Botox or Filler for Neck Wrinkles? The Right Choice Depends on Your Wrinkle Type

When you look into treatments for neck wrinkles, the first two options you will likely come across are Botox and filler. Because the two treatments work differently and suit different types of wrinkles, identifying the type of wrinkle you have is the starting point for choosing a treatment. This article explains the difference between Botox and filler for neck wrinkles, and which treatment suits each wrinkle type.

Summary in Three Sentences

Botox is suited to vertical wrinkles (neck bands), while filler is suited to horizontal wrinkles (creases).

It is important to choose a treatment that matches your wrinkle type, and when horizontal wrinkles are deep, the two treatments are sometimes performed together.

Side effects, duration, and aftercare differ for each treatment, so it is helpful to understand these differences before your procedure.

Contents

1. Horizontal, vertical, fine lines, and sagging: what type of neck wrinkles do you have?

2. How are Botox and filler different?

3. Which treatment suits my neck wrinkles?

4. Botox and filler: a complementary relationship

5. Duration and cost

6. Possible side effects

7. Care to help prevent neck wrinkles

8. FAQ

1. Horizontal, vertical, fine lines, and sagging: what type of neck wrinkles do you have?

Neck wrinkles fall into four main types depending on their shape and cause. Understanding these differences first makes choosing a treatment much clearer.

Horizontal wrinkles: creases deepened by repeated folding

These wrinkles form as the skin folds repeatedly, creating long, deep lines that run horizontally across the neck. Once a crease becomes deep, it tends to remain like a scar, and it can appear in most people from their late 30s. It can also develop in teenagers, and some people are born with it.

Vertical wrinkles: contraction of the platysma (neck bands)

The thin muscle that becomes visible when you tense your neck is called the platysma. As this muscle contracts repeatedly, vertical band-like wrinkles form¹. They usually become noticeable from the mid-to-late 50s.

Fine lines: skin thinned by collagen loss

After the age of 20, skin collagen decreases by about 1% each year, and this cumulative loss leads to fine lines. The cause is thinning of the skin itself, and fine lines tend to increase rapidly around the age of 50.

Wrinkles caused by sagging: weakened supporting tissue

As the skin's supporting tissue and subcutaneous fat decrease, the entire neck begins to loosen and droop. This often appears from the 40s and can be seen in most people from their 50s. When sagging is significant, lifting or a neck lift surgery is considered rather than Botox or filler.

The timing and form of wrinkles can vary greatly from person to person.

¹ Reference: Yi et al., 2022, Anatomical Proposal for Botulinum Neurotoxin Injection Targeting the Platysma Muscle (Toxins)

2. How are Botox and filler different?

The two treatments differ fundamentally in what they target and how they work. The key differences are summarized below.

Results can vary greatly depending on the individual, technique, and dosage.

3. Which treatment suits my neck wrinkles?

The table below summarizes suitable treatments for each wrinkle type.

Deep horizontal wrinkles: Filler

Filler helps by directly filling in the creases. However, because neck skin is thin, using a firm filler can cause nodules or an uneven surface. During your consultation, it is advisable to confirm whether a soft-textured filler will be used. Adding Skin Botox may enhance the perceived results.

Visible vertical wrinkles: Botox

Since contraction of the platysma is the cause, Botox, which relaxes the muscle itself, is the appropriate choice. Adding Skin Botox may further improve the results.

Fine lines: Skin Botox

Standard Botox is injected into the muscle to limit its movement. Skin Botox, on the other hand, is diluted and injected into the shallow layers of the skin, helping improve skin texture such as pores and fine lines, which makes it well suited to fine lines on the neck². Combining it with skin boosters such as Rejuran, Juvelook, or Re2O Skin Booster can also stimulate collagen regeneration, offering a more fundamental improvement.

Significant sagging: Lifting, neck lift surgery

When overall sagging is significant, Botox and filler alone are unlikely to be sufficient. Radiofrequency lifting or thread lifting, which add firmness, may help, and a neck lift surgery can also be considered.

Suitability for treatment can vary greatly depending on each individual's skin condition, so please make your decision after consulting with a medical professional.

