Neck bands tell stories most faces try to hide. The thin, vertical cords you see when someone grimaces or says an emphatic “Eee” are platysmal bands, and they can steal attention from an otherwise well-balanced face. Softening those lines with botulinum toxin is not a beginner’s maneuver. The anatomy is deceptively simple, yet the margin for error feels narrow because the neck guards critical functions: swallowing, speaking, and head posture. Done thoughtfully, treatment lightens the neck, refines the jawline, and harmonizes the lower face without looking frozen or tight.
What follows is the way experienced injectors tend to approach platysmal band softening. I will cover assessment, realistic outcomes, dosing ranges, dilution logic, and practical technique. I’ll also point out pitfalls that even careful clinicians sometimes fall into, and how to avoid them.
What the platysma actually does
The platysma is a thin, superficial muscle sheet that runs from the mandibular border down over the front of the neck into the upper chest. It pulls the lower face and skin of the neck downward, helps shape the cervicomental angle, and with age, can separate into distinct vertical bands that animate with speech and expressivity. Those bands are dynamic. If you see cords at rest, you are dealing with both static skin laxity and dynamic pull.
Two forces drive what we see: thinning skin and collagen loss overlying a muscle that becomes more hyperactive and sometimes fibrous with age. In younger patients, bands mostly appear with animation. In older necks, the bands etch in, and the skin itself folds, so toxin alone will not erase them. Recognizing whether the concern is dynamic, static, or mixed determines your plan, and it sets the bar for outcome expectations.
Who benefits, and who does not
The ideal candidate is someone with visible, dynamic vertical bands that become prominent when saying “Eee” or grimacing, and with reasonable skin quality. A patient in their 30s to 50s with early banding, good subcutaneous volume, and modest laxity tends to get the cleanest result. For thicker necks, heavy subcutaneous fat, or significant skin laxity, toxin can soften movement but will not redefine structure. In these cases, combining approaches usually works better. Energy devices or microneedling radiofrequency can contract skin modestly. Submental fullness may call for deoxycholate injections or liposuction. Significant platysmal laxity and diastasis can require surgical corset platysmaplasty.
Contraindications include pregnancy, breastfeeding, neuromuscular disorders, and a history of dysphagia. Prior neck surgery or radiation requires caution. A history of voice changes, chronic cough, or swallowing issues warrants a conversation and possibly a conservative test dose, or referral.
Setting expectations that hold up
If you treat only the bands and ignore the lower face, some patients will feel little change in their overall look. Explain that the goal is to soften vertical lines when speaking, create a calmer neck at rest, and sometimes achieve a subtle lift of the jawline if the depressor effect of platysma is reduced. The results are more about neatness and serenity than theater.
Onset is gradual. Most feel improvement by day 5 to 7, with peak effect by two weeks. Duration tends to be shorter in the neck than in the glabella or forehead. A practical range is 8 to 12 weeks for noticeable softening, sometimes stretching to 14 weeks in first-time, low-dose patients who return promptly for maintenance. Heavy exercisers and fast metabolizers often run shorter. I tell patients to plan treatments three to four times per year if they like a consistently soft look.
Dosing philosophy, not just numbers
Textbook numbers exist, yet every neck needs its own calculus. Consider muscle thickness, band width and length, asymmetry, and whether your target is focal bands versus a broader Nefertiti-type approach to the mandibular border and lower face.
For standalone band injections with onabotulinumtoxinA (the most studied in this zone), practical total doses often fall in the 20 to 60 unit range across the entire neck. Leaner, younger patients with two focal bands may need 10 to 20 total units. Heavier bands or more numerous cords can require 40 to 60 units. Some advanced cases go higher, but push beyond 60 units only with clear rationale, conservative dilution, and precise placement. With abobotulinumtoxinA, adjust for unit equivalency. With incobotulinumtoxinA or prabotulinumtoxinA, many clinicians use onabotulinumtoxinA-equivalent numbers but respect each product’s known pattern of spread.
Dilution deserves a moment. Higher concentration delivers control. In the neck, where diffusion risks dysphagia or voice weakness, I prefer a tighter dilution for bands, commonly 2.5 to 4 units per 0.1 mL with onabotulinumtoxinA. If you prefer very small aliquots, you can concentrate further. The Nefertiti lift or broad platysma fan may justify a slightly more dilute mix to cover a larger area, but stay conservative over the midline and above the hyoid.
