Resumo

Objectives: Can we obtain lifting, how much and how to maximise lift utilising botulinum toxin Introduction: While Botulinum Toxin Type A (BoNT-A) is predominantly used for the treatment of static and dynamic rhytides, its potential for achieving non-surgical facial and neck lifting remains a critical area of optimization. Dynamic aging is heavily influenced by the hyperfunction of muscle depressors, leading to apparent gravitational descent of features like the brow, jowl, and neck. Maximizing the lifting effect requires a strategic shift from strictly treating lines to achieving functional muscle balance. Materials / method: To systematically review and synthesize the current global literature on multi-vector BoNT-A protocols designed to maximize the lifting effect of the brow, jawline, and neck, thereby establishing evidence-based best practice recommendations for practitioners. A systematic literature search was conducted across major electronic databases focused on clinical studies and established protocols detailing multi-site injection for lifting effect. Data on optimal injection patterns, unit dosing, and objective efficacy metrics were extracted to identify common, effective strategies. Results: The review identified three consistently reported key depressor muscle targets for maximizing the lifting effect: the superior lateral platysma (for neck and jawline contouring), the depressor anguli oris (DAO) (for mouth corner elevation and jowl reduction), and the lateral orbicularis oculi (for the brow lift). Synthesis of pooled data suggests that simultaneous treatment of these three vectors is the most highly reported and effective approach, with studies citing mean objective brow height increases of up to 2.5 mm and significant reported improvement in jawline definition. Conclusion: Multi-vector injection of BoNT-A targeting the three principal depressor muscles (platysma, DAO, and orbicularis oculi) is an evidence-based strategy for optimizing non-surgical lifting. The synthesized "Triple-Depressor Protocol" offers a standardized, highly efficacious approach for functional facial and neck contouring based on current literature.