Queen Nefertiti, ruler of Ancient Egypt, is perhaps the oldest beauty icon on record. An impeccably preserved 3,000-year-old bust of the queen (whose name literally means “a beautiful woman has come”) is said to perfectly capture her legendary features—a powerful jawline and graceful neck, the most notable among them. Her neck, so enduringly famous, even inspired the eponymous neurotoxin treatment. The “Nefertiti lift” was first described by Swiss dermatologist Phillip M. Levy in 2007 as a “minimally invasive and acceptable alternative for those patients seeking an effective way to push back surgery.”
While legions of plastic surgeons would likely challenge Dr. Levy’s assertion that some strategic shots can stave off surgery, the procedure does boast certain irrefutable benefits. “Neuromodulators reduce the bulk of the platysma muscle and the strain that the muscle exerts on the jawline and lower face,” explains Dr. Jessica Weiser, a board-certified dermatologist in New York City. “This reduced muscle bulk and diminished pull creates a sharper jawline delineation and a smooth neck contour.”
Can it deliver angles that rival the queen’s? That too is debatable—and depends on an individual’s age, anatomy, and unique neck issues. Ahead, doctors reveal how the neck evolves over time (majorly influencing your profile), the precise way in which toxins work to reshape the neck, and how injectors spot ideal candidates for this treatment.
How the neck changes with age
Stretching from our lower jawbone to our collarbone, the platysma is largely responsible for how the neck looks. A “paired” muscle, it consists of two halves, both thin rectangular sheets, which “act to tense the neck and assist with the downward pulling of the corners of the mouth,” says Dr. Danny Soares, a board-certified facial plastic surgeon in Fruitland Park, Florida.
In youth, Dr. Soares explains, “the platysma is tight and elastic, hugging the contours of the jawline and neck.” Its two sides lie nice and flat, abutting each other in the midline of the neck. With age and repeated use, the muscle weakens, droops, and separates, blunting the contour of the neck and contributing to the formation of jowls, lax skin, and static neck bands.
What we perceive as bands or cords under the skin are the free edges of the platysma (or, in some cases, wrinkles in the muscle), which become more pronounced as the muscle stretches and descends. Some bands, it’s worth noting, are unrelated to age and tend to stand out on certain people when they’re eating, speaking, or expressing. “That’s just the muscle flexing,” notes Dr. Amir Karam, a board-certified facial plastic surgeon in San Diego. These dynamic bands are not generally caused by looseness.
As the platysma stretches over time, its natural tone changes. “In an attempt to maintain its function, the platysma transitions into being more hyperactive,” Dr. Soares tells us. And as the muscle holds increasingly more tension, it gradually thickens, making bands more evident.
What neuromodulators can do for the neck
Typically, during a Nefertiti lift, a neurotoxin, like Botox or Dysport, is injected into the platysma at various points along the underside of the jawline and down each vertical band. (Dr. Levy’s original technique focused on treating the muscle overlapping the jawline, but injectors have since expanded the concept, to treat the length of the platysmal bands as well.) This series of injections may require anywhere from 20 to 50 units of toxin, notes Dr. Weiser.
The classic Nefertiti lift is “very superficially treating the upper facial platysma that inserts along the mandible,” explains Dr. Elizabeth Chance, a board-certified facial plastic surgeon in Charlottesville, Virginia. “You’re inactivating all the muscle fibers that pull the mouth and neck down, essentially allowing the elevator [or lifting] muscles to work unopposed.” In addition to targeting the jawline, Dr. Chance also injects the central platysmal bands that run right under the chin as well as those found along the sides of the neck.
@drjanellevega #Botox has so many more used than you think and one is to snatch the #jawline. #learnontiktok #dermatologist #foryourpage #fillers ♬ original sound – DrJanelleVega
Botox has an undeniable mellowing effect on dynamic neck bands—the ones that pop up when we grimace or clench. When doctors relax those bands and loosen the muscle’s grip on the lower face, the neck looks smoother and the jawline appears somewhat crisper. “In a simple sense, it’s like a vertical game of tug-of-war,” says Dr. Laurel Geraghty, a board-certified dermatologist in Medford, Oregon. “If the lower half releases tension on the rope, the upper half can spring back up.” This effect, she adds, is more dramatic for some people than others.
When neck bands are born primarily of muscle laxity, however, the usefulness of neurotoxin is less clear-cut. Sometimes the rationale for treating a mature neck links back to that aforementioned change in tone. Alleviating strain on a muscle that has grown rigid and thick with age can lessen its downward pull to some degree, delivering a “modest but still powerful” lifting effect to the tissues of the neck and lower face, Dr. Soares says.
