Lower-Face Botulinum Toxin Trial Examines Injection Extent and Lift
Key Takeaways
- A recent trial found measurable lower-face lifting across all botulinum toxin treatment groups.
- Greater injection coverage was associated with more tissue displacement at day 15 and greater persistence over time, while patient-reported outcomes peaked at day 30.
- More extensive treatment was also associated with higher patient-reported adverse effects at day 90, and higher BMI was associated with less tissue displacement.
Data from a new randomized, double-blind study suggests that expanding the number and distribution of botulinum toxin injection points across lower-face depressor muscles may increase the magnitude and durability of tissue lifting, although broader treatment was associated with more patient-reported adverse effects.
Researchers evaluated 80 patients assigned to 4 treatment groups that differed in the number and distribution of injections targeting the platysma and depressor anguli oris muscles. Outcomes were assessed at 15, 30, and 90 days using 3-dimensional stereophotogrammetry, the Global Aesthetic Improvement Scale (GAIS), and FACE-Q Satisfaction with Outcome and Adverse Effects modules.
Greater Injection Coverage Associated With More Tissue Displacement
All treatment approaches produced measurable lifting. Greater treatment extent was associated with increased tissue displacement at day 15 (P = 0.004) and greater persistence of displacement during follow-up. Patient-reported outcomes showed a similar pattern, peaking at day 30 and remaining higher among the intermediate- and high-extent treatment groups.
The number of injection points was positively associated with tissue displacement in multivariable analysis (β = 1.875; P = 0.040). BMI showed a negative association with displacement (β = −4.361; P = 0.022), indicating that patient characteristics may influence treatment response.
Tolerability findings showed a potential tradeoff with broader treatment. Although adverse effects decreased over time overall, patient-reported adverse effects were higher in the most extensive treatment group at day 90 (P = 0.006).
“Lower-face neuromodulator treatments produce measurable lifting effects that scale with the extent of muscular coverage,” the authors wrote. “Broader distribution enhances the magnitude and durability of tissue repositioning, although with a modest increase in perceived adverse effects. BMI may act as a response modifier.”
Source
Monoz-Lora, VRM, et al. Aesthetic Surgery Journal. 2026. Doi:10.1093/asj/sjag165