Botulinum Toxin for the Jawline and Neck (Nefertiti Lift)

What is the Nefertiti lift (jawline botulinum toxin)?

Jawline botulinum toxin, or the Nefertiti lift, is the injection of botulinum toxin into the platysma muscle, which runs along the edge of the jawbone. The aim is to reduce this muscle’s downward pull on the lower face so that the jawline looks more defined. In everyday speech, botulinum toxin is often called Botox®, but this word actually comes from a brand name; the name of the active ingredient is botulinum toxin. You can read about how the toxin works and its general risks on the Botulinum Toxin page; this page covers only questions specific to the jawline.

A systematic review brought together research on the lifting effect of botulinum toxin in the lower face and neck; of the 1,843 publications screened, only 11 could be included. The most common method in these studies was injections into the skin (intradermal) or under the skin along the lower border of the jaw. Patient satisfaction with the results was reported to be high, and the effect was reported to last up to 12 weeks. The researchers also stress that consistent, objective criteria need to be established to measure the lifting effect accurately.

The lifting effect depends on a balance: when the muscles that pull the face down are relaxed, nothing is left to counterbalance the muscles that lift it, and the face looks lifted. The platysma is the main target muscle both in treatments for neck bands and in treatments aimed at lifting the lower face. One more point you should know: these uses, including jawline contouring, are off-label, which means they are not among the medicine’s licensed uses. Side effects can also occur.

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Where does the name come from?

Nefertiti was an ancient Egyptian queen known for her famous bust; the treatment takes its name from the jaw and neck line of this bust. The name “Nefertiti lift” entered the medical literature through an article published in 2007. The article describes a technique in which botulinum toxin is injected along the lower border of the jaw. It describes the aim as tightening the skin along the jawline to give the look of a small lift (a “mini lift”), and it reports the author’s experience with 130 patients.

However, this article is not a controlled study; it is a description of a technique based on one practitioner’s experience. Its information on satisfaction and on how often side effects occurred is also based on the author’s own assessment. The name became established over time: the Nefertiti lift technique was included in an expert consensus for the first time in a 2022 consensus statement in which Italian experts set out their shared views.

The fact that the name refers to a historical figure does not mean that the treatment describes a standard or goal of beauty; it is the name of a technique, not an anatomical term. In Turkish, the same treatment is often searched for as “jawline botoksu” (jawline botulinum toxin). However, this name is sometimes also used for treatment of the chewing muscle. The two are separate treatments aimed at different muscles.

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How does the platysma muscle affect the jawline?

The platysma is a thin, superficial muscle just beneath the skin that covers the whole neck and the lower part of the face; it is one of the muscles that pull the lower face downwards. According to a meta-analysis combining the results of several studies, platysma prominence is a common age-related aesthetic concern with two consequences: visible bands in the neck and a loss of definition along the jawline. In other words, the muscle may also play a part when the jawline becomes less defined.

The part of the muscle that lies in the face was overlooked for a long time. In a retrospective study of 161 patients, the upper part of the platysma was treated with superficial injections just above and just below the lower border of the jaw. The study reported that the lower face contour became more defined from the front and from the side, and that the horizontal lines just below the jaw border softened. The researchers concluded that the upper part of the platysma plays an important role in the functional anatomy of the lower face.

The muscle’s nerve supply also explains why this area is considered separately. A cadaver (anatomical) study found that, in all the specimens examined, the platysma was supplied mainly by the cervical (neck) branch of the facial nerve, while its uppermost part also received nerve supply from the marginal mandibular branch of the facial nerve, which runs along the lower border of the jaw. Other nerves from around the neck were also seen in the lower half of the muscle. According to the researchers, treatment should take into account not only the cervical branch, which spreads throughout the muscle, but also the other nerves that reach its middle and lower parts.

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How does it differ from botulinum toxin for the neck?

Botulinum toxin for the neck and the Nefertiti lift target the same muscle, but they do not address the same concern. With botulinum toxin for the neck, the target is the vertical platysma bands that appear at the front of the neck when the muscle contracts. With the Nefertiti lift, the target is the muscle’s downward pull on the lower face along the lower border of the jaw. In practice, the two targets are often treated together; a study evaluating the technique also defines the Nefertiti lift as injections into both the platysma bands and the lower border of the jaw.

The strength of the evidence is not the same for the two targets. A meta-analysis brought together three randomised controlled trials (comparative trials in which participants are randomly assigned to groups) with 912 participants. The treatment led to a significant improvement compared with placebo (a dummy treatment), and adverse effects occurred at a rate similar to that with placebo. The condition studied in these trials is platysma prominence, a term that covers both neck bands and a loss of definition along the jawline. In a phase 3 trial of the same condition (an advanced stage of drug research carried out with large groups of patients), participants reported being less bothered by the appearance of their jawline and neck bands. In a phase 2 trial from the previous stage of research, jawline definition improved compared with placebo in the patients’ own assessments.

