Neck bands and platysmal bands: Botox, Nefertiti lift, and what actually works

Visible neck bands — the vertical cords that appear along the neck with age, expression, or weight change — are one of the most common complaints patients bring to med spas after addressing the face. They're also one of the more technically demanding areas to treat well. Here's what works.

Anatomy: what creates neck bands

The platysma is a thin, sheet-like muscle that runs from the upper chest and clavicle up across the neck to the lower jaw and face. With age, this muscle:
Loses support as facial fat and bone volume decrease
Develops increased resting tone in some individuals
Separates into discrete bands (platysmal banding) as the overlying skin loses collagen

Two types of neck aging:

Vertical platysmal bands: The vertical cord-like bands running from jaw to chest. Most visible when the patient clenches their teeth or flexes the neck. Dynamic bands (visible only with expression/flexing) respond better to Botox than static bands (visible at rest).

Horizontal neck lines ("necklace lines"): The horizontal creases running across the neck. Caused by repeated neck flexion and skin laxity. Separate from platysmal banding.

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Botox for platysmal bands

Botox (or any neuromodulator) injected directly into the platysma relaxes the muscle, reducing the prominence of the vertical bands. This is one of the most elegant uses of Botox — functional anatomy mapped precisely to a visible correction.

Who responds to Botox for neck bands

Good candidates:
Dynamic bands — visible predominantly when the patient flexes or expresses, not just at rest
Patients with good skin quality overlying the muscle
Patients with early-to-moderate banding, not severe long-standing bands

Poorer candidates:
Severe, prominent bands visible at full rest in photos
Patients with significant skin excess ("turkey neck") — Botox addresses muscle, not skin
Patients with bands where the skin has permanently stretched over prominent bands

The technique

The platysma is injected along the length of each band, with small aliquots (2–3 units per injection point, 4–6 points per band). The specific dosing varies by injector experience and band prominence.

Key risk: The platysma's action is depressing the lower face and assisting in neck flexion. Excessive Botox to the platysma can cause:
Difficulty swallowing (dysphagia) if too much toxin spreads to the strap muscles of the neck
Weakening of neck flexion
Flattening of the neck in a way that looks unnatural

This is not a beginner injection. Injectors should have specific experience with platysmal band treatment. The neck's anatomy — carotid artery, jugular vein, strap muscles — requires precise needle depth awareness.

Dose and duration

Typical total dose: 20–50 units of Botox across both bands (depending on severity)
Duration: 3–4 months, similar to other muscle relaxation treatments
Cost: $200–$600 per treatment depending on units used

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The Nefertiti lift

The Nefertiti lift (named for the Egyptian queen's famously defined jawline) combines:
Platysmal band injections (relaxing the muscle pulling the jaw down)
Injections along the jawline margin — targeting the depressor muscles pulling the lower face downward

The goal: By relaxing the downward-pulling platysma and depressors along the jaw, the upward-pulling facial muscles (zygomaticus, etc.) gain relative dominance — creating a subtle lift in the lower face and improved definition along the jawline.

What it achieves:
Softens platysmal bands
Subtly sharpens the jawline
Slightly lifts the jowl area
Does not add volume or remove skin — purely a muscle-relaxation lift

Who benefits most: Patients with early jowling, a slightly soft jawline, and platysmal pull visible on the lower face — particularly women in their 40s–50s who want a non-surgical, non-filler approach to lower face definition.

Total dose: 40–80 units of Botox across the bands + jawline margin. Cost: $400–$800.

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Treating horizontal neck lines

Horizontal necklace lines are more resistant to treatment than platysmal bands. Options:

Botox microdroplets (mesoBotox): Very small doses of diluted Botox injected superficially along horizontal lines can slightly soften their appearance by relaxing the underlying tension. Results are subtle.

Filler: HA filler injected very superficially along the deepest necklace lines — technically demanding and best done by experienced practitioners. Overcorrection risk; migration risk in thin skin.

RF microneedling (Morpheus8): Subdermal heating can improve skin texture and mild skin laxity on the neck. For early horizontal lines with a skin-quality component.

Laser resurfacing (fractional CO2 or erbium): Resurfacing the neck skin can improve fine horizontal creases, but the neck heals more slowly and scars more easily than the face. Aggressive resurfacing on the neck is generally avoided.

Honest expectation: Deep horizontal necklace lines are difficult to fully correct without surgery. Most non-surgical treatments improve rather than eliminate them.

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Surgical options for neck aging

For patients with significant platysmal banding at rest, significant skin excess, or advanced neck aging — non-surgical options produce limited improvement. A plastic surgery consultation for:

Platysmaplasty: Surgical tightening of the platysma muscle, often combined with liposuction of submental fat — the foundational surgical neck rejuvenation procedure
Neck lift / lower facelift: Addresses both muscle and skin in severe cases

Setting expectations: Botox for neck bands is excellent for early-to-moderate cases and as maintenance. Patients with significant resting bands and skin excess should be counseled honestly about the limits of Botox and when a surgical consultation makes sense.

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Questions to ask before booking

Are my bands dynamic (visible only with flexing) or static (visible at rest)? Which responds better to Botox?
Do you inject the platysma regularly, and what is your technique for avoiding the strap muscles?
For the Nefertiti component — how many units along the jawline vs the bands?
At my level of neck aging, is non-surgical treatment realistic, or should I consider a surgical consultation?
For horizontal lines — what do you realistically expect in terms of improvement?

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