A patient sits down and names one problem. “My jawline is sagging.” They want one answer. What they aren’t thinking about is their smile, their speech, or how comfortably they’ll eat dinner that night, because none of that is what brought them in. That gap between what a patient asks and what a treatment actually touches is where new injectors get caught off guard.
A new clinical trial on lower-face Botox is a useful example of exactly this problem. Botulinum toxin can create a real, measurable lift in the lower face by weakening the muscles that pull it downward, particularly the depressor anguli oris (DAO) and the platysma. The data even show that treating more of those muscles produces more lift. But those same muscles control how a patient smiles, speaks, and moves their mouth day to day, and the study also found that broader treatment came with more side effects. The patient asking about their jawline was never thinking about any of that. The provider has to be.
That is the real skill this study points to for a new injector: not memorizing an injection map, but learning to think through a treatment fully before a patient ever sits in the chair, so you can guide the conversation and the result instead of reacting to one the patient didn’t expect.
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New injectors are trained to answer the question in front of them. A patient asks about a jawline, a provider reaches for a jawline answer. That instinct makes sense, but it treats the visit like a single transaction instead of a full clinical assessment.
Every muscle in the face is connected to more than one function. Weakening a muscle to soften a downward pull can also change how that muscle contributes to a smile, a word, or a bite. A patient focused on one visible concern has no reason to think about any of that. Anticipating it is the provider’s job, not the patient’s.
The lower face works like a tug-of-war. Some muscles lift. Others pull downward. Two of the primary downward-pulling muscles are the depressor anguli oris (DAO), which pulls the corners of the mouth down and can make a resting face look unhappy even when it isn’t, and the platysma, a broad, thin muscle that runs from the lower face into the neck and contributes to downward pull along the jawline.
Botulinum toxin temporarily weakens muscle contraction. Carefully weakening some of those downward-pulling muscles gives the upward-pulling muscles relatively more influence, which can produce a subtle lift or repositioning of lower-face tissue. That is the mechanism a new trial set out to measure.
The trial, published in Aesthetic Surgery Journal on August 18, 2026, enrolled 80 patients and divided them into four groups, each receiving a different number and distribution of botulinum toxin injections into the platysma and DAO. Instead of relying on before-and-after photos or subjective opinion, researchers measured tissue position using three-dimensional stereophotogrammetry at 15, 30, and 90 days. They also recorded patient satisfaction and adverse effects using validated outcome measures. (Munoz-Lora et al.)
All four treatment approaches produced measurable lifting, confirmed by 3D imaging rather than patient impression alone. As the number and distribution of injection points increased, so did the amount of tissue displacement, a statistically significant relationship. In practical terms, broader treatment of the downward-pulling muscles generally produced more lift than treating a small area alone.
The groups receiving intermediate to more extensive treatment also maintained more of their improvement over time, with most patients reporting their best results around 30 days rather than immediately.
But more treatment wasn’t automatically better. The group receiving the most extensive treatment also reported more adverse effects at 90 days. That doesn’t mean broader treatment is unsafe. It means more muscle coverage creates more lift while also interfering with more of the muscle function patients rely on daily: smiling, speaking, eating, and expressing emotion. There is a point where chasing additional lift may not be worth the functional trade-off, and that point looks different for every patient.
Imagine a patient asks, “My jawline is sagging. Can Botox fix it?” A common answer from a newer injector is simply “yes.” A better answer accounts for what the patient hasn’t considered: “Botulinum toxin may create a subtle lifting effect in some patients by reducing the downward pull of certain muscles. How much improvement you’ll see depends on your anatomy and what’s actually causing the change in your lower face.”
That second answer does two things at once. It sets an honest expectation, and it signals that Botox can’t fix everything. If the underlying cause is significant skin laxity, volume loss, heavy jowling, bone structure, or substantial fat displacement, weakening the platysma won’t correct it. This study supports a muscular lift, not a nonsurgical facelift, and that distinction matters when a patient is deciding what treatment to pursue.
Build this habit into every new treatment you learn, not just this one. Before you see the patient, think through what they’re likely to assume by default, what they haven’t thought to ask, and what’s actually happening in the tissue beyond their stated concern. Prepare your answer to the question they haven’t asked yet, not only the one they did. That preparation is what lets you guide a result instead of explaining an unexpected one after the fact.
Two injectors can use the same total number of units, distribute them differently, and get different results. That’s why good aesthetic medicine training spends as much time on facial anatomy, muscle function, and patient assessment as it does on injection maps. A treatment map is a starting point, not the final path. Understanding where a given patient’s trade-off lies between lift and function is what determines whether a treatment plan actually fits that patient.
For providers building this foundation, IAPAM offers online and hands-on CME Botox® training options. Training covers the anatomy and assessment skills that sit underneath any injection technique, including lower-face treatment.
The study also found that patients with a higher BMI tended to show less tissue displacement from treatment. That doesn’t mean botulinum toxin doesn’t work at a higher BMI. A more reasonable interpretation is that the visible effect of changing muscle pull can be influenced by the tissue sitting over those muscles. The same treatment doesn’t produce the same cosmetic result on every face, which is one more reason patient selection and honest expectation-setting belong in every consultation, not just complex ones.
IAPAM’s Aesthetic Medicine Symposium is designed for physicians, nurse practitioners, and physician assistants who want to add aesthetic services to their practice — or formalize and expand what they are already doing. The program is hands-on, taught by board-certified dermatologists, and held in an actual clinical setting in Scottsdale, Arizona — not a hotel conference room. It covers injectables, lasers, skin treatments, medical weight management, and the business fundamentals of running a profitable aesthetic practice. If you are a licensed provider who is serious about doing this correctly and profitably, the next available dates are September 18–21, 2026 and November 13–16, 2026 in Scottsdale, AZ. Call 1-866-211-6901 with questions.
What is the DAO botox injection technique used for?
Injecting botulinum toxin into the depressor anguli oris weakens its downward pull on the corners of the mouth, which can soften a resting frown appearance and contribute to a subtle lift when combined with treatment of nearby muscles like the platysma.
Can Botox really lift the jawline?
It can create a measurable, muscle-based lift by reducing downward pull along the jawline, but it doesn’t address sagging caused by skin laxity, volume loss, or bone structure. Setting that expectation with patients is part of the treatment.
What’s the difference between platysma botox and a Nefertiti lift?
“Nefertiti lift” is a commonly used patient-facing term for treatments that target the platysma and jawline muscles to create a lifted, more defined lower face and neck contour. Platysma botox injection points are the clinical technique behind that outcome.
How many injection points are used in lower-face Botox treatment?
The number varies by patient and treatment goal. Recent trial data show that more injection points generally produce more measurable lift, but the right number for a given patient depends on their anatomy and how much functional trade-off they’re willing to accept.
What are the risks of treating more muscles in the lower face?
Broader treatment increases the chance of side effects because the DAO and platysma contribute to everyday functions like smiling, speaking, eating, and expression. More extensive treatment groups in recent research reported more adverse effects at 90 days.
Does BMI affect Botox results in the lower face?
Recent findings suggest patients with a higher BMI showed less measurable tissue displacement after treatment, likely related to the tissue overlying the treated muscles rather than the treatment failing to work.
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