These data come from studies carried out with a single product and specific dosing schedules; the great majority of participants in the phase 2 trial were women and were white. The technique aimed only at the lower border of the jaw, on the other hand, has mostly been studied in case series, that is, studies that report the results of a group of patients without a control group. In the study that assessed the Nefertiti technique in 30 patients, a statistically significant improvement was seen only in the platysma bands. You can find details of treatment for neck bands on the Botulinum Toxin for the Neck page.

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How does it differ from botulinum toxin for the masseter (chewing muscle)?

In Turkish, searches for “jawline botoksu” sometimes also cover treatment of the chewing muscle (masseter), but the two are different. In masseter treatment, the target is the chewing muscle, which can change the contour of the lower face when it is enlarged, and the aim is to reduce the size of the muscle. In the Nefertiti technique, the target is the platysma, and the aim is to reduce the downward pull along the lower border of the jaw. In short, one is about the size of the chewing muscle and the other is about the contour of the jawline.

The evidence on masseter treatment is based on more controlled studies than the evidence on the Nefertiti lift. A meta-analysis that brought together five randomised, placebo-controlled trials with 536 participants reported a reduction in muscle thickness and an improvement in prominence in the short term. However, the differences between the studies are large, and the evidence is not sufficient to establish the best treatment protocol.

The two treatments can affect each other. In a 20-patient study, the masseter and platysma muscles were treated together, because side effects such as sagging in the lower jaw area can occur in some patients after masseter injection. In this small series, a raised jawline and improved symmetry were reported. Which muscle is involved in your case, or whether both should be considered together, is decided at your consultation. Masseter treatment is described on the Botulinum Toxin for Jaw Clenching and the Masseter Muscle page.

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How strong is the evidence?

The short answer: limited. For the lifting technique aimed only at the lower border of the jaw, most of the data come from case series, retrospective analyses and reviews. The systematic review of lifting in the lower face and neck could bring together only 11 studies, and it stressed that consistent, objective criteria for measuring the lifting effect still need to be established.

The results of these studies are positive, but how they are read matters. One study retrospectively reviewed 192 of 512 Asian women who had regional platysma injections for facial sagging. Improvement scores were high, but improvement in the 28–39 age group was significantly greater than in the group aged over 40. The level of evidence for this study was given as level V, the lowest step in the hierarchy of evidence. In another study using three-dimensional measurement, 57 patients with mild or moderate sagging were treated, but only 32 of them could be followed up.

The information closest to controlled data comes from two sources. The first is the platysma prominence studies described above, which look at neck bands and the jawline together. The second is a randomised, double-blind study (neither the patients nor the assessors knew who was in which group) of 80 patients, which compared different extents of injection into the platysma and into the muscle that pulls the corner of the mouth down in the lower face. In this study, a measurable lifting effect was found in all groups, and tissue movement increased as the treatment area widened; however, adverse effects at day 90 were also more common in the group with the widest treatment. The effect decreased as body mass index increased.

A review of lifting with botulinum toxin also states that more placebo-controlled and objective data are needed. For this reason, the figures above do not represent a success rate or duration that applies to you; they only show who the studies looked at and how.

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Muscle, sagging and volume: three separate questions

A less defined jawline may not have a single cause. An active muscle pulling downwards, descent of the tissues, volume loss around the lower jaw and fat under the chin can all create a similar look. The Nefertiti lift targets only the first of these, the part played by the muscle. The others do not change when the muscle relaxes.

According to a review of non-surgical neck rejuvenation methods, botulinum toxin may help people whose skin is not very loose but who develop prominent platysma bands when the muscle contracts; for looser skin and for fat under the chin, other methods are considered. In the study that assessed the Nefertiti technique, too, the patients who improved most were those with lower regional assessment scores at the start. The researchers concluded that the technique is useful especially in young patients whose platysma muscle is overactive and whose skin has kept its elasticity.

Volume is a separate question. If loss of volume and contour at the chin or along the lower border of the jaw is the main issue, relaxing the muscle will not replace that volume. Filler treatments aim to address this problem; they are described on the Chin and Jawline Filler page. Muscle, sagging and volume problems can also occur together in the same face. Which one is the main factor is decided at your consultation, by assessing your face both at rest and when the muscles are contracting.

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Limits of this treatment

The Nefertiti lift is a muscle treatment. It does not lift sagging tissue, tighten excess skin, add volume or reduce fat under the chin. Its effect is not permanent; muscle movement returns over time.

