Botox is the best. I have used it for over 20 years now, and it is a clear staple of any plastic surgical practice. Botox is used in different areas, and many are “off label.” The neck has been one of those areas.
What is the platysma muscle in the neck?
The neck has a superficial muscle called the platysma. It is a thin muscle that fans like a sheet. This muscle does not control your head and neck movement. In fact, I was curious what AI would say the platysma does. It’s answer?
- Facial Expression. “It pulls down the corners of the mouth and lower lip to make expressions of sadness, horror, surprise, grimacing, and pouting”
- Jaw and Mouth Movement. Helps depress the lower jaw to open the mouth (Note: The major mouth depressors are the digastrics and hyoid muscles)
- Creates Neck Skin Tension. “Contraction tenses the skin of the neck, creating slight wrinkling or a bowstring effect.”
Ug. You have a muscle, which isn’t necessary, but helps make you look sad and creates wrinkles.
Botox for the neck
This is not new. Most of us have been using Botox into the platysmal bands for years. But I have found it takes a fair amount of Botox, you need to redo every 3 months (ie it wears off quickly), and some patients get much better results than others. So I was curious about this study- any pearls? new insights?
Botox for Platysma Study
This was a study published in the July 2026 issue of Plastic and Reconstructive Surgery. “OnabotulinumtoxinA for Platysma Prominence: Safety and Efficacy REsults from a Phase 3 Open Label REpeat Treatment STudy.” They start by stating how Botox is safe in the bands. They wanted to see what repeated injections would do.
Study
- 8 month study at 28 sites
- Double blind placebo controlled
- They were seen 14 days after each tretment and had scheduled monthly visits
- 408 patients, BMI 18-30, needed to contract and visibly see platysma muscles.
- Graded on severity of platysma prominence.
- Treatment along jawline and vertical bands. Jawline- 16 units ( 8 units on each side done with 4 injections) and 5 units to each continuous vertical neck band on both sides. (5 injection sites of 1 unit each), doing 1-2 vertical bands/side. So total dose depended on the vertical band number- 26 units, 31 units, of 36 units
Findings
- Most common treatment issue was bruise – 3.7%. There were a couple patients who had dysphagia. (0.9%) which resolved spontaneously. This was thought to be due to inadvertent injections into deeper muscles.
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