Neck Lines: Horizontal vs Vertical, Is Tech Neck Real, and Which Treatments Have Evidence
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Most neck lines are horizontal creases that ring the neck. Vertical cords are often platysmal bands, a separate feature of neck aging. The best neck-specific evidence is for hyaluronic acid filler on horizontal lines, from small studies and one 48-person randomized trial. Creams have weaker data, and no study we found tests whether "tech neck" causes lines.
Evidence: Limited.
Key takeaways
- Horizontal lines and vertical bands are different problems. A 2016 review lists wrinkles and "prominence of the platysmal bands" as separate features of neck aging (Vanaman et al., 2016).
- Filler beat Botox in the only head-to-head trial. In a multicenter, evaluator-blinded randomized trial of 48 Chinese women, hyaluronic acid (HA) filler plus mesotherapy improved horizontal line grades more than one botulinum toxin session at every visit up to 10 months (Li et al., 2022).
- Filler results fade, then plateau. In a 30-person study, benefit peaked at 1 month, declined significantly by 3 months and held to 6 months (Rongthong et al., 2023).
- The neck responded least to a moisturizer. In a 12-week randomized, grader-blinded trial of a vitamin A palmitate oil, improvement ranked legs > arms > décolletage > face > neck (Rawlings et al., 2013).
- Glycolic acid didn't significantly reduce wrinkles. In a 3-month placebo-controlled trial of 75 people, 5% glycolic acid on the face and neck improved texture and discoloration, but the wrinkle trend was not significant (Thibault et al., 1998).
- "Tech neck" is untested as a cause. The only study using the label tested a cream, not posture (Young et al., 2023).
This page covers lines, creases and bands. Sagging after weight loss is a different issue, covered in Ozempic neck and turkey neck after weight loss. Lines that continue below the collarbone are covered in chest wrinkles. For where neck care fits in a full routine, see our step-by-step skincare routine order.
What are neck lines?
Neck lines usually means horizontal creases that run around the neck, sometimes called "necklace lines." Vertical cords that show with age are a different feature, often called platysmal bands. The platysma is a thin sheet of muscle in the front of the neck.
Reviews treat these as separate problems. Vanaman et al. list neck aging as a set of changes: skin dyspigmentation, laxity, rhytides (wrinkles), loss of jawline contour, submental fat, volume loss and "prominence of the platysmal bands" (Vanaman et al., 2016). Roy's 2005 review says neck rejuvenation targets all tissue layers and can be surgical, nonsurgical or combined (Roy, 2005).
| Feature | Horizontal neck lines | Vertical neck bands |
|---|---|---|
| What you see | Creases running around the neck | Vertical cords down the front of the neck |
| How reviews list them | Rhytides (wrinkles), one of several neck-aging features | Prominence of the platysmal bands, listed separately |
| Most-studied in-office option | HA filler, in 4 neck-specific studies | Botulinum toxin, per trial authors' background notes |
| Botulinum toxin | Limited effect, per one trial; beaten by HA plus mesotherapy | Trial authors say toxin and energy devices can help bands |
Bottom line: Get the line type assessed first, because the studied treatments differ. Sources: Vanaman 2016, Li 2022.
Loose, sagging skin is a third issue. For laxity, see peptides for skin tightening and peptides for loose skin.
Evidence: Limited (expert reviews).
What causes horizontal neck lines?
Study authors attribute horizontal neck lines to aging and sun exposure, but no study in our sources tested a cause directly. So these are authors' explanations, not proven mechanisms.
Cai et al. open their filler-alternative study by stating that horizontal neck wrinkles "develop as a result of the aging process" (Cai et al., 2020). Young et al. describe neck and jawline aging as driven by intrinsic and extrinsic factors (Young et al., 2023). Rawlings et al. note that lifetime sun exposure plays a major role in photoaging, and they suggest their results differed by body site because of differences in likely photodamage (Rawlings et al., 2013).
You'll see other explanations online, such as natural skin folds or genetics. We found no study in our sources that tests them, so we don't repeat them as fact.
Evidence: Limited (authors' background statements, not tested).
Is "tech neck" real? Do neck lines come from looking down?
We don't know. People often blame phone use for neck lines, but no study in our sources tests whether looking down causes them.
The only study with "tech neck" in its title measured a cream, not posture. Young et al. ran a prospective, open-label, single-center study (no control group) in 35 Chinese women aged 25 to 50 with mild to moderate neck aging. They applied a topical neck treatment twice daily for 84 days, and the authors reported significant improvement in horizontal neck fold lines versus baseline (Young et al., 2023).
The abstract doesn't name the product or its ingredients, and we couldn't verify the sponsor. The authors suggest early topical care for younger people with "tech neck," but the study never measured screen time or head position.
Evidence: Limited. No study in our sources tests posture as a cause.
Why do I have neck lines at 18, 25 or 28?
No study in our sources looked at neck lines in teenagers or people in their early 20s, so we can't tell you why they appear early. A recurring worry in online forums comes from people in their 20s who notice horizontal creases and fear they're aging fast.
The neck-line studies enrolled adults. The youngest participants were 20 in one filler study (Rongthong et al., 2023) and 25 in the cream study (Young et al., 2023). The largest filler study had a mean age of 55 (Renga & Ryder, 2022). Results from those groups may not apply to a teenager.
If lines bother you, are changing, or come with redness or itching, a dermatologist can look at them in person. That's general guidance, not a finding from these studies.
Evidence: Limited. No data exist in people under 20.
Can skincare help neck lines?
Skincare has only small studies on the neck, and the results are modest. In the one controlled trial that compared body sites, the neck improved least of five.
