Defining the Jawline With Neuromodulator: A Review of the Evidence

A 2024 academic review gathered published approaches to using botulinum toxin type A along the jawline and neck to sharpen the lower face, a technique often nicknamed the "Nefertiti lift." The review found that several methods exist and some small studies report improvement, especially in visible neck bands, but there is no agreed dose or technique and the overall evidence is limited. For patients, it is a modest, temporary option for some people, not a substitute for treating sagging skin or lost bone and fat.

Why this was studied

The platysma is a thin, sheet-like muscle that runs from the collarbone up over the jawline. When it contracts, it pulls the lower face downward. Over time, this pull is thought to contribute to a softer jaw edge, more noticeable jowls and vertical cords in the neck.

The idea behind jawline neuromodulator treatment is to relax parts of the platysma so that the muscles that lift the face meet less resistance. Since the technique was first described in 2007, several variations have appeared. This review aimed to bring them together and summarise what is known.

What the review covered

The author, Dr. Ricardo Limongi Fernandes, searched the medical literature for articles on botulinum toxin and jawline contouring. The review describes a range of approaches published between 2007 and 2023. These include:

• Small injections placed along the lower border of the jaw and into the back neck bands, forming a "T" pattern on each side
• Patterns that also include nearby muscles around the chin and mouth corners
• Very superficial, widely spread micro-injections across the front of the neck
• A small number of points aimed at shifting the balance of lift in the lower and mid face

Doses and injection patterns differed considerably between authors. The review concludes that a moderate total dose appears to be enough for most people, but that there is no consensus.

What the studies reported

The results summarised in the review are mostly from small studies. In one study of 30 people, visible neck bands improved clearly both at rest and when tensed. Changes to jowls, marionette lines and mouth corners showed only a trend toward improvement, and about one in three people needed a touch-up. Another study of 25 people compared two techniques and found both helpful, with one better for neck bands and the other better for the jaw-neck angle.

The original 2007 description included 130 people, but the review reports no detailed outcome numbers from it. Side effect data were sparse. One cited study reported temporary side effects in about 16% of people, all settling within a month. Most others did not report a rate.

How strong is this evidence?

This is a narrative review, meaning the author selected and summarised studies without a formal, systematic method for finding and grading them. Narrative reviews are helpful for describing a field, but they can miss studies and are more open to bias.

Several points lower confidence in the conclusions:

• The studies included are small, several have no comparison group, and they measure results in different ways.
• The author works in medical affairs for the company that markets one particular botulinum toxin product, and much of the review promotes that product. Any claims about specific brands should be read with that in mind.
• Claims that one product can be dosed the same as another for the jawline were drawn from studies in other areas of the face, not from jawline trials.
• The paper contains some internal inconsistencies in its dates and references.

Taken together, this review is a useful map of techniques rather than strong proof of how well they work.

What it means for you

Neuromodulator along the jaw and neck may help some people, particularly those with prominent neck bands and good skin quality whose main issue is muscle pull. The effect is typically subtle and temporary, wearing off over several months, like other neuromodulator treatments. Our article on neck bands and the platysma explains who tends to be a reasonable candidate.

It is less likely to help when the main concern is loose skin, significant jowling, fat under the chin or bone loss along the jaw. In those situations, other approaches, a combination of treatments or a surgical opinion may be more appropriate. Our guide to early jowls covers some of those options.

Botulinum toxin type A is not suitable during pregnancy or breastfeeding, with infection at the injection sites, or for people with certain neuromuscular conditions. Possible side effects include bruising, tenderness and, rarely, temporary weakness of nearby muscles. In the neck, too much spread can, in uncommon cases, affect swallowing or neck strength, which is one reason careful dosing and an experienced injector matter.

Questions to ask at your consultation

• Is my jawline concern mainly caused by muscle pull, skin laxity, fat or bone change?
• What realistic change could neuromodulator make for me, and how long would it last?
• Which side effects are most relevant for treatment in the neck area?
• Would another approach, or no treatment, suit my goals better?

Frequently asked questions

Is the "Nefertiti lift" a facelift?

No. It does not lift or remove skin. It relaxes parts of a muscle that pulls the lower face down, which may slightly improve definition in suitable people. Results vary from person to person and fade as the medication wears off.

How many units are used?

Published approaches vary widely and there is no standard dose. Your physician would base any dose on your anatomy, muscle strength and goals, and usually starts conservatively.

Can it be combined with other treatments?

Sometimes. Some people combine it with filler or skin treatments, but this should be planned around an assessment of what is actually causing the change in your jawline.

If you are curious whether jawline neuromodulator could help you, HealthPark Medical Aesthetics in Sydney can assess your lower face and neck and discuss all the options, including whether treatment is worthwhile at all.

Source

Fernandes RL. Botulinum toxin type A and redefinition of the mandibular contour ("Nefertiti lift"): academic review. Mathews Journal of Dermatology, 2024. Read the study