Anatomy worth re-visualizing each time
The platysma lies superficially, typically within the subcutaneous plane just below the dermis. Bands become more palpable and visible with animation, which makes targeting straightforward. The great hazard is deeper injection that touches the infrahyoid strap muscles or diffuses toward the pharyngeal constrictors, both of which can alter swallowing or voice. Staying superficial and within the band, with small aliquots, reduces that risk.
Marking the mandibular border matters. If you plan a Nefertiti component, staying 1 to 1.5 cm below the mandibular margin helps avoid the marginal mandibular nerve. A simple, consistent rule lowers stress in busy clinics.
The patient exam that steers your map
I ask patients to make an exaggerated “Eee” and then to grimace gently. I watch which cords pop first and which stay visible as the patient relaxes. I confirm how far superiorly the bands run, and whether they reach near the mandibular border. I palpate to check band thickness and note asymmetry. I assess skin redundancy at rest, the cervicomental angle, and whether there is submental fullness pushing forward. Finally, I evaluate lower-face dynamics, especially DAO and mentalis activity, because treating the platysma alone sometimes unmasks imbalances higher up.
If the patient previously had toxin in the lower face or neck, I document timing, product, and dose. A history of even mild dysphagia after prior neck treatment nudges me toward smaller aliquots and a staged plan.
The core injection technique for bands
I seat the patient at 60 to 80 degrees so gravity shows what people see in real life. After aseptic prep, I mark the bands lightly with a non-permanent skin pencil while the patient says “Eee.” I use a 30 or 32 gauge half-inch needle. A 1-inch needle encourages over-penetration in this superficial muscle.
Injections are intramuscular, but the muscle is thin and close to the skin. I tent the band slightly to secure it, then enter perpendicular at shallow depth. The bleb should feel superficial and confined. If it feels too easy, check that you are not in the dermis. If there is too much resistance, you may be pinching too much skin and missing the band.
Most bands can be treated with a series of small deposits spaced along the visible length of the cord. Aliquots of 1 to 2 units per point with onabotulinumtoxinA are common, spaced roughly 1 to 1.5 cm apart. For a typical single band, 6 to 12 units often suffices, divided among 4 to 8 points. When treating both sides, totals frequently reach 20 to 40 units. Wider, thicker bands may need 2 units per point, perhaps 6 to 10 points per side, depending on length. I avoid midline deepening and stay superficial over the laryngeal prominence, where diffusion matters more.
After the bands, I recheck animation. If an inferior segment remains stubborn, add one small spot rather than raising every aliquot. Precision beats volume in the neck.
The Nefertiti add-on and when to use it
If patients lament a heavy jawline or downturned corners in addition to bands, relaxing the platysma insertion along the mandibular border can add a subtle lift. This is not a facelift substitute, but in the right face, it sharpens the lower cheek-to-jowl transition and lightens the downward pull at rest.
I start by marking a line 1 to 1.5 cm below the mandibular margin from the mid-mandible to just anterior to the angle, staying anterior to the sternocleidomastoid. Small aliquots, often 1 to 2 units per point with onabotulinumtoxinA, placed 1 to 1.5 cm apart, usually suffice. Typical totals for this component range from 8 to 15 units per side when done alone, less if combined with direct band injections. The key is avoiding over-relaxation that may de-emphasize natural mandibular definition, especially in patients with existing tissue laxity.
Avoiding trouble: the judgment calls that matter
Two complications dominate discussion in this area: dysphagia and voice changes. Most cases are mild and transient when they occur, but prevention is the smarter path. Stay superficial. Inject into the palpable band, not the soft tissue next to it. Keep doses per point small. Avoid heavy, diffuse injections over the midline and the subhyoid area. Use tighter dilution for precision.
Posture-related heaviness can occur if you over-relax the platysma in someone who relies on it subconsciously for neck tension. Patients who do a lot of hot yoga or high-repetition neck exercises sometimes feel “weak” in a way that is hard to describe. In athletes, I reduce dose and recommend spacing sessions so they can judge comfort.
