Another important jawline treatment involves injection into the masseter muscles.8 In females, an overly squared jaw can be masculinizing. In addition, the Asian face can have overly accentuated masseter muscles and they seek out this treatment to make their face more oval. Injection into this muscle results in a softening of the determined, clenched appearance of the face and a more feminine oval or heart shaped face (Figures 19 and 20). This injection is best saved for a younger patient where sagging at the jawline is not an issue. Patients will often report improvement in teeth grinding, temporal-mandibular joint symptoms, and headaches after treatment of an over-active masseter. I usually recommend a mouth guard in these patients to help retrain the masseter from being in constant tension. It may help reduce the need for constant injections into this area.
Platysma injections have been touted to improve the definition of the jaw line, decrease the downward pull of the lower face, reduce hyperactive platysmal banding (Figures 21 and 22), and
soften the depth of horizontal neck lines.5,9 In my experience, this use of neuromodulator should be reserved for younger patients who are not in need of surgical intervention, in some cases of residual banding post-surgery, and in those patients who have undergone treatment for submental chin fat, and newly exposed platysmal hypertrophy needs to be addressed to complete the non-surgical injectable neck rejuvenation. Moving further away from the face, the chest gains more attention for rejuvenation. Small aliquots of neurotoxin have been recommended to rejuvenate the aging décolletage area of women.10 Results can be expected to be improved when combined with non-ablative resurfacing, vascular devices and ultrasound or radiofrequency devices to improve pigmentation, redness, and texture.
Botulinum toxins have known inhibitory effects on both acetylcholine and vasoactive intestinal polypeptide. These mechanisms of action have prompted many doctors to try using hyper-diluted product delivered into the dermal plane
