Neck Botox and Platysmal Bands: What It Treats and What It Cannot
Reviewed for medical accuracy against our Medical Review Board · Last updated 19 August 2026
Part of Botox Guides: Basics, Dosing and Safety
Neck Botox treats the vertical cords that stand out when you tense your neck, and it takes roughly 25 to 50 units. It does very little for the horizontal creases people photograph and call tech neck, because those are skin rather than muscle. This is also the area where getting it wrong carries the most serious consequences.
Two completely different complaints arrive under the same heading. One responds well to a neurotoxin. The other does not respond at all, and being sold the treatment anyway is the most common disappointment in this area.
1. Two different necks, one treatment
When people say they want something done about their neck, they almost always mean one of these, and the two have nothing in common except location:
| What you see | What it is | Does Botox help? |
|---|---|---|
| Vertical cords running down the front of the neck, most obvious when you tense or talk | Platysmal bands: the edges of a sheet of muscle pulling tight | Yes. This is the treatment. |
| Horizontal rings or creases across the neck, visible when still | Skin: sun damage, laxity, and years of looking down | Barely. This is not a muscle problem. |
The second one is what most people mean by tech neck, and it is the one clinics are most often asked about. It is worth being clear before you spend anything: relaxing a muscle does not remove a crease that is set into the skin. Section 7 covers what does.
2. The mirror test that tells you which you have
Do this now. Face a mirror and clench your teeth hard while pulling the corners of your mouth down, as though grimacing. If vertical cords spring up down the front of your neck, that is platysma, and Botox will soften it. Now relax completely. Whatever horizontal lines remain visible at rest is skin, and a neurotoxin will not remove those.
Most people over forty have some of both, in which case the honest answer is that Botox handles part of the problem and something else handles the rest. An injector who tells you a single treatment fixes both is either not looking or not telling you.
3. The platysma, and why it pulls down
The platysma is a broad, thin sheet of muscle running from the collarbone up over the front of the neck and into the lower face. It is unusual: most facial muscles are compact, and this one is a wide sheet just under the skin.
Its action is to pull down. It depresses the corner of the mouth and drags on the jawline. As it thickens and tightens with age, two things happen. The free edges of the sheet start to stand out as visible vertical cords, and the constant downward pull works against the muscles that hold the lower face up.
That second point is the interesting one, and it is what section 4 is about. Relaxing a muscle whose job is to pull down does more than just soften the cords.
4. The Nefertiti lift, and what it can honestly do
The Nefertiti lift is the name given to treating the platysma along the underside of the jawline as well as in the neck, so the downward pull is released along the mandibular border. The name refers to the jawline on the famous bust.
What it can genuinely do: soften the cords, reduce the downward drag, and give a slightly crisper jawline in someone whose jawline is being pulled on rather than buried.
What it cannot do, and this needs saying because it is marketed hard:
- It is not a substitute for a neck lift. If there is loose skin, it will still be loose. Releasing a muscle does not remove tissue.
- It does not treat submental fat. A full under-chin area is a volume problem, and relaxing the platysma does nothing to it. That is a different treatment entirely, which our Botox versus Kybella comparison covers.
- The effect is subtle. Expect a softening, not a transformation. Before-and-after photographs of this treatment are frequently taken at different head angles, which does more work than the injection did.
It is a good treatment for the right neck. It is oversold for every other neck.
5. How many units, and why the range is wide
The usual working range is 25 to 50 units across the neck and jawline, and the range is wider here than anywhere else on the face for a simple reason: it depends entirely on how many bands you have and how long they are.
- Two prominent bands might take 20 to 30 units in total, placed along the length of each cord rather than in one spot.
- A Nefertiti approach adds a line of small doses along the underside of the jaw, pushing the total higher.
- Injections are placed along the band, not clustered, because the target is a long thin edge of muscle rather than a compact bundle.
- Superficial is the point. The platysma sits directly under the skin. Depth is covered in the next section and it is the thing that matters most here.
Treating the neck is off-label in the United States, as is everything except frown lines, crow's feet and forehead lines. Full dosing for every area is in our units guide and calculator.
6. The one area where the risk is genuinely serious
Everywhere else on this site, the honest summary of risk is that mistakes are temporary and cosmetic. The neck is different, and it deserves a plain warning rather than a reassuring one.
