Will Botox Get Rid of Neck Bands?

Question

Hello, I have had "necklace bands" or those horizontal lines that go all the way around my neck since childhood. Now they have deepened and look worse than ever.

	I have a nice slim neck, but the lines are very unattractive. I have heard both yay and nay with regards to botox for necklace lines. What's the verdict? Also, are there other treatments that would work better such as laser or peels? Please help, I am desperate to get rid of these bands!

Alan B. Brackup, MD, FACS · Answer

Usually when you receive both positive and negative answers it really means "sometimes." I have have found that while I can sometimes improve the necklace lines with Botox, there are others times when it is of little or no benefit. Treatments can be additive, and I will also use the Fraxel Repair laser to improve these lines, Fillers may also help as well.

Young R. Cho, MD, PhD · Answer

Thank you for your question.  Botox can be a very safe and effective way
 in helping to soften the appearance of neck bands by relaxing the 
muscles.  I would recommend visiting with a  board certified plastic 
surgeon or dermatologist in your area to address your concern as it is 
an advanced area to treat.  And in addition, there may be alternatives 
that can be used as a standalone or in conjunction with Botox to provide
 an even more effective treatment.

Jerome Edelstein, MD · Answer

Botox injections are effective at softening the neck bands (also known as platysmal bands). The treatment can also be combined with a “Nefertiti Treatment”, which will improve the definition of your jaw line and create a beautiful neck lift at the same time.

Larry S. Nichter, MD, MS, FACS · Answer

The Botox® neck lift refers to the use of an off-label FDA usage of a  muscle Toxin like Botox to relax Platysmal bands (midline muscular bands (Platysmal bands). It is not a true neck lift. In the right hands it is effective in temporarily relaxing these muscle bands which causes the skin to be less stretched in appearance. The treatment is temporary and needs to be repeated every 3-4 months for most.Risks include if injected too deeply or using too much - swallowing difficulties,  or  head movement from weak neck muscles.Lasers like the BBL by Sciton do a reasonable job at tightening and smoothing the skin when done as a series.Ultherapy also helps some, thermage less so in my experience

Raffy Karamanoukian, MD, FACS · Answer

Botox can certainly work well in targetted areas of neck bands and neck cords formed by overactive platysma muscles. Raffy Karamanoukian Los Angeles

Ron Shelton, MD · Answer

Vertical neck bands may respond partially with Botox but I have not been successful to minimize horizontal neck bands with Botox although I have heard that some physicians claimed in the past that this can help. Some, not all, patients who are undering Ultherapy have noticed improvement in the horizontal neck bands. There have been reports of Thermage helping and even Fraxel laser, but I would be doubtful that the horizontal bands would improve much.

Stephen Prendiville, MD · Answer

Horizontal neck lines are a rather vexing problem and aren't treated particularly well be any individual therapy. Botox is not something I would recommnend for this particular issue. A series of low energy fractionated CO2 laser treatments can be helpful, but will not eliminate the problem. The same can be said for fillers.

Nelson Lee Novick, MD · Answer

The most effective approach in my experience is to inject tiny amounts of a filler (my favorite for this is Juvederm) along the entire length of each horizontal necklace line. Just enough of the material is injected to elevate the depression until it is flush with the surrounding skin surface. The results of this alone are quite gratifying to most patients. However, to prolong the duration and enhance the effect I most often subsequently (usually during the same treatment session) treat the lines with Botox or Dysport to relax the underlying thin muscle sheet.  

	I have been treating necklace lines with Botox and more recently with Dysport with a great deal of patient satisfaction for over fifteen years since this was first described in the medical literature. Microdroplet amounts are injected in a beadlike fashion across the entire length of each necklace line. Until all of the material is absorbed (usually about an hour) the treatment area will look like a string of tiny mosquito-bite-like hives ringing the neck.

	Years back, before the introduction of the sophisticated and versatile fillers that are available nowadays, Botox was the only treatment offered and the results were typically variable. Some people saw improvement, but many had results that were less optimal. The combination of filler with Botox or Dysport that has become my standard practice, however, has yielded more consistent improvement and only takes about ten or fifteen minutes to perform.

Eric M. Joseph, MD · Answer

I read your concern. I would not suggest Botox treatments for horizontal neck wrinkles. Botox can diminish "platysma-bands" that tend to run in a vetical direction. A well-performed Injectable Filler treatment may be employed to soften the appearance of these wrinkles. My personal preference is to use Silikon-1000, an off-label filler for permanent results.

	I hope this is helpful for you.

	Regards from NJ.

Harold J. Kaplan, MD · Answer

Hi anon. The results of this treatment are highly variable as you can see from the answers. Generally we would not perform the procedure because we feel the alternative (surgery) is a much better option. If you do decide to move forward with the procedure, it's best to find someone very experienced as patient selection (to see if you are a good candidate) is important.

Theda C. Kontis, MD · Answer

Botox can be used to improve the deep horizontal creases in the neck, often referred to as "necklace bands." Treatment can require varying doses of Botox, so I would suggest seeing a physician who has experience with treatment of these bands and start with a low dose. The dose should then be titrated up until the wrinkles improve.

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