In October 2024, the FDA approved Botox Cosmetic (onabotulinumtoxinA) for the temporary improvement of moderate to severe vertical bands connecting the jaw and neck — commonly called platysma bands. It is the first and only neurotoxin with a specific FDA indication for this area, and the approval expanded Botox Cosmetic's aesthetic indications to four: forehead lines, glabellar lines, lateral canthal lines, and now platysma bands.
This article covers what the approval means, what the Phase III data actually showed, who is and isn't a good candidate, how the FDA-labeled dosing works, how it compares to the older off-label "Nefertiti lift" technique, and what results actually look like in practice.
What are platysma bands
The platysma is a thin, sheet-like muscle that covers the anterior and lateral neck. It originates from the fascia of the upper chest, passes upward over both sides of the neck, crosses the mandibular border, and inserts into the skin of the lower face and jawline. It acts as a depressor — when it contracts, it pulls the jawline downward and creates visible vertical cords on the neck.
With age, the platysma loses tone, the overlying skin thins, and the medial edges of the muscle separate. The result is the appearance of two or more prominent vertical bands running from below the chin toward the collarbone. These bands are most visible when the patient clenches their jaw or strains their neck.
Platysma bands are distinct from horizontal neck lines (sometimes called "tech neck" lines), excess submental fat, and skin laxity. Botox addresses the muscle activity behind vertical bands — it does not improve skin quality, remove fat, or tighten loose skin.
The FDA approval: what changed
Before the 2024 approval, injecting Botox into the platysma was an off-label technique. Providers used various approaches — the most well-known being the "Nefertiti lift," described by Phillip Levy in 2007 — with inconsistent dosing and no standardized injection protocol.
The FDA approval established three things that did not exist before:
- A specific indication for moderate to severe platysma bands in adults.
- A labeled dosing protocol with three dose tiers (26, 31, or 36 units) based on band count and severity.
- Phase III clinical trial data supporting efficacy and safety in the neck.
This does not mean other neurotoxins (Dysport, Xeomin, Daxxify, Jeuveau, Letybo) cannot be used for the same purpose — but those uses remain off-label, without the same body of pivotal trial data.
What the Phase III trials found
The approval was based on two randomized, double-blind, placebo-controlled Phase III trials involving 407 Botox-treated subjects and 425 placebo subjects.
Primary endpoint
Both trials met their primary endpoint. Investigators and subjects independently assessed improvement in platysma band prominence using a validated scale (the Allergan Platysma Prominence Scale). The improvement from baseline was statistically significant versus placebo at p<0.0001.
In two clinical studies, 32% and 31% of Botox-treated patients achieved a ≥2-grade improvement in platysma band severity at day 14 (assessed at maximum expression), compared to 2% and 0% in the placebo groups.
Patient satisfaction
In the same two trials, 65% and 62% of patients reported being "Very Satisfied" or "Satisfied" with the appearance of their neck and jawline definition 14 days after treatment, compared to 12% in both placebo groups.
Safety
The safety profile was consistent with Botox Cosmetic's known profile for facial indications. Common side effects included localized pain, swelling, redness, bruising, and tenderness at the injection site. No new safety signals were identified.
The FDA label includes the same boxed warning present for all botulinum toxin products regarding the potential for distant spread of toxin effects (dysphagia, dysphonia, breathing difficulties), though no such events were reported in the platysma trials at the labeled doses.
The FDA dosing protocol
The approved protocol involves two injection zones: the jawline and the neck bands themselves. All injections are administered superficially and intramuscularly with the needle perpendicular to the skin surface.
Jawline injections (both sides)
- 2 units (0.05 mL) per injection site
- 4 sites per side (8 total)
- 16 units total in the jawline
Neck band injections
- 1 unit (0.025 mL) per injection site
- 5 injection sites per band, spaced 1–2 cm apart vertically
- 1 to 2 bands treated per side
Total dose by severity
| Anatomy | Jawline Dose | Band Dose | Total |
|---|---|---|---|
| 1 band per side | 16 units | 10 units | 26 units |
| 1 band one side, 2 bands other side | 16 units | 15 units | 31 units |
| 2 bands per side | 16 units | 20 units | 36 units |
The most superior injection site on the neck band should be approximately 1–2 cm inferior to the jawline injection sites. For each band, the provider identifies the band while the patient contracts their platysma, then gently pinches the band to isolate the muscle from deeper structures before injecting.