Directly beneath and around the platysma are the muscles you use to swallow and to hold your head up. Botox injected too deeply, or in too large a dose, can affect them. The recognised risks are:
- Difficulty swallowing. This is the one that matters. It is uncommon with correct technique, and it is the reason the injection has to stay superficial in a sheet of muscle that sits just under the skin.
- Neck weakness. A heavy-headed feeling, most noticeable lifting your head from a pillow or holding it forward.
- Voice changes or hoarseness, from spread towards the structures of the larynx.
- An uneven smile, since the platysma connects into the lower face and the muscles that move the mouth are close by.
All of these resolve, because there is no reversal agent and everything wears off. But "it resolves in three months" is a far less comfortable sentence when the symptom is trouble swallowing than when it is a heavy brow.
What this means practically. This is not the area to try a new injector, a mobile service or a discounted package. Ask how many necks they treat, how they keep the injection superficial, and what they would do if you had trouble swallowing afterwards. A clinician who has thought about it will answer immediately. Confirm they hold a current license too: it is free and public, and we list the lookup for every state in how to verify a Botox injector's license.
7. What actually works for horizontal neck lines
If your mirror test showed lines at rest, here is the honest menu, and Botox is not on it:
- Skin boosters and hyaluronic acid, placed to hydrate and thicken thin neck skin. See Botox versus skin boosters.
- Microneedling and radiofrequency microneedling, which work on the collagen in the skin itself. See Botox versus microneedling.
- Energy-based tightening for laxity, covered in Botox versus radiofrequency tightening.
- Sun protection on your neck, which almost nobody does and which is the reason neck skin so often looks a decade older than the face above it.
- Surgery, if there is genuine skin excess. Nothing injectable substitutes for it.
A realistic plan for most people over forty is Botox for the bands plus a skin treatment for the creases, staged rather than combined.
8. What it costs at real published rates
Below is 25 to 50 units against the per-unit prices published by clinics in the cities we verify.
| City | Published rate per unit | 25 to 50 units |
|---|---|---|
| Atlanta, GA | $9 to $15 | $225 to $750 |
| Austin, TX | $11 to $13.5 | $275 to $675 |
| Charlotte, NC | $9 to $15 | $225 to $750 |
| Chicago, IL | $9 to $15 | $225 to $750 |
| Denver, CO | $10 to $16 | $250 to $800 |
| Las Vegas, NV | $10 to $16 | $250 to $800 |
| Nashville, TN | $10 to $14 | $250 to $700 |
| Phoenix, AZ | $9.99 to $13 | $250 to $650 |
| Raleigh, NC | $13 to $14 | $325 to $700 |
| San Antonio, TX | $10.5 to $12.5 | $262 to $625 |
| Scottsdale, AZ | $10.5 to $13.5 | $262 to $675 |
| Tampa, FL | $10 to $18 | $250 to $900 |
Several clinics price the neck as a package rather than per unit, sometimes described as starting from a figure. As with the masseter, ask how many units that covers and what happens if you need more. Our Botox price guide covers the per-unit versus per-area question.
9. How long it lasts
Roughly three to four months, similar to the upper face, with onset in a few days and full effect at about two weeks.
Some people find neck results fade a little sooner. The platysma is large, the dose is spread thin along the length of each band rather than concentrated, and the muscle is active whenever you talk or swallow. A thin dose in a busy sheet of muscle recovers faster than a concentrated dose in a compact one, which is the same reason described for the forehead.
It does not build the way masseter treatment does, because you are not waiting for the muscle to shrink. What you get at two weeks is what the treatment does.
10. What to ask before you agree
- Are my bands muscle, or is my problem skin? Ask them to show you in the mirror, tensed and relaxed.
- How many necks do you treat? A fair question here in a way it is not for a forehead.
- How do you keep the injections superficial? You are listening for an answer about depth and about the muscles underneath.
- What would you do if I had trouble swallowing afterwards? There should be an immediate answer and a way to reach them.
- How many units, and is this priced per unit or as a package?
- What would you use for my horizontal lines, if anything? An honest injector will tell you Botox is not the answer for those.
Frequently asked questions
How many units of Botox for the neck?
Does Botox get rid of tech neck lines?
What are platysmal bands?
What is a Nefertiti lift?
Is neck Botox dangerous?
How much does neck Botox cost?
Is neck Botox FDA approved?
How long does neck Botox last?
