Risk of Being Unable to Swallow After Botox in the Neck?

I read that some people that got injected with Botox in their neck couldn't swallow and had to be fed by a tube for months because the injector injected it incorrectly. If I go to a board certified plastic surgeon for Botox of the platysma muscle, what are the statistics or how high is the risk of that happening?

Doctor Answers 9

Botox and the treatment of neck bands

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This might have happened rarely, in the past, when very high doses were used. Speak to your physician to consider doing very small doses your first treatment. You don’t have to treat the whole area, and if you have your physician perform a smaller treatment, you might be happy with the results and then undergo further treatment. The other risk of higher doses in the neck, is that the muscles are not strong enough after treatment to allow you to lift your head out of the hairdresser’s sink. This has not been reported as a result of the lower doses more commonly used.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Botox in the neck is perfectly safe if done properly.

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Hi.  Difficulty swallowing after Botox injections in the platysma muscle of the neck is extremely rare and caused only by bad technique.   Go to an experienced plastic surgeon or dermatologist.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Risk of difficulty swallowing with Botulinum toxin injection

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Beware these reports. I believe these injections were performed for torticollis or neck spasms. These muscles are located deep in the neck and require large doses. The techniques that are utilized for the "turkey neck" involve the muscles that are considerably more superficial than the swallowing muscles. If you go to an experienced injector, the risk of this should be extremely low.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Botox in the neck

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Botox for vertical neck bands can be performed safely. The keys are to limit the number units utilized to 50-75 units (certainly no more than 100 units) and to inject superficially. I suspect that most board certified dermatologists and plastic surgeons have not caused this problem in their patients.

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist

Botox for neck treatment is safe

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Dear Stacey,

While treatment of neck cords is considered off-label and lacks FDA approval, there are very clear guidelines for this type of treatment. Experienced injectors are extremely unlike to have patients with difficulty swallowing. Swallowing is a complex mechanism and the structures that are responsible for swallowing are relatively deep in the neck. I am not aware of any cases of difficulty swallowing following BOTOX for the neck cords.

However, this type of issue has been reported with a product called Myobloc following facial cosmetic treatment. Difficulty swallowing, which medically is called dysphagia, is considered a systemic complication of these treatments. Myobloc is still used medically but is no longer used for cosmetic purposes precisely because of these types of issues at relatively low dose. Low doses of Dysport and BOTOX used for cosmetic purposes are not associated with systemic side effects. However, there are some injectors who elect to use much higher doses of these products to treat larger cords. This is generally not a safe practice. Under this circumstance, surgical options become preferred.

Finally, it is not necessary to only go to a "board certified general plastic surgeon." These techniques are so widely practiced and standardized that you should be perfectly comfortable getting treatment with any of the core aesthetic specialities: Dermatology, Facial Plastic Surgery, Oculoplastic Surgery, and General Plastic Surgery. However, like everything in life, some are better than others.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox in the neck is very safe

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Botox treatments in the neck when used for cosmetic indications are very safe when performed by a skilled knowledgeable physician. The results for softening the neck area called platysma bands can be excellent as well. I have been performing Botox treatments safely in this area for many years. When it was first proposed, the initial study reported a few patients with weakness in swallowing. However, they used over 100 units per treatment. I never use more than 60 units in any given visit for neck bands and lines, usually much less.

To reiterate the previous answer, it is off label for use in the neck. Use in this area by physicians is based on their skill and an explanation that given their experience, this medication is being used for purposes not specifically FDA approved, but helps their patients. There was a recent "Black Box" warning issued by the FDA for Botox. The vast majority of patients who had complications were given Botox for neurologic conditions such as muscular dystrophy and not cosmetic uses.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 141 reviews

Botox for Neck Bands

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These injections need to be done by an experienced injector. Ideally, the individual is board certified by the American Board of Facial Plastic and Reconstructive surgery or Plastic and Reconstructive surgery. A clear knowledge of the anatomy of the neck is important in these cases. Also the dose chosen must be appropriate. When done correctly, the risk is low, however, many cases do not respond to botox and require surgical modification. Your surgeon should be able to differentiate and assess whether you are a good candidate or not.

Amir M. Karam, MD
San Diego Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

Swallowing difficulties rare with Botox

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The platysma muscle is one of the less common areas for Botox but it works really well in the right patients. I have not seen any difficulties swallowing or any published statistics on it. If the injector is experienced, it should be extremely rare.

We are hearing more concern about spread of toxin effect since the FDA mandated a "Medication Guide" handout which came out a couple of weeks ago. It talks about the sort of thing you describe but also mentions that "there has not been a confirmed case of spread of toxin effect away from the injection site when Botox has been used at the recommended dose".

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Botox injections in the neck

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Botox injecttions to the neck are an off label use of the Botox.  I suppose if the injector is not careful, and injects too deeply, it could affect swallowing.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.