Neck problems after Botox: stiffness, difficulty swallowing

The neck is the area of the atlas where a problem can become serious, because it contains the swallowing muscles and lies close to the airways. Botulinum toxin is sometimes injected into the platysma, the thin, broad muscle under the skin of the neck, to soften the vertical bands it forms. This page is part of our guide to problems after a botulinum toxin injection, organised area by area.

What problems can affect the neck?

Two situations are presented. A stiff or weak neck means a feeling of stiffness or fatigue when holding up your head, bothersome but usually not dangerous. Difficulty swallowing, or dysphagia, is the situation that calls for the greatest vigilance in the whole atlas.

The labels describe the spread of the toxin’s effect away from the injection site: muscle weakness, swallowing and speech disorders, aspiration pneumonia, difficulty breathing^1,2. They advise against injection in people with a history of swallowing problems or aspiration^1,2, and stress that people with a disorder of the junction between nerve and muscle, even one not yet diagnosed, are at risk of severe dysphagia².

Each page details the cause, when it appears, how long it lasts and what to do.

Which signs mean you should see a doctor quickly?

For the neck, the rule is simple: any difficulty swallowing, any change in your voice or any difficulty breathing after an injection means calling emergency services (15 or 112 in France, or your local emergency number), without waiting for advice from the doctor who injected you. The labels state that these difficulties are serious and can be fatal¹ and that immediate medical care is then needed^2,4. These signs can appear late: according to the warning of a type A toxin in the United States, from hours to weeks after the injection³.

Simple neck stiffness, without any of these signs, should be reported to the doctor who performed the injection. Write down the date of the injection, the areas treated and the day the problem appeared.

Why is the neck injected?

Neck injections target the vertical bands formed by the platysma. In France, no label provides for this indication in aesthetic use^1,2: it is an off-label use. In the United States, a type A toxin has been approved since October 2024 for moderate to severe neck bands linked to the activity of this muscle, according to the manufacturer’s press release³. The short-acting botulinum toxin (serotype E), for its part, is approved only for frown lines, as of 9 October 2026 in the European Union and Canada^5,6. To understand why and how the neck can be treated, see the page for this area in our atlas of treatment areas.

If your problem concerns the angle of the jaw instead, see the page on the jaw after masseter injections; if it affects the lower face, the page on the chin after an injection.