What is neck botulinum toxin?
Neck botulinum toxin is a procedure directed at the appearance of the vertical bands formed when the broad, thin muscle at the surface of the neck contracts. Whether any change in appearance is possible is assessed at the examination. The neck and jawline procedure known colloquially as the Nefertiti technique is covered on this page.
The substance used in this procedure, which is popularly known by a brand name, is botulinum toxin. Botulinum toxin is a prescription-only medicinal product for human use (opens in a new tab) that temporarily reduces contraction in the muscle to which it is administered. The procedure is performed with an authorised product, within the terms of use in its authorisation, and by a physician.
The neck is where the muscles responsible for swallowing and head control are located. For this reason, the side effects reported in neck procedures differ from those on the face: difficulty swallowing, weakness in the neck muscles and difficulty holding the head upright are specific to this area.
The limit of what can be expected: This procedure is not directed at skin laxity, fatty tissue or bone structure. Where laxity is advanced, the expected contribution is limited, and an assessment by the relevant surgical specialty may be needed.
The procedure is performed at the practice (opens in a new tab) by Dr. Suzan Alp, Specialist in Internal Medicine.
Which factors determine whether the procedure is suitable?
The decision on suitability is made at the end of the examination. The decisive factors in the assessment of this area are:
- Whether the muscle at the surface of the neck becomes prominent when it contracts
- Whether there is any complaint relating to swallowing, speech and head control
- The degree of skin laxity and the state of the fatty tissue
- Whether there is swelling, a mass or an enlarged lymph node in the neck
- Whether there is a history of surgery to the neck or thyroid region
- Procedures previously performed in the area
In which patients is the procedure not performed?
- In patients with a disease affecting the neuromuscular junction (myasthenia gravis, Lambert-Eaton syndrome, amyotrophic lateral sclerosis and similar conditions)
- In pregnant and breastfeeding patients
- In patients under 18 years of age
- In patients with a history of allergy to the product to be used or to its components
Situations that require separate assessment
- Muscle disease (an assessment by the relevant specialist physician is required)
- Use of medicines that affect neuromuscular transmission (aminoglycoside antibiotics, muscle relaxants and similar)
- Bleeding or clotting disorder, or use of blood-thinning or anticoagulant medicines
- Active infection or febrile illness (the procedure is postponed)
- A recent procedure in the same area (the timing is adjusted accordingly)
Additional conditions specific to this area
The procedure is not performed if the following are present in the area to be treated:
- Difficulty swallowing
- Weakness in the neck muscles or difficulty with head control
- Active infection or an open wound
- Swelling, a mass or an enlarged lymph node whose cause has not been assessed (this needs to be assessed first)
In these situations, the procedure is planned subject to the physician’s assessment:
- Hoarseness or a change in the voice (this needs to be assessed first)
- A respiratory tract disease with limited respiratory capacity (an assessment by the relevant specialist physician is required)
- A previous surgical procedure to the neck or thyroid region (the opinion of the relevant specialist is sought)
- A condition relating to the cervical vertebrae or the neck muscles (the opinion of the relevant specialist is sought)
- Previously applied dermal filler in the area (timing and planning are adjusted accordingly)
How is the procedure performed?
- Assessment. Any complaint relating to swallowing, speech, the voice and head control is asked about in detail. How the muscle at the surface of the neck behaves on contraction, and the degree of skin laxity, are assessed. The neck is examined for swelling, a mass or an enlarged lymph node. Any history of neck or thyroid surgery, respiratory disease or neuromuscular disease, together with current medication and allergies, is recorded. Blood pressure and pulse are measured.
- Product check. The marketing authorisation status of the product to be used and its compliance with the storage conditions are checked.
- Information and consent. The procedure, the limit of the expected contribution, the fact that the effect is temporary, the possibility of difficulty swallowing and of weakness in the neck muscles, and the possible side effects are explained in writing and verbally; the form is signed. In this area, the consent process is conducted in detail.
- Preparation. There must be no make-up or cream on the area. Antisepsis is ensured.
- Administration. The product is administered to the determined points with a fine needle.
- Observation and follow-up. The patient is kept under observation after the procedure. Vital signs and anything observed are recorded in the file. A follow-up appointment is arranged at which the outcome will be assessed.
When does the effect begin and how long does it last?
The time it takes for the effect to appear varies from person to person; the full outcome is assessed between a few days and two weeks. The effect is temporary, and how long it will last cannot be stated in advance. The timing of any repeat is determined at the follow-up.
What should you do before and after the procedure?
Before the procedure, report:
- A list of all the medicines and supplements you use (in particular blood thinners, painkillers and antibiotics)
- Your known allergies
- Any history of nerve or muscle disease
- Your pregnancy and breastfeeding status
Come with no make-up or cream on the area.
For this area, please also tell the physician:
- Do you have any difficulty swallowing, speaking or holding your head upright?
