooths out wrinkles in the upper face by relaxing the underlying muscles and thereby creating a more refreshed, alert appearance. The effects of BoNT/A on the lower face typically have a different purpose in addition to the above and is used to rejuvenate the face through lengthening the upper lip (gummy smile), smoothing the chin, reversing a downturned mouth, softening upper and/or lower lip lines, or relaxing neck bands. Although the effects are temporary, lasting approximately 3–4 months, consistent use can lead to longer-term benefits such as enhanced muscle memory and prevention of additional lines. Treatment of the lower face and neck with BoNT/A is off-label and is considered an advanced technique. These areas can pose a challenge to the practitioner because of the function and complexity of the musculature in the lower face. It is recommended the novice injector become comfortable with injecting the upper face before delving into treating the lower face for these reasons. Patients who have lines, dimples, or other issues caused from muscle contraction or tension are candidates for neurotoxin treatment, and this chapter will discuss lower face treatment indications for BoNT/A.