In the 30-patient study that assessed the technique using photographic scales, jowls (sagging along the jawline), marionette lines (lines running down from the corners of the mouth towards the chin), the corners of the mouth and neck volume showed a trend towards improvement, but this improvement did not reach statistical significance. In the retrospective study of facial sagging, improvement was also more marked in the younger age group. This means that when sagging is the main issue, the effect that can be achieved through the muscle is limited.

How long the effect lasts is also limited. According to the systematic review of lifting in the lower face and neck, the effect lasts up to 12 weeks; keeping it depends on repeating the treatment. The phase 3 trial that studied repeated treatment for platysma prominence provides data for up to four treatment cycles given at least three months apart. These sources do not include controlled data for longer periods.

Methods for sagging, such as a thread lift, are described with their own limits on separate pages; for the one aimed at the jawline, see the Lower Face & Jawline Thread Lift page. Which option makes sense for you — the Nefertiti lift, another method or none at all — is decided by the assessment at your consultation and by your own decision.

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Anatomy of the area: why does it need care?

The platysma is a thin muscle at the front of the neck that lies next to structures involved in swallowing and voice production. According to a review of platysma anatomy, difficulty swallowing (dysphagia), voice changes and weakness of the neck muscles can develop if the anatomy of this muscle and the properties of the toxin are not well understood. The researchers also proposed injection points based on landmarks of the jawbone that can be identified from the outside. The aim is to reduce the risk of side effects by keeping the dose and the number of injection points as low as possible.

Spread of the toxin is especially important in this area. Most complications seen at the injection site or in distant areas after botulinum toxin injections are thought to result from the unwanted spread of the medicine’s effect to nearby and distant muscles. The injected volume and the dilution ratio can also affect this spread. A case report from the neck also highlights that the toxin can spread to the underlying swallowing muscles, to the larynx (voice box) and to the muscles that bend the neck forwards.

The upper part of the jaw border is also close to muscles involved in lip movement. According to the Italian experts who prepared a consensus statement on the lower face muscles, these muscles have important functions, so treatment in this area increases the risk of side effects and complications. When the muscle that pulls the corner of the mouth down is treated, staying within a safe zone is recommended to reduce the risk of the toxin spreading to the muscle that pulls the lower lip down. The dose, the number of injection points and the injection depth are decisions that depend on the doctor’s anatomical assessment and technique.

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Known risks

The Nefertiti lift is a medical procedure carried out with a prescription-only medicine. Most reported side effects are mild and temporary; however, there are risks specific to the neck area that must be taken seriously. The rates below come from other studies; they are not this clinic’s data and cannot be used to calculate your personal risk.

Lower face and jawline: In a systematic review of the safety of cosmetic botulinum toxin treatments covering 8,787 people, lip asymmetry and imbalance were reported at a rate of 6.9% after lower face treatments, and all of these cases were reported to have resolved on their own. In the phase 3 trial that studied repeated treatment for platysma prominence, six events that the trial specifically monitored were seen in four participants: four cases of difficulty swallowing and two of facial muscle weakness (paresis). All were mild, there was no sign that the toxin had spread to distant areas, and almost all had resolved by the end of the study.

Difficulty swallowing and neck weakness: Cases of difficulty swallowing have been reported after treatment of platysma bands. In one of these cases, the problem appeared after a dose that the authors described as very low; the possible causes given were spread of the toxin, the injection technique and injection into a blood vessel. A systematic review that brought together three studies on platysma bands (78 patients) reported a complication rate of 15.4%; none of the complications needed any additional intervention. In a phase 3 trial with a single treatment, no difficulty swallowing or muscle weakness was reported. Case reports do not show how often a risk occurs, but they do show that it exists.

Serious conditions that affect the whole body (systemic): A review of the serious side effects of botulinum toxin reports conditions such as difficulty swallowing, breathing difficulties and widespread muscle weakness. These conditions are more common when the toxin is used for medical treatment, but they can also occur after cosmetic use. One study looked at 15 patients who developed severe iatrogenic botulism (toxin poisoning caused by treatment) needing breathing support after cosmetic injections; jawline contouring was among the reasons for treatment. Seven patients had received an unlicensed product or a product of unknown brand, and six had been treated at premises that were not authorised to carry out the treatment. The researchers linked unlicensed products, unauthorised treatment, overdose and seeking medical help late with the condition becoming more severe.

Neuromuscular disorders: In a systematic review of the link between myasthenia gravis (a neuromuscular disorder that causes muscle weakness) and botulinum toxin, all eight people who had not yet been diagnosed with myasthenia and were treated developed marked muscle weakness. If you have a known neuromuscular disorder or unexplained muscle weakness, always mention it at your consultation. Your doctor’s own protocol sets out which symptoms after treatment need medical attention and where to go for help; this is explained to you at your consultation.

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