Efficacy and safety of onabotulinumtoxin A in the treatment of platysma prominence: A systematic review and meta-analysis of randomized clinical trials.

Abstract

The platysma muscle influences lower face and neck aesthetics and expression. Aging can lead to platysma prominence (PP), manifesting as visible neck bands that affect appearance and well-being. Although surgical treatments exist, they are invasive and carry notable risks. This systematic review and meta-analysis evaluated the efficacy and safety of onabotulinumtoxinA for treating PP. We systematically searched the PubMed, Cochrane Library, and Embase databases through May 2025 for studies comparing onabotulinumtoxinA with placebo. Primary outcomes were ≥1-grade bilateral neck improvement on Participant Allergan Platysma Prominence Scale (P-APPS) and Clinician Allergan Platysma Prominence Scale (C-APPS) at days 14, 60, and 120. Secondary outcomes included patient satisfaction evaluated using the Appearance of Neck and Lower Face Questionnaire and safety indicators such as bruising, hemorrhage, post-dose swallowing or talking difficulties, and other adverse events. Three randomized controlled trials with 1003 intention-to-treat and 912 modified intention-to-treat patients were included. OnabotulinumtoxinA significantly improved P-APPS on days 14 (RR 3.64), 60 (RR 3.46), and 120 (RR 2.57), and C-APPS on days 14 (RR 4.03), 60 (RR 3.73), and 120 (RR 2.21), all p < 0.01. Patient satisfaction was also higher on days 14 (RR 5.71), 60 (RR 5.56), and 120 (RR 5.29), all p < 0.01. No significant differences were found in the safety outcomes between the onabotulinumtoxinA and placebo groups. OnabotulinumtoxinA provides significant and sustained improvements in aesthetic and psychosocial outcomes in patients with PP, without increased risk of adverse events. These findings support its role as a less invasive and effective alternative to surgery.