Botox has not helped my neck band. What can I do? (Photo)

I recommend trying to inject additional 10 units of Botox into this particular area. Since you have such strong Platysma muscle in that area you might just require more Botox in that area.

Thank you for your question and for providing helpful background. It’s not uncommon for certain platysmal bands to be more resistant to Botox, especially if they are congenitally prominent or structurally thick. Since you’ve already had 50 units of Botox with minimal improvement, here are your potential next steps:

1. Additional or Targeted Botox
Adjustment, not more: Sometimes the issue is not the amount but the placement or depth of injection. If the band is isolated and very strong, it may require more precise targeting or slightly more units directly into the resistant band.

2. Platysmaplasty (Surgical Option)
Since you noted the band has been visible since childhood, it may be due to anatomical variation or a naturally hypertrophic platysmal edge. In this case, Botox may not be sufficient, and a minor surgical procedure like a platysmaplasty (cutting or stitching the muscle) could provide a more permanent solution.

3. Non-Surgical Energy Devices
Treatments like Ultherapy, RF Microneedling, or laser skin tightening may help modestly with skin laxity, but they will not significantly flatten a thick platysma band.

These can complement other treatments but won’t replace Botox or surgery for an anatomical band.

4. Consideration of Dermal Fillers (Carefully)
In some rare cases, strategic filler placement around the jawline or adjacent areas can improve contour and reduce visual prominence of the band—but this must be approached carefully and is not suitable for everyone.

Summary
Your case sounds like a structural prominence that may not fully respond to Botox alone. If you've seen this band since childhood, it may be best addressed through platysmaplasty. A consultation with a facial plastic surgeon or board-certified dermatologist experienced in neck rejuvenation could help tailor the best next steps for your specific anatomy.

What you have may not be platysmal band but a part of your sterno-Cleido mastoid muscle or just an aberrant ligament. You need to be evaluated by a plastic surgeon, and if this is just an aberrant band, it can easily be divided to improve the appearance of your neck. I hope the salt and good luck from Leonard Grossman, MD, organic Plastic surgeryNYC