Asymmetry is another trap. Some people have three strong bands on one side and only one on the other. Match dose to the muscle you see, not to the urge for symmetry on paper. If one band drops beautifully and a neighbor still pulls, the patient will interpret that as uneven aging rather than an injection imbalance. Also watch the interplay with DAO and mentalis. If you lessen the downward pull of the platysma but a strong DAO remains, marionette shadows may look harsher. A conservative, balanced plan across the lower third preserves harmony.
What to do when bands remain at rest
Static banding at rest signals skin laxity or fibrous change. Toxin softens motion but cannot rebuild a crisp cervicomental angle if the tissue itself lacks support. Combine approaches. Collagen-stimulating options, including radiofrequency microneedling or ultrasound-based tightening, help in mild to moderate laxity. For heavier tissue or fat pads, debulking via liposuction or deoxycholate can improve the framework so toxin reads better. In truly advanced cases with pronounced diastasis and crepey skin, surgery is the right language. Offering toxin alone in these necks tends to disappoint.
Managing product choices and unit translation
OnabotulinumtoxinA remains the most commonly referenced for neck work, and the dosing guidance above assumes its unit frame. Clinicians switching between abobotulinumtoxinA and onabotulinumtoxinA use established conversion awareness, but approach the neck with fresh caution until familiar with each product’s spread profile at your chosen dilution. IncobotulinumtoxinA and prabotulinumtoxinA perform similarly to onabotulinumtoxinA in many facial zones for experienced injectors, yet the neck punishes sloppy spread. If you change products, reduce the first session dose, review at two weeks, and layer if needed.
Real numbers from exam rooms
A 42-year-old fitness instructor with two dominant bands per side and minimal skin laxity: 24 total units of onabotulinumtoxinA, 3 to 4 units per band per side divided across 3 to 4 injection points, at a concentration of 2.5 units per 0.1 mL. Recheck at 14 days showed clean softening with no dysphagia. She repeats every 10 to 12 weeks.
A 58-year-old with four distinct bands, mild submental fullness, and early jowling: 48 total units for bands, plus a conservative Nefertiti of 12 units per side spaced along the mandibular line, staying 1.5 cm inferior to the border. At two weeks, bands softened well, jawline subtly lighter. At three months, she added radiofrequency microneedling to the central neck to address the remaining laxity at rest. The combination performed better than either alone.
A 66-year-old with etched bands at rest local botox services near me and significant skin redundancy: 32 units yielded modest improvement in animation only. We discussed a surgical consult. She opted for lower face and neck lift, then resumed low-dose maintenance toxin six months later to preserve surgical crispness.
The aftercare that actually matters
Neck toxin aftercare is pragmatic. I ask patients to avoid strenuous neck workouts and massage for 24 hours, to skip sauna or hot yoga the day of treatment, and to keep their hands off. Normal head turning and daily life are fine. I encourage gentle hydration and to report any swallowing discomfort, voice changes, or unusual tightness. Most adverse sensations are mild and pass within days. If someone notices minor swallowing effort with solids, I advise slow bites, mindful chewing, and room-temperature fluids for a week. Significant or progressive symptoms deserve evaluation.
Stitching the neck to the rest of the face
A refined neck highlights everything above it. If the glabella is serene but the neck shouts, the contrast distracts. Align timing across zones. Many practices pair band softening with low-dose lower-face toxin in DAO and mentalis, and conservative filler support along the prejowl sulcus or chin, if indicated. If you are integrating other treatments like botoxforforeheadwrinkles or botoxforcrow’sfeet, schedule them in the same session to keep onset synchronized, unless you are testing first-time neck dosing for safety.
For patients exploring broader non-surgical care, the conversation may extend to topics like botoxforjawlineslimming or botoxformasseterreduction, especially when masseter hypertrophy widens the lower face and overshadows the neck. Tasteful sequencing matters. I prefer to address masseters first if they are large, then revisit the neck at the next visit to judge the new balance.
Costs, expectations, and cadence
The botoxcost for neck treatment varies by region and practice model. Some charge per unit, others per area. Because dosing is individualized, per-unit billing often feels fair. A realistic range for bands can fall between 20 and 60 units of onabotulinumtoxinA. When you add a Nefertiti component, totals rise. Patients appreciate plain conversation about cost and the shorter durability relative to the glabella. If someone wants to budget, I propose a three-visit annual plan with a review at each visit. Some clinics offer touch-ups at two weeks to shape the last 10 percent, usually adding only a few units if needed.