² Reference: Kandhari et al., 2022, Microdroplet Botulinum Toxin: A Review (J Cutan Aesthet Surg)

4. Botox and filler: a complementary relationship

In general, Botox is suited to vertical wrinkles and filler to horizontal wrinkles, but when horizontal wrinkles are deep, the two treatments are sometimes performed together.

Injecting Botox around deep horizontal wrinkles relaxes the tension in that area. Filling the creases with filler in this relaxed state can improve both the perceived results and their duration. If fine lines are also present, Skin Botox, which helps with skin elasticity, may be added.

Combination treatments are not suitable for everyone, and it is best to proceed with only the treatments you truly need, based on consultation with a medical professional.

5. Duration and cost

Typical durations are as follows.

Duration can vary greatly depending on the individual, technique, and dosage.

NAYA CLINIC's treatment prices as of 2026 are as follows.

Costs can vary greatly depending on the clinic, product used, and dosage.

¹ Reference: Yi et al., 2022, Anatomical Proposal for Botulinum Neurotoxin Injection Targeting the Platysma Muscle (Toxins)

² Reference: Kandhari et al., 2022, Microdroplet Botulinum Toxin: A Review (J Cutan Aesthet Surg)

6. Possible side effects

Most side effects resolve naturally over time, but some may require additional procedures or treatment. Receiving treatment at an appropriate dosage based on an accurate diagnosis is the key to preventing side effects.

With Botox

Difficulty swallowing: There are various structures around the platysma, so injecting too deeply may affect the muscles used for swallowing.

Bruising and swelling: Bruising tends to last longer than on the face and may persist for about 4–7 days³.

Embossing: Due to the thinness of the skin, the surface may appear slightly raised temporarily after treatment. In most cases, this subsides quickly.

With filler

Nodules and lumps: Using a firm filler on thin neck skin or injecting too superficially can result in an uneven surface.

Tyndall effect: If filler is injected too superficially, it may show through the skin with a bluish tint.

Bruising and swelling: These may last for about 1–2 weeks after treatment.

Granuloma: A chronic inflammatory nodule in which the filler hardens rather than being absorbed. This occurs rarely.

Side effects can vary greatly depending on the individual, technique, and dosage.

³ Reference: Li et al., 2022, HA Compound Filling vs Botulinum Toxin A for Horizontal Neck Lines (Aesthet Surg J)

7. Care to help prevent neck wrinkles

Following the guidelines below, both in daily life and after treatment, can help delay the formation of neck wrinkles and maintain treatment results for longer.

Check your posture

When using your smartphone, it is important to hold it at eye level rather than bending your head down. A low pillow of about 6–8cm is recommended. If your pillow is too high, your neck may bend during sleep, deepening horizontal wrinkles.

Moisturize and protect from UV, down to the neck

Dehydration and UV exposure are major causes of skin aging, and neck skin is no exception. We recommend making it a habit to apply moisturizer and sunscreen to your neck as well as your face.

Helpful home care

Consistent use of creams containing retinol or tripeptides may help improve fine lines and elasticity. Antioxidants such as vitamins C and E may also help maintain skin elasticity.

8. FAQ

Q. Can I return to my daily routine right after treatment?

Due to the nature of the treatment area, bruising or needle marks may be visible for about 1–2 weeks. Since the neck is difficult to cover with clothing, if you have an important event, it is best to schedule your treatment 1–2 months in advance. In winter, a scarf can cover the area, making the recovery period relatively easier.

Q. After one treatment, will I no longer need further treatment?

Neck wrinkle treatment is closer to regular maintenance than a one-time procedure. Filler lasts about 6–9 months and Botox about 3–6 months, after which the effects gradually diminish. Neglecting posture after treatment can cause the effects to fade more quickly, so it is important to manage your lifestyle habits as well.

Q. What should I do if a nodule forms after filler treatment?

Hyaluronic acid, the main component of filler, can be dissolved with hyaluronidase. If you suspect a nodule, please visit the clinic where you received treatment promptly for a consultation.

Q. What should I be careful about right after treatment?

It is generally recommended to avoid alcohol, saunas, jjimjilbang (Korean bathhouses), and strenuous exercise for about one week after treatment. Please also avoid strong massages and clothing that puts pressure on the neck, such as turtlenecks, for about a week.