- Do you have hoarseness or a change in your voice?
- Do you have a respiratory tract disease?
- Have you had an operation on your neck or thyroid region?
After:
- The area must not be massaged or rubbed on the day of the procedure
- Take care with eating and drinking in the first few days; small mouthfuls and slow swallowing are recommended
- You are asked to avoid lifting heavy objects and movements that strain the neck for the period of time given
- For a while, avoid tight-collared clothing that presses on the neck
- You are asked to avoid bending forward, remaining head-down for long periods and lying face down for the period of time given
- Avoid hot environments, saunas, sunbeds and intense exercise for a while
- Temporary raised bumps, redness and mild bruising may occur at the points of application
Recommendations specific to you, and the periods of time involved, are given in writing at the end of the procedure.
Risks and side effects
The side effects reported in this area may be more serious than those reported for the face.
Risks specific to this area
- Difficulty swallowing (a side effect that requires care in neck botulinum toxin)
- Weakness in the neck muscles and difficulty holding the head upright
- Hoarseness and a change in the voice
- Difficulty breathing
- A temporary change in speech
- A feeling of tightness or heaviness in the neck
- Asymmetry of the smile (the neck is adjacent to the jawline)
- The expected change not being seen (where skin laxity is marked, the outcome is limited)
General risks that may occur with any minor procedure
- Pain, redness, swelling and bruising
- Infection at the site of the procedure
- Headache
- An allergic reaction
- Flu-like symptoms
- Vasovagal syncope (fainting)
These side effects are temporary; however, the time they take to resolve varies from person to person and may take weeks. It is not possible to reverse the effect of the botulinum toxin; when an unexpected outcome arises, the effect of the product is expected to decrease.
Results vary from person to person.
When should you see a physician without delay?
If you experience these symptoms during treatment, contact your physician without delay:
- Increasing redness, increased warmth, swelling or discharge at the site of the procedure
- A high fever
- Widespread rash, itching
In the event of difficulty swallowing, a sensation of choking, disturbance of speech, hoarseness or a marked change in the voice, double vision, shortness of breath, difficulty holding the head upright, widespread muscle weakness, or swelling of the lips or eyelids, go directly to the emergency department.
Frequently asked questions
Will neck botulinum toxin affect my swallowing?
Difficulty swallowing is the side effect in this area that requires the most care; the neck is where the muscles responsible for swallowing and head control are located. The procedure is not performed in people who already have difficulty swallowing. If difficulty swallowing arises after the procedure, a physician should be consulted without delay.
Why is neck botulinum toxin assessed more carefully than other areas?
The muscles in the neck play a part in swallowing, speech and head control. For this reason, the side effects reported in this area (difficulty swallowing, weakness in the neck muscles, a change in the voice) may differ from, and be more serious than, those reported for the face. The assessment and the consent process are handled accordingly.
Is neck botulinum toxin enough for a sagging neck?
This procedure is not directed at skin laxity, fatty tissue or bone structure. Where laxity is advanced, the expected contribution is limited, and an assessment by the relevant surgical specialty may be needed. Which clinical picture applies is determined at the examination.
I have had thyroid surgery; can I have neck botulinum toxin?
In those who have undergone a surgical procedure to the neck or thyroid region, the opinion of the relevant specialist physician is obtained as part of the assessment. Please state the type and date of your operation at the consultation.
I have swelling in my neck; can I still have neck botulinum toxin?
In those with swelling, a mass or an enlarged lymph node in the neck, this needs to be assessed first. The finding needs to be addressed before an aesthetic procedure is planned.
Is the Nefertiti technique described on this page?
Yes. The neck and jawline procedure known colloquially as the Nefertiti technique is covered on this page. Assessment directed at the jawline alone is on the Jawline Botulinum Toxin page.
How long does the effect of neck botulinum toxin last?
The effect is temporary and its duration cannot be stated in advance. It varies with the individual, muscle strength and the pattern of procedures. The timing of any repeat is determined at the follow-up consultation.
Is neck botulinum toxin performed during pregnancy?
No. The procedure is not performed during pregnancy or breastfeeding.
Sources
- Ministry of Health of the Republic of Türkiye, Turkish Medicines and Medical Devices Agency, Beşeri Tıbbi Ürünler Ruhsatlandırma Yönetmeliği, Official Gazette 11 December 2021 / 31686. https://www.resmigazete.gov.tr/eskiler/2021/12/20211211-5.htm (opens in a new tab)
- Ministry of Health of the Republic of Türkiye, Ayakta Teşhis ve Tedavi Yapılan Özel Sağlık Kuruluşları Hakkında Yönetmelikte Değişiklik Yapılmasına Dair Yönetmelik, Official Gazette 7 January 2025 / 32775. https://www.resmigazete.gov.tr/eskiler/2025/01/20250107-3.htm (opens in a new tab)
