Vertical bands that stand out down the front of the neck, especially when you talk, grimace or tense your neck, are called platysma bands. In October 2024, BOTOX® Cosmetic was FDA-approved to treat them. At Shield Dental Care in Burke, VA, Dr. Ghorbani treats neck bands as part of our Botox service.

What causes neck bands

The platysma is a thin, flat sheet of muscle just under the skin of the neck. It runs up over the jawline into the lower face. When it tightens, its edges can stand out as vertical cords down the neck, and its pull on the lower face can make the jawline look less defined.

How Botox helps, and the approved dose

Small amounts of Botox placed along the bands and the jawline relax the muscle, so the bands stand out less and there is less downward pull on the jaw. BOTOX Cosmetic is FDA-approved for the temporary improvement in the appearance of moderate to severe platysma bands in adults. The approved dose depends on how many bands you have:

  • 26 units for one band on each side
  • 31 units for one band on one side and two on the other
  • 36 units for two bands on each side

The dose is spread over many small, shallow injections: 2 units at each of four points along each side of the jawline, and 1 unit at each of five points along each band. The label says the injections go into the platysma only, never into the deeper structures at the front of the neck, and at least a centimeter below the edge of the jaw.

BOTOX Cosmetic is the only product approved for this area. Using Dysport or Daxxify on the neck is off-label, which is legal, and we will always tell you when a use is off-label.

Limits worth knowing

Botox relaxes muscle. It does not tighten loose skin on the neck, remove fullness or fat under the chin, or treat horizontal creases in the neck. If those are the main concern, Botox will make only a small difference, and we will tell you that at the consultation.

What to expect

  • Consultation. We ask you to tense your neck so we can see each band, and review your medical history and medicines, including any problems with swallowing or breathing.
  • Treatment. Each band is gently pinched away from the deeper tissue while the small injections are made along it and along the jawline. It takes a few minutes.
  • Afterwards. You can go straight back to your day, with written aftercare.

The change starts to show within a few days and builds over about two weeks. Movement then gradually returns over the following months. Treatment should not be repeated more often than every three months.

Neck-specific risks

As with any injection, small bumps, redness or a bruise can appear where the needle went in. In the trials, the side effects of BOTOX Cosmetic for neck bands were in line with those seen for its other approved uses. Because the neck contains the muscles you use to swallow, speak and help you breathe, these points matter here:

  • Trouble swallowing. Botulinum toxins can cause swallowing or breathing difficulty, which can be life-threatening. People who already have swallowing or breathing problems are at the highest risk. Tell us about any before treatment.
  • Neck weakness and breathing. The label warns that botulinum toxins may weaken neck muscles that help with breathing, which matters most for people with lung or breathing conditions.
  • Voice changes. Hoarseness, a change in your voice or trouble saying words clearly are among the signs that the effect has spread.

All botulinum toxin products carry an FDA boxed warning: rarely, the effect can spread away from the injection site, causing trouble swallowing, speaking or breathing, vision problems or general muscle weakness, hours to weeks after treatment. These are medical emergencies. If they happen, get help immediately.

Who should wait

  • Anyone pregnant or breastfeeding. Cosmetic botulinum toxin has not been adequately studied in pregnancy, so we recommend waiting.
  • Anyone allergic to a botulinum toxin product, or with an infection or skin problem where the injections would go.
  • Anyone with a nerve-and-muscle condition such as myasthenia gravis, Lambert-Eaton syndrome or ALS, or with existing swallowing or breathing problems.
  • Tell us if you take blood thinners, have recently taken aminoglycoside antibiotics, or have had any botulinum toxin treatment in the last four months.

Neck bands can be treated at the same visit as jaw slimming or downturned mouth corners. To book, contact us.

FAQ

Frequently Asked Questions

Is Botox for neck bands FDA-approved?+

Yes. BOTOX Cosmetic was FDA-approved in October 2024 for the temporary improvement of moderate to severe platysma bands in adults. Dysport and Daxxify are not approved for the neck.

How much Botox is used for neck bands?+

The approved dose of BOTOX Cosmetic is 26, 31 or 36 units, depending on whether you have one or two bands on each side, spread across the bands and the jawline.

Can Botox for the neck affect swallowing?+

It can. Trouble swallowing, breathing or speaking after treatment needs urgent medical help. The risk is highest in people who already have swallowing or breathing problems, so tell us about any before treatment.

Will Botox tighten loose skin on my neck?+

No. Botox relaxes the muscle that forms the bands. It does not tighten loose skin or remove fat under the chin.