{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T16:54:45Z","timestamp":1793724885845,"version":"4.6.1"},"reference-count":78,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Background: Treatment of the lower face with botulinum toxin type A (BoNT-A) is particularly challenging because of the important functional roles of the involved muscles, which increases the risk of adverse events and complications. Methods: To address this issue, a panel of 14 experts conducted a three-round consensus study, including digital surveys and a formal meeting, on the aesthetic treatment of the mentalis (MT), depressor anguli oris (DAO), and platysma (PL) muscles using BoNT-A. The study was complemented by a literature review of 16 international consensus papers published between 2004 and 2024. Results: The primary indications for MT treatment that achieved strong consensus were \u201cpeau d\u2019orange\u201d (\u201cgolf ball\u201d) chin appearance and hyperactivity. The Italian panel recommended a mean total dose of 8 U (distributed bilaterally), which was higher than the international mean dose of 6.5 U. The preferred injection technique consisted of a combination of intramuscular and intradermal injections. For the DAO, the strongest indication was correction of downturned oral commissures. Both the Italian panel and the international consensus reported a mean total dose of 5.6 U. Most experts (92.8%) preferred intramuscular injections, typically administered at a single injection point lateral to the marionette line in order to remain within a safe treatment zone and avoid diffusion to the depressor labii inferioris muscle. Indications for PL treatment included platysmal bands, jawline recontouring, and improvement of skin texture. The techniques discussed included treatment of both platysmal bands and the jawline. The consensus panel recommended a significantly higher mean total dose (48.4 U) than the international average (38.2 U). The paper also highlights the growing importance of ultrasound imaging as a tool for identifying individual anatomical variations in the lower facial musculature. Conclusions: As the demand for lower face rejuvenation continues to increase, standardized injection techniques and the integration of ultrasound imaging are essential for minimizing functional complications and optimizing aesthetic outcomes.<\/jats:p>","DOI":"10.3390\/toxins18080332","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T13:23:20Z","timestamp":1785504200000},"page":"332","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Italian Consensus and Review in Lower Face Mimetic Muscle Treatment with Botulinum Toxin-A"],"prefix":"10.3390","volume":"18","author":[{"given":"Salvatore","family":"Fundar\u00f2","sequence":"first","affiliation":[{"name":"Qute Clinic, Via Zucconi 92, 41126 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Molinari","sequence":"additional","affiliation":[{"name":"Private Practice, Via Pietro Giardini 45, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Brunelli","sequence":"additional","affiliation":[{"name":"Private Practice, Via Guido Zadei, 64, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Cazzulani","sequence":"additional","affiliation":[{"name":"Master of Aesthetic Medicine of the Face, Unicamillus International Medical University, 00131 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Dalla Costa","sequence":"additional","affiliation":[{"name":"Private Practice Clinica Citt\u00e0giardino, Via Francesco Piccoli 6, 35123 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2822-4335","authenticated-orcid":false,"given":"Roberto","family":"Dell\u2019Avanzato","sequence":"additional","affiliation":[{"name":"Rigenera Care, Via Carlo Marenco 32, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3635-5391","authenticated-orcid":false,"given":"Roberta","family":"D\u2019Emilio","sequence":"additional","affiliation":[{"name":"Private Practice, Via Filippo Antonio Gualterio, 127, 00139 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Di Gregorio","sequence":"additional","affiliation":[{"name":"Plastic Reconstructive Aesthetic Surgery Private Practice, Via Roma, 325, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Franceschelli","sequence":"additional","affiliation":[{"name":"Master of Aesthetic Medicine of the Face, Unicamillus International Medical University, 00131 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5730-4302","authenticated-orcid":false,"given":"Monica","family":"Renga","sequence":"additional","affiliation":[{"name":"Private Practice, Via della Moscova, 40\/1, 20121 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Salti","sequence":"additional","affiliation":[{"name":"Private Practice, Via Claudio Monteverdi, 2, 50144 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0500-461X","authenticated-orcid":false,"given":"Adriano","family":"Santorelli","sequence":"additional","affiliation":[{"name":"Private Practice, Via Raffaele Morghen, 88, 80129 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo Simone","family":"Urso","sequence":"additional","affiliation":[{"name":"Private Practice, Via Roma, 2, 40069 Zola Predosa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Zollino","sequence":"additional","affiliation":[{"name":"Private Practice, Via Marcello Tassini, 6, 44123 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/S1064-7406(23)00393-0","article-title":"Anatomy and pathophysiology of facial aging","volume":"9","author":"Zimbler","year":"2001","journal-title":"Facial Plast. 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