Important technique notes
The FDA label specifically warns against injecting into structures deep to the platysma muscle, particularly in the anterior neck. Injections should be at least 1 cm inferior to the lower mandibular border. This is because the anterior neck contains critical structures — including the sternocleidomastoid, omohyoid, and the swallowing apparatus — that can be affected by toxin spread if injections are placed too deep.
How this differs from the Nefertiti lift
The Nefertiti lift, described by Levy in 2007 and widely adopted before the FDA approval, is a different technique with different goals.
The Nefertiti lift primarily targets the jawline. It involves injecting 15–20 units of onabotulinumtoxinA per side intradermally along the inferior mandibular border to weaken the depressor pull of the platysma and create the visual effect of a "mini lift." The jawline becomes sharper because the platysma no longer pulls it downward as strongly.
The FDA-approved platysma band protocol targets the bands themselves — the vertical cords on the neck. The jawline component is present (16 units), but the primary intent is band reduction, not jawline lifting per se.
In practice, many experienced injectors use a combination approach: the FDA-labeled protocol for the bands, supplemented by additional off-label jawline or lower-face treatment as needed. But the labeled protocol is the one supported by Phase III data.
Who is a good candidate
Good candidates
- Patients with visible vertical platysma bands that are caused by muscle activity (test by asking the patient to contract — bands that become more prominent are muscular and likely to respond)
- Mild to moderate banding
- Good skin elasticity without significant laxity
- Patients in their 30s, 40s, or early 50s (bands can begin appearing as early as the late 20s)
- Patients who want a non-surgical option with zero downtime
- Patients who want to "test" neck rejuvenation before committing to surgery
Poor candidates
- Patients with significant excess submental fat (Botox does not address fat)
- Patients with heavy jowls (muscle relaxation alone will not correct jowling)
- Patients with significant skin laxity or "turkey neck" appearance (Botox does not tighten skin)
- Patients whose bands are caused by skin ptosis rather than muscle activity
- Patients with a history of dysphagia or neck muscle weakness
- Patients who are pregnant or breastfeeding
For patients with skin laxity or fat, the appropriate treatments might include submental liposuction, a neck lift, skin tightening devices (Ultherapy, Sofwave, Thermage), or deoxycholic acid (Kybella) — but these address different anatomy than Botox does.
Results timeline and duration
- Onset: Initial softening of bands is typically visible within 3–7 days. Full effect at approximately 14–30 days, consistent with the trial timepoints.
- Duration: Results last approximately 3–4 months, consistent with other Botox Cosmetic treatment areas. Muscle activity gradually returns as the body metabolizes the toxin.
- Maintenance: Repeat treatments every 3–4 months are required to maintain results. Some providers report that with consistent treatment, the interval may stretch slightly over time.
It is worth noting that the clinical trials measured outcomes at days 14 and 30. There is limited published data on whether repeated platysma treatments produce cumulative improvement over multiple cycles.
Cost
The cost of Botox for platysma bands depends on the total units used and the per-unit price charged by the provider.
At a national average of approximately $10–$15 per unit for Botox Cosmetic:
- 26 units: approximately $260–$390 per treatment
- 31 units: approximately $310–$465 per treatment
- 36 units: approximately $360–$540 per treatment
Some providers charge by the area rather than by the unit. A "neck Botox" or "Nefertiti lift" treatment is often priced between $300 and $600.
Maintenance every 3–4 months means an annual cost of approximately $1,000–$2,200 depending on dose and pricing. This is substantially less than surgical neck rejuvenation but is a recurring expense.
Risks and side effects
Common side effects
These are consistent with Botox injections in other treatment areas:
- Localized pain, swelling, redness, bruising at injection sites
- Tenderness
- Mild headache
Neck-specific risks
- Dysphagia (difficulty swallowing): Rare but reported in historical off-label use with higher doses. The risk increases if toxin diffuses into deeper neck muscles. The FDA-labeled protocol (maximum 36 units total) and the instruction to inject superficially into the platysma specifically address this risk.
