Vertical Neck Lines: Are There Neck Lines That Botox Cannot Smooth?

Hello, I'm Dr. Jinho Kim of Cheongdam Chaoreum Clinic.

When clients come in about vertical neck lines, their first question is almost always about Botox.

But vertical neck lines do not all form in the same place.

Some are caused by the muscle pulling, others by the skin thinning, and the right treatment differs depending on which it is. Let me clear up the misunderstandings that often come up in consultations, one by one.

1. Can all vertical neck lines be smoothed with Botox?

Some people see thick vertical bands rise on the front of the neck when they tense it or clench their teeth.

That is the shape of the platysma, the thin muscle covering the area from under the chin to the collarbone, as it contracts. For vertical neck lines made by muscle like this, letting the muscle rest with Botox works well.

On the other hand, if fine crinkled lines remain on the neck skin even when you relax, the story changes. In this case the cause is the skin, not the muscle, so resting the muscle often leaves the fine lines unchanged.

You can get a rough idea in front of a mirror by tensing and then relaxing your neck: if the lines disappear when you relax, the muscle is the likely cause; if they stay, the skin is. Quite a few people have a mix of the two.

2. Why do fine crinkled lines form?

In the dermis, collagen and elastin are woven into a dense net that holds the skin taut. With age and long sun exposure this net gradually thins and loosens; the weakened skin becomes thinner, loses elasticity and folds easily with even small movements.

The neck has thinner skin and less sebum than the face, so these changes tend to show earlier and more clearly.

That is why fine lines that originate in the skin are best approached with treatments that rebuild the skin's foundation.

3. How is the skin's foundation rebuilt?

Depending on the condition of the neck skin, we consider three main directions.

① Microneedle radiofrequency (Secret RF)
Very fine needles enter the skin to a set depth, and radiofrequency heat is released only from the needle tips. Heat is delivered to the dermis with little disturbance to the surface, and as the area recovers, new collagen fills in.

In a study that treated neck skin with a device working on the same principle (Morpheus8), two treatments 12 weeks apart produced a visible reduction in neck lines at 24 weeks compared with before treatment.

② Collagen-booster injections (Juvelook Skin, GOURI, Re2O)

Instead of heat, ingredients can be injected to draw out collagen.

Juvelook Skin adds hyaluronic acid to PDLLA, giving hydration at first and supporting collagen production over time. GOURI is a liquid form of PCL, which breaks down slowly in the body, and stimulates the fibroblasts responsible for making collagen. Re2O is human dermis with the cells removed, leaving only the matrix (ECM), so it is closer to adding supporting material to thinned skin.

All three aim at collagen, but the ingredients, the formulation and the way they act in the skin differ. So the product is chosen after looking at the thickness of the neck skin, how much elasticity has been lost and the area to be treated.

③ When sagging or rough texture is present as well

If the neck skin is sagging downward, smoothing the fine lines alone leaves something to be desired. In that case we also consider a lifting treatment such as Ultherapy, which uses ultrasound energy to induce collagen regeneration in the deep layers, and if a bumpy, rough texture is the concern, a laser treatment (Hollywood Fraxel) is added so that each issue is improved separately.

In closing

Treatment for vertical neck lines differs considerably depending on whether they come from the muscle or from the skin. If you have had Botox several times and the neck lines are still there, I'd ask you to check first which side the cause is on.

What people who have had more than three neck-line treatments commonly find lacking is written up separately in the post below.

Neck-line treatments: the limits felt by people who have had more than three (Korean)

This was Dr. Jinho Kim of Cheongdam Chaoreum Clinic.

※ Eligibility for treatment, the products used, the number of sessions and the course of recovery may vary with individual condition. Please confirm the details in a consultation with our medical staff.