What Is the Best Treatment for Neck Lines?
Treatments for horizontal neck lines and vertical neck bands compared: hyaluronic acid filler, Botox for platysma bands, retinoids, sunscreen, and what the evidence shows.
The best treatment for neck lines depends on the type. The short answer: horizontal "necklace" lines respond to hyaluronic acid filler, vertical neck bands respond to Botox, and crepey, sun-damaged neck skin benefits from a retinoid and daily sunscreen. Many people need a combination.
Match the treatment to the line
| Concern | Best-studied option | Evidence |
|---|---|---|
| Horizontal neck lines | Hyaluronic acid filler | Meta-analysis of 11 studies (Wong et al., Aesthet Surg J Open Forum, 2025) |
| Vertical bands (platysma prominence) | OnabotulinumtoxinA (Botox) | Phase 3 trial (Fabi et al., J Am Acad Dermatol, 2025); FDA-approved indication (Botox Cosmetic label) |
| Crepey texture, sun damage | Retinoids, sunscreen | Retinol trial (Kafi et al., Arch Dermatol, 2007); sunscreen trial (Hughes et al., Ann Intern Med, 2013) |
Filler for horizontal lines
A 2025 meta-analysis pooled 11 studies with 379 people treated with hyaluronic acid filler for horizontal neck lines. It found significant improvements in aesthetic scores and wrinkle grades, plus better hydration and elasticity on instrument tests. Half of patients were retreated within 12 months, and 14% had complications, all mild and temporary (Wong et al., Aesthet Surg J Open Forum, 2025). The included studies were mostly lower-level evidence.
Botox for neck bands
Botox Cosmetic is FDA-approved for the temporary improvement of moderate to severe platysma bands (Botox Cosmetic label). In the phase 3 trial, 32.3% of treated participants reached the main combined goal at day 14, compared with 1.9% on placebo. Adverse events were similar to placebo, and no trouble swallowing or muscle weakness was reported. Only one treatment was tested (Fabi et al., J Am Acad Dermatol, 2025).
Energy-based treatments
In-office radiofrequency improved skin laxity, elasticity and wrinkles on the face and neck in a systematic review of 121 studies (Austin et al., Lasers Surg Med, 2022).
At-home care
- Sunscreen on the neck and chest every morning (AAD: sunscreen FAQs).
- A retinoid at night, starting two or three nights a week, since neck skin can be more sensitive.
- Moisturizer to soften the look of crepey skin.
- Posture breaks from looking down at phones. This is commonly advised, though evidence that it prevents lines is limited.
What doesn't have good evidence
Neck creams marketed as "firming" without retinoids or other proven actives, neck exercises, and taping.
Frequently asked questions
Can neck lines be removed permanently? No treatment is permanent; filler and Botox need repeating.
What age do neck lines start? Horizontal neck lines are a concern for younger people as well as older adults (Wong et al., Aesthet Surg J Open Forum, 2025).
Is filler in the neck risky? Complications in the meta-analysis were mild, but choose an experienced injector.
This article is for educational purposes only and is not medical advice. Talk to a board-certified dermatologist about your situation.
Sources
- Wong ZY et al. Efficacy and safety of hyaluronic acid fillers for horizontal neck lines: a systematic review and meta-analysis. Aesthet Surg J Open Forum. 2025. PubMed
- Fabi S et al. Improvement of platysma prominence with onabotulinumtoxinA: a randomized, double-blinded, placebo-controlled phase 3 trial. J Am Acad Dermatol. 2025. PubMed
- Austin GK et al. Evaluating the effectiveness and safety of radiofrequency for face and neck rejuvenation: a systematic review. Lasers Surg Med. 2022. PubMed
- Kafi R et al. Improvement of naturally aged skin with vitamin A (retinol). Arch Dermatol. 2007. PubMed
- Hughes MC et al. Sunscreen and prevention of skin aging: a randomized trial. Ann Intern Med. 2013. PubMed
- Botox Cosmetic (onabotulinumtoxinA) prescribing information. DailyMed
- American Academy of Dermatology. Sunscreen FAQs