- Neck weakness: Reported primarily with off-label doses above 50 units. The FDA protocol stays well below this threshold.
- Dysphonia (voice changes): Theoretically possible if toxin reaches the deeper muscles of the larynx. Not reported in the Phase III trials at labeled doses.
- Asymmetric smile: If toxin affects the depressor labii inferioris or other perioral muscles through spread from the jawline injections. Avoidable with precise injection placement.
Mitigation
The risk of adverse events in the neck is closely tied to injection depth and total dose. The FDA label explicitly instructs providers to inject superficially and avoid deep placement. Providers with extensive experience in neck anatomy have lower complication rates.
Other neurotoxins for platysma bands
Other botulinum toxin type A products can be used off-label for platysma bands, though they lack the Phase III data that supports Botox Cosmetic's labeled indication.
- Dysport (abobotulinumtoxinA): Several studies have evaluated Dysport for platysma bands, including a 2024 dose-ranging study in the Journal of Drugs in Dermatology. Doses of 40–180 Speywood units have been studied. The conversion ratio from Botox units is not linear and should be applied with caution in the neck.
- Xeomin (incobotulinumtoxinA): Used off-label at doses roughly equivalent to Botox units. No specific published platysma band trials.
- Daxxify (daxibotulinumtoxinA-lanm): The extended-duration neurotoxin could theoretically offer longer-lasting platysma results, but no clinical data for this indication has been published as of 2026.
When to consider surgery instead
Botox for platysma bands is a maintenance treatment that temporarily addresses muscle activity. It is not a substitute for surgery when the underlying anatomy requires more significant correction.
A surgical neck lift or platysmaplasty may be more appropriate when:
- There is significant skin laxity that Botox cannot address
- Submental fat deposits create a heavy appearance
- The bands are severe and do not adequately respond to Botox
- The patient wants a permanent solution rather than ongoing maintenance
- There are anatomical concerns (midline platysma dehiscence, significant jowling) that require structural correction
Some patients use Botox for the neck as a bridge — maintaining improvement while they decide whether to pursue surgery, or as an adjunct to a surgical plan.
Sources
- AbbVie/Allergan Aesthetics. "BOTOX® Cosmetic (onabotulinumtoxinA) Receives FDA Approval for Moderate to Severe Vertical Bands Connecting the Jaw and Neck (Platysma Bands)." Press release, October 18, 2024. https://news.abbvie.com/2024-10-18-BOTOX-R-Cosmetic-onabotulinumtoxinA-Receives-FDA-Approval-for-Moderate-to-Severe-Vertical-Bands-Connecting-the-Jaw-and-Neck-Platysma-Bands
- U.S. FDA. BOTOX® Cosmetic Prescribing Information, Highlights and Dosing Tables for Platysma Bands. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/103000s5316s5319s5323s5326s5331lbl.pdf
- BOTOX® Cosmetic HCP. Dosing and Injection Guide for Platysma Bands. https://www.botoxcosmetichcp.com/indications/pb-indications
- Levy PM. "The 'Nefertiti lift': A new technique for specific re-contouring of the jawline." Journal of Cosmetic and Laser Therapy. 2007;9(4):249-252. doi:10.1080/14764170701545657
- Sugrue CM, Kelly JL, McInerney N. "Botulinum Toxin Treatment for Mild to Moderate Platysma Bands: A Systematic Review of Efficacy, Safety, and Injection Technique." Aesthetic Surgery Journal. 2019;39(2):201-206. doi:10.1093/asj/sjy179
- de Almeida ART, et al. "Anatomical Proposal for Botulinum Neurotoxin Injection Targeting the Platysma Muscle for Treating Platysmal Band and Jawline Lifting: A Review." PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9783622
- Jabbour SF, et al. "Botulinum Toxin for Neck Rejuvenation: Assessing Efficacy and Redefining Patient Selection." Plastic and Reconstructive Surgery. 2017;140(1):9e-17e. doi:10.1097/PRS.0000000000003429
- IAPAM. "January 2026 Aesthetic Medicine Update: Evidence-Based Expansion for Neck & Midface." https://iapam.com/january-2026-aesthetic-medicine-update
