Aesthetic Plastic Surgery

, Volume 43, Issue 4, pp 1044–1053 | Cite as

BTX-A Rejuvenation: Regional Botulinum Toxin-A Injection of the Platysma in Patients with Facial Sagging

  • Rongrong Zhou
  • Yanghonghong Fei
  • Leqi Sun
  • Jian Guo
  • Xiaofei Zhou
  • Xudong ZhangEmail author
Original Article Non-Surgical Aesthetic



To establish botulinum toxin-A (BTX-A) rejuvenation as an innovative technique to treat facial sagging with descent of the mid and lower face in Asian females.


Between March 2016 and March 2017, 512 female patients with facial sagging were treated with regional platysma BTX-A injection. Droplet injection into the dermis was performed. Among the patients, 192 were recruited into our retrospective study. Eligible patients were divided into a pre-senile group (28–39 years old) and a senile group (> 40 years old). We analyzed the patient/physician-graded improvement, the mean scores of the 5-point improvement scale, and any reported complications.


The overall degree of both patient- and physician-graded mid-face aesthetic improvement was very high. Improvement ratings reached 97.92% for patients and 94.79% for physicians. Improvement ratings were significantly greater in the pre-senile group compared to the senile group (p < 0.001), suggesting that the pre-senile patients were more satisfied with their improvement. Moreover, the percent of patients who reported as “much improved” was significantly higher than the percent of physicians (p < 0.05), suggesting that patients felt more positively about their aesthetic results than the physicians. No severe side effects were reported.


Our results demonstrated that regional BTX-A injection in the dermis for the purpose of aesthetical platysma rejuvenation is safe and effective in patients with facial sagging with descent of the mid and lower face. Specifically, regional platysma injections of BTX-A (BTX-A rejuvenation) can correct descent of the mid and lower face in Asian females, demonstrating clinical utility of this treatment strategy.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Botulinum toxin-A Regional platysma injection Droplet injection Deep dermal injection BTX-A rejuvenation Descent of mid and lower face 


Compliance with Ethical Standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by our institution’s ethics committee. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

266_2019_1396_MOESM1_ESM.pdf (560 kb)
Supplementary material 1 (PDF 559 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  • Rongrong Zhou
    • 1
  • Yanghonghong Fei
    • 1
  • Leqi Sun
    • 1
  • Jian Guo
    • 1
  • Xiaofei Zhou
    • 1
  • Xudong Zhang
    • 1
    Email author
  1. 1.Department of Aesthetic and Plastic SurgeryPLA 117 HospitalHangzhouChina

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