Who is a good candidate for neck Botox?
Young people wanting to quiet dynamic neck bands are no-brainer candidates for this treatment.
Patient selection gets trickier in older populations, but generally speaking, folks who see the biggest payoff from neck toxin tend to have relatively firm skin, minimal excess fat, mild muscle laxity, and defined platysmal bands, our experts say.
“I look for patients with very strong lateral [or side-lying] bands, which represent the outer margins of the platysma that typically insert into the jawline,” says Dr. Soares. “They can form thick folds that disrupt the continuity of the jawline during smiling and other expressions. In these cases, botulinum treatment can be very helpful in smoothing and enhancing the jawline.”
But if someone has obviously loose neck skin and muscle, then the bands are not likely due to the contraction of the muscle, he adds, and treating them with toxin won’t improve them. Dr. Chance agrees: “When you’re seeing a ton of laxity and those platysmal bands are hanging, you’re not going to see much of a difference [with neuromodulator],” she says. Likewise, “if I see a jowl, in combination with a platysma that is down, in combination with submental fat—those patients, I basically just tell them, this is like whistling Dixie,” she says.
However, notes Dr. Karam, there are some “borderline situations, where a patient, usually in their mid-40s, might have some dynamic nature to the muscle and may also have some laxity—but you don’t know which is more dominant and you can’t totally tell if toxin will work,” he says. In those scenarios, the only way to gauge the drug’s effect is to try it.
The algorithm for treating the neck with toxin—knowing who will benefit and who won’t—can be incredibly complex, adds Dr. Chance. “If you have your head in a neutral position and I can see the entirety of those bands, any impact that I have [with toxin] will be minimal.” But skin quality and other anatomical considerations may sway her decision to inject. “If I have a superthin patient who has minimal visible bands at rest but I’m seeing them, by and large, because of their weight—because they don’t have a lot of subcutaneous fat—that patient, I’m much more likely to treat than someone with [bands resulting from] actual neck laxity.”
Only through a proper exam can a doctor determine if you’re a good candidate for neck toxin. There may be some element of trial and error initially, but your injector should be fairly certain that you’ll see an improvement, since this treatment demands large doses and can be pricey.
Can Botox injections slow neck aging?
“Neurotoxins are powerful in their preventive abilities,” insists Dr. Geraghty, and when used routinely, “can absolutely change the trajectory of how our necks and faces age through time.”
When done early and in the right patient, toxin may delay certain signs of neck aging that are directly related to muscle activity. “Starting neuromodulator injections into the neck at the first sign of platysmal bands can be helpful for keeping bands [relaxed] and maintaining a sharper jawline,” says Dr. Weiser.
Offering evidence of how immobilizing a platysma can slow the rate of neck aging—particularly in terms of banding—Dr. Soares points to a study involving subjects with facial and platysma paralysis (resulting from accidental nerve injury), who saw significantly less band formation on the paralyzed side versus the healthy side, over a 10-year span. Neurotoxins, via controlled and temporary paralysis, provide a safe way to dial down muscle activity, he adds, which is why many surgeons urge neck lift patients with hyperactive platysma muscles to maintain their results post-op with regular botulinum injections.
Interestingly, Botox seems to subtly condition the muscle too. When Dr. Chance operates on a platysma that has been repeatedly treated with toxin, she finds it lacks the bulk of an untreated muscle—which may translate to better skin quality or a slightly cleaner contour, pre–neck lift. “I think these patients may go into the aging process a little more gracefully,” she says.
Risks of treating the neck with toxin
As with any neurotoxin treatment, injecting the neck can cause temporary bruising, discomfort, and swelling. “If done incorrectly, treatment of the neck with neuromodulators could have more significant side effects, such as difficulty swallowing or even speaking,” Dr. Geraghty warns.
Following neck injections, she adds, some patients notice temporary weakness or discomfort when they’re trying to sit up or pull their head and neck forward.
For this reason, Dr. Chance tends to treat her yoga/Pilates enthusiasts and horseback riders with lighter doses of neck Botox. “The platysma actually contributes to head stabilization,” she says. “It’s not a big contributor, but people who use their platysmas a lot—whether to do crunches or when cantering on a horse—can often tell if I completely knock out the platysma.”
If you’re thinking about having your neck treated with a neuromodulator, give your injector a heads-up if you have similar lifestyle considerations, to avoid feeling out-of-sorts, or even sidelined, for several months post-injection.