If a patient is new to botoxinjections and is also interested in other applications like botoxforfrownlines, botoxforsmilelines, or botoxforliplines, I guide them to start where the imbalance is most visible in conversation and daily interactions. For many, the neck becomes the second or third zone after the brow and periorbital area. Patients seeking botoxnearme often ask for a jawline lift by name. The Nefertiti makes sense only when the anatomy agrees. Careful selection prevents disappointments that shape online reviews more than results.
Troubleshooting the tough necks
The athletic neck with minimal subcutaneous fat can be twitchy and quick to respond. In these cases, very small aliquots deliver impressive change, and overtreatment looks obvious. Start low. Conversely, thicker skin and diffuse bands force you into more points, not just more units per point. Think coverage and add points along the cord’s length.
Fibrous bands feel like guitar strings and sometimes resist improvement with toxin. In these cases, gains are subtle. Warn patients before the needle touches skin. If you promise a smooth column and deliver a modest softening, trust erodes. Pairing with energy-based tightening or micro-coring for etched lines serves the outcome better.
If voice feels “thin” after treatment, listen carefully. If this follows a heavy midline approach, back off in the future. A two-phase protocol helps: treat lateral and mid-lateral bands first, review at two weeks, then lightly address any central segments still active.
Safety habits you keep forever
Consent needs to state risks of temporary swallowing difficulty and voice changes. Document your dilution, total dose, and point count. Map asymmetry in the chart. Photograph with neutral posture and with “Eee.” Recheck at two weeks before deciding that a dose failed. Avoid aggressive early top-ups; diffusion takes time to settle and perception lags reality in the neck more than in the brow.
Staff training should cover the superficial nature of the platysma, the danger zones inferior and midline, and how to prepare tighter dilutions for precision. Keep your needle short and your aliquots small until you fully trust your hand and your product in this area.
Where bands fit in the broader toxin landscape
Neck band softening rarely lives alone. Patients seeking botoxforwrinkles often benefit from a cohesive plan that includes upper-face lines, the brow, and perioral detail. Someone thrilled with botoxforforeheadlines and botoxforbrowlift will notice their neck more. Those exploring botoxforhyperhidrosis in the underarms or botoxforbruxism in the masseter sometimes ask, while in the chair, whether you can also “fix the cords.” The answer is yes, with the caveats we have covered. The same precision that makes axillary botoxforexcessivesweating effective applies doubly in the neck. In contrast to masseter work or botoxfortmj, where deeper muscle targets are the point, platysma demands a delicate superficial touch.
A quick note on the laundry-list uses patients mention: botoxforgummysmile, botoxforbunnylines, botoxformarionettelines, botoxforchindimpling, botoxforfacialasymmetry. Many are micro-map territories around delicate muscles. The neck shares that delicacy, but raises the stakes. Treat it with the same restraint and respect you use around the perioral and periorbital regions.
Practical step-by-step, simplified
- Mark dynamic bands with “Eee,” confirm at rest, map asymmetry. Choose a tight dilution for control, plan small aliquots per point. Inject superficially into the band, 1 to 2 units per point, spaced 1 to 1.5 cm. Reassess at the end, add a single point only where needed. Review at two weeks, layer lightly if required.
This pared process keeps you honest. It holds up under clinic pressure and still respects the anatomy.
Closing perspective from the chair
The most satisfying moments in platysmal band softening are quiet ones. A patient checks their profile in the mirror, turns their head to the side, smiles, speaks, and the cords that used to stand at attention now stay soft. They look less tense, not different. That is the win. When you choose doses that match the muscle, keep injections superficial and precise, and support the skin when needed, the neck stops drawing focus. The face reads as one piece, which is the whole purpose of aesthetic work.
If you are a patient considering treatment, ask your injector about their approach to dosing, dilution, and safety in the neck. If you are a clinician refining your technique, keep notes on your aliquots and outcomes and adjust by one small variable at a time. The platysma rewards restraint and consistency, and it will tell you, plainly, when you have listened well.