Is Botox the only non surgical procedure for platysma bands? (photo)

Would any other injectable work as well with less risks of side effects

Doctor Answers 17

Is Botox the only non surgical procedure for platysma bands?

YES! After reviewing your question & photos you have severe platysma banding. Best results are incisional surgery. But high dose Botox (100 units) could improve the appearance of the bands, but will last only 4 to 6 months before needing repeating of the treatment. Also the risks of vocal cord issues with higher dose of Botox musty be considered.  Another thought might be using the Silhouette Insta Lift concept of minimal surgery under local to slightly improve the banding. This should last for 18 months to 2 years. And easily tightened if needed. Though fees are in $3,000 range. Otherwise best to seek many in person opinions. As for Ultherapy - save your $$s - a total waste to treat banding! 

Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Botox for neck bands, Nefertiti Lift

Botox is a very popular non-surgical treatment for loose neck bands due to its effectiveness, often called Nefertiti Lift. Other neuromodulator like Dysport or Xeomin would not necessarily be as effective as Botox. It will help in tightening/lifting the neck bands and it will last for 3 to 4 months. It will not address the loose skin. Choosing the right physician to inject you is key to the success and durability of the treatment. For severe cases, platysmaplasty surgery remains the most effective procedure giving patients long term benefits.

Sarmela Sunder, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 19 reviews

Non-Surgical Neck Band Lift / platysmaplasty

Dear perritos:

Thank you for sharing your photos. 

Botox is a muscle relaxer. It will relax the muscle columns you present on the front of your neck. Botox for neck bands has many limitations for which you may wish to re-consider a platysmaplasty.
  1. Botox will soften the banding but not remove the extra wave of skin just above the muscle bands
  2. Botox is short lived and will require reinjection every 3 to 6 months
  3. If injected improperly, Botox may affect other muscles such as swallowing and voice muscles
  4. Botox may relax the floor of mouth muscles allowing the tongue and other tissues within the jaw to descend. 
A platysmaplasty requires a small incision well hidden under the chin. It takes the 2 muscle bands and sews them together to:
  1. sling or support the neck
  2. refine the jaw line
  3. add a suspension suture to further define the neck line
  4. feminize the neck by carrying the platysmaplasty below the "adam's apple"
  5. if necessary, make incisions in the crease behind the ears to redrape skin excess.
There are other options I would recommend against as they leave undesirable scars or are short lasting and provide little value. These include:
  • laser approaches to "tighten" skin
  • "z-plasty" neck lift
  • "thread-lift" and other similar minimally invasive neck lift options.
Above all, consult with a reputable, well versed, Board Certified Plastic Surgeon or ENT Facial Surgeon for proper examination and to review the options you care comfortable with. 

I wish you the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.8 out of 5 stars 82 reviews


You would get some improvement from any nuerotoxin (Botox, Dysport, Xeomin) for platysmal bands. However, the results are 3-6 months and can be costly. You may consider consulting with a plastic surgeon regarding a neck lift.

Ava Shamban, MD
Santa Monica Dermatologic Surgeon
3.9 out of 5 stars 9 reviews

Non-Surgical Treatment for Neck Bands

Your photos show very prominent platysma muscle bands in your neck.  Bands can be passive (loose and saggy), active ( low but firmer with more muscle tone), or a combination of both.  Treatments differ depending on the type of bands you have and the degree of loose neck skin.  Botox and its alternatives (Xeomin or Dysport) can relax muscle tone and therebye improve the appearance of "active" muscle bands.  However, the effect only lasts about 4-5 months, and has some possible side effects.  On the other hand, surgery to tighten, lift and partially divide the platysma muscle bands, along with skin tightening (essentially a necklift) is generally considered the most successful and longest lasting treatment for neck bands.  Other than the neuromodulators, such as Botox, I don't know of any other worthwhile non-surgical treatment for neck muscle bands.  Interestingly, if you don't have any significant loose neck skin, you could just have the muscles tightened through a small incision under your chin using numbing medicine, local anesthesia, in a doctor's office.  You should first see an experienced plastic surgeon for a thorough analysis of your neck.

Richard G. Schwartz, MD
West Palm Beach Plastic Surgeon
5.0 out of 5 stars 30 reviews

The Nonsurgical 3D Vectoring Necklift Can Work Well For Neck Sagging & Banding

It is not clear to me from the question whether the term Botox was intended to cover all neuromodulators currently available (i.e. Dysport and Xeomin). In my nearly a quarter of a century using neuromodulators I have sometimes found that when one neuromodulator has not proven effective or sufficiently effective, substituting another, such as Xeomin, may prove to be.

Moreover, occasionally the fault for lack of effect in treating platysmal banding may be the wrong technique or insufficient concentration or amounts of the neuromodulator injected. For best results I do not simply recommend the injection of the bands themselves, but a combination with a neuromodulator injection technique known as the "Nefertiti Lift,"  which, when performed properly, can result in additional, secondary upward pull on the neck. 

Finally, a technique known as The Nonsurgical 3D Vectoring Necklift, which uses volumizing fillers to provide "deep support volumetry" in order to achieve lifting and projection, in properly selected individuals, can yield quite gratifying results, especially when combined with neuromodulators. I have been routinely performing this technique for nearly a decade. The technique takes only about fifteen minutes to perform and the results are immediate and typically quite gratifying often engendering an immediate "Wow!" effect.

I was one of the first to try threadlifting in the U.S. when it was introduced and approved in the early 2000s. I gave it up after only two years, since the procedure was expensive, minimally invasive, engendered down time, and mostly because the results did not last at best more than 8-12 months.

I am not much of a fan of expensive treatments with fraxels, radiofrequency, and ultrasound devices, which often yield unimpressive, subtle and inconsistent results and are proving themselves to be far more device manufacturer supported marketing hype than hard science.

For more information on the above techniques, check out the archives of

Consultation with a board certifed aesthetician physician with experience and expertise in nonsurgical neck rejuvenation is a must. Insist upon seeing his/her before and after photos of  nonsurgical neck rejuvenation in persons within your particular degree of banding and laxity.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 30 reviews

Any neuro-modulator

Botox, Xeomin and Dysport are neuro-modulators that weaken the muscle. They all have similar potential side effects.  

Jeffrey S. Rosenthal, MD
Fairfield Plastic Surgeon
5.0 out of 5 stars 6 reviews

Treatment for platysmal bands

Hello Perritos,

Botox and other neuromodulators are the only non surgical option to improve platysmal bands.  Lasers and resurfacing can help with the skin and you may get some tightening with energy devices such as Ulthera but the benefit you would get without a true surgery would be minimal.  I would not recommend any fillers be placed into the neck.  My recommendation would be for a more invasive surgical procedure.  It may sound more scary upfront but when you consider the costs of Botox done every few months over your life surgery becomes the more affordable option and will provide you with a better result.

I hope this helps and good luck. 

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

Botox for Platysmal Bands

Botox is a fabulous non-surgical way to treat platysmal bands.  Botox can definitely help soften the look of these deep bands but best to find an experienced dermatologist to have the best results with this procedure.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Is Botox the Only Nonsurgical Treatment for Platysmal Bands?

The answer is that Botox is the only nonsurgical therapy for platysmal bands, but the results pale when compared to surgery.  If you are looking at Botox as a viable alternative to surgery for this problem, you will be disappointed. Ultherapy is completely ineffective for platysmal bands as is Thermitight and other energy based devices.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 93 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.