My Neck Looks Wrinkly and The Muscles Tighten Up When I Speak. What Can I Do? (photo)

I am a 41 year old female and only a year ago I started to see how my neck muscles tighten up and when I'm speaking, and my neck looks so wrinkly. It happens too when I inhale my cigarette. I am a TV journalist and how my neck looks now really bothers me. I get a lot of "I thought you were early 30's" comments from people, thanks to my Asian genes, but my neck just doesn't want to cooperate. Pls help. Thank you!

Doctor Answers 8

Botox or Dysport for Neck Bands

At my practice in New York, I have found the use of Botox/Dysport to be helpful with "neck bands". As you've probably observed, the neck skin gets thinner as we age and the underlying muscles become more prominent. In my practice, I often combine Botox/Dysport for the muscle bands with radiofrequency (Pelleve) treatment for the skin.

New York Oculoplastic Surgeon
4.3 out of 5 stars 69 reviews

Good Options for Wrinkly Neck Skin with Tightened Neck Muscles

It’s hard to tell exactly what is bothering you from the picture (the problem sounds more dynamic- seeing you in person would obviously help) but there are a few options available depending on the specific issue. If it is the platysma muscle (the thin circular muscle just under the skin of your neck) that is tightening up (which gives the appearance of tight bands that form with certain movements) then a neuromodultor like Botox, Dysport, or Xeomin can work well. This is injected into the muscle and causes it  to relax. Since it is the tightening that causes the problem, this option makes sense. It is done in the office, needs no anesthesia, starts working within 4 days, and lasts 3-6 months. If it is the neck skin that is getting a little bit lax and causing the wrinkly look, then a combination of good skin care used daily  (Retin A, antioxidants such as vitamin C, and human derived growth factors), a series of chemical peels (2-3 days of peeling, essentially no down-time), and/or 3-4 in office laser treatments (using a fractionated non- ablative laser such as the Palomar Icon 1540 or the Cynosure Affirm) would cause some nice tightening of the neck skin. If you really wanted to be aggressive, you could consider a neck lift (where we would remove the excess skin, remove any excess neck fat, and re-suspend the neck muscle). While this would give a near perfect result, it looks from the picture that this would be more aggressive than you would need to be.

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 26 reviews

Neck cords respond to Botox

Neck cords may respond well to Botox as long as the skin tone is OK.  If Botox doesn't help then a neck lift may be the next step

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Wrinkly neck and tightened neck muscles

Most 41-year-old women do not require a facelift.  The only neck muscle that can be treated with a neck lift is the platysmal muscle.  The anterior most platysmal bands are tightened along the submental jaw line in the center portion of the neck and when the 2 cords are present, they are released through the submental incision as well.  The sternocleidomastoid muscle is not adjusted with the neck procedure.  Any excess skin that is present will need to be addressed with a lower face/neck lift.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Neck Muscle Treatment for Wrinkles

The platysma contributes to wrinkles of the neck and sagging tissue. For younger patients like yourself, Botox Cosmetic can help soften the neck wrinkles. It may be too early for other treatments such as a lower face lift or neck lift. However, only after a comprehensive evaluation can a neck lift plastic surgeon help determine appropriate for you.

Lastly, please stop smoking. Your face and neck will look much better, and you voice will better too. Best of luck.


Dr. Chaboki


Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Botox can help early muscle bands (platysma) in the neck.

Botox along the edge of the platysma muscle can give some temporary help to platysma banding.  Later on, they will need surgical repair.  I think skin tightening technology is a waste of time and money.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

My Neck Looks Wrinkly and The Muscles Tighten Up When I Speak. What Can I Do?

 Botox or Dysport injections can soften the horizontal lines and over-active Platysma muscle within the neck.  For neck skin laxity, either Ulthera or a localized skin ellipse through an incision under the chin.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Neck Changes at Age 41

You are describing 2 issues:

1. Hyperactivity of your superficial neck muscle known as platysma;

2. Early skin laxity.

When I examine the photo you provided I would describe these issues as "early" and "mild". I think you can expect some nice improvements with non-surgical treatments such as Ultherapy and Botox or Dysport.

Consult with a facial cosmetic surgeon for a thorough in-person assessment.

Lastly, smoking does do significant harm - also related to aging; but you knew this already.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 48 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.