Topical studies that included the neck
Rawlings 2013
Result: Improved fine lines and coarse wrinkles on face and neck vs no treatment (P < 0.001); neck improved least
Randomized, grader-blinded trial against a no-treatment group. Some changes appeared as early as 2 weeks. PubMed tags it as having non-US-government research support; the abstract doesn't name the funder.
Humbert 2003
Result: Better global score on the treated side; deep furrows decreased
Double-blind randomized trial on photoaged low-neck and arm skin in healthy women. Biopsies showed elastic tissue repair. Funding not stated in the abstract.
Thibault 1998
Result: Improved texture and discoloration; wrinkle reduction not significant
Double-blind, placebo-controlled randomized trial on face and neck. Funding not stated in the abstract.
Young 2023
Result: Improved horizontal neck fold lines vs baseline
Open-label, single-center, no control group. Product, ingredients and sponsor not stated in the abstract.
The ranking is ordinal only; the abstract gives no percentages per site. Vitamin A palmitate (retinyl palmitate) is a vitamin A ester, a milder relative of prescription retinoids.
Retinoids. No tretinoin study on neck lines is in our sources. For face data, see does tretinoin help with wrinkles; tretinoin is prescription-only, so talk to a prescriber. For over-the-counter retinol, see can you use retinol every night.
Sunscreen and moisturizer. No neck sunscreen trial is in our sources. Extending sunscreen to the neck is clinic convention, consistent with the photodamage framing in Rawlings et al. See picking an SPF level, how often to reapply sunscreen and sunscreen before or after moisturizer. For moisturizers, see how the skin barrier works.
Peptides. Untested on neck lines. For face data, see what Argireline does and our peptide ingredients ranked by evidence.
How long to try a cream. The studies ran 84 days to 6 months. Any other trial period you hear is clinic convention.
Evidence: Early / preliminary.
What's the best in-office treatment for horizontal neck lines?
HA filler has the most neck-specific data, including one small randomized trial where it beat botulinum toxin. HA filler is a gel injected to fill lines directly. The evidence is still limited, and the 4 studies used different scales, so their numbers can't be compared directly.
| Renga 2022 | 50 women (8 also had HIFU) | 1 month primary; follow-up up to 30 months | About 1 mL VYC-12 | 92% improved 1+ grade; mean ATNLS 2.64 to 1.44 (p < .0001) |
| Rongthong 2023 | 30 (women and men, 20 to 69) | 6 months | About 3 ml Belotero Balance by blunt cannula, 1 session | Peak at 1 month, significant decline at 3 months, sustained to 6 months |
| Lee 2018 | 14 patients (28 neck halves) | 2 months | 1.01 ± 0.13 cc per side, 1 session | GAIS 4.04 ± 0.79; vertical technique 4.27 vs linear threading 3.60 (P = .027) |
| Li 2022 | 48 women (25 HA + mesotherapy, 23 toxin) | 10 months after final treatment | 2 to 3 sessions of non-cross-linked HA + mesotherapy vs 1 toxin session | HA arm had better line grades at every visit (P = 0.000) |
Renga 2022
Result: 92% improved 1+ grade; mean ATNLS 2.64 to 1.44 (p < .0001)
Prospective, uncontrolled study of consecutive women, mean age 55. FACE-Q neck appraisal rose from 31.0 to 49.7. Repeats at 9 to 12 months gave progressive gains. No treatment-related adverse events. Funding not stated in the abstract.
Rongthong 2023
Result: Peak at 1 month, significant decline at 3 months, sustained to 6 months
Prospective, uncontrolled. Patients and 2 blinded dermatologists graded photos. One bruise. Funding not stated in the abstract.
Lee 2018
Result: GAIS 4.04 ± 0.79; vertical technique 4.27 vs linear threading 3.60 (P = .027)
Retrospective chart review, Fitzpatrick skin types IV to V. Transient skin irregularity and accentuation of neck lines. Funding not stated in the abstract.
Li 2022
Result: HA arm had better line grades at every visit (P = 0.000)
Multicenter, randomized, evaluator-blinded, moderate-to-severe lines. HA arm had more pain and more, longer-lasting redness, swelling and bruising (P < 0.001). No serious adverse events. Funding not stated in the abstract.
ATNLS, GAIS and line grades are different scales. GAIS is a 5-point Global Aesthetic Improvement Scale (5 = very much improved).
Show data table
| Time point | Mean ATNLS score |
|---|---|
| Baseline | 2.64ATNLS points (lower = fewer lines) |
| 1 month | 1.44ATNLS points (lower = fewer lines) |
Mesotherapy means many small, shallow injections into the skin. In the Lee study, lines briefly looked worse after injection in some patients, which is worth asking an injector about.
Other options have one small study each:
- Profhilo after toxin. Profhilo is a non-cross-linked high and low molecular weight HA gel. In a randomized trial of 19 participants (the abstract doesn't make clear whether this is the total), Dysport plus Profhilo gave higher hydration (p < 0.001), thickness (p = 0.028) and GAIS scores (p < 0.001) at 3 months than Dysport alone (Noormohammadpour et al., 2022). Funding not stated in the abstract.
- SVF gel. Stromal vascular fraction gel is made from liposuctioned fat. In a single-center study of 28 women given SVF gel and 22 given toxin, results were similar for type II wrinkles in the first 3 months, but SVF gel scored higher for type III to IV wrinkles, with longer-lasting side effects (Cai et al., 2020).
- One-syringe mix. In a 15-woman pilot, calcium hydroxyapatite, toxin and HA injected together gave 93.3% at least a 1-grade improvement on a skin flaccidity scale at 4 months (de Sanctis Pecora, 2024). It measured sagging, not lines.
A 2025 review covers fillers, mesotherapy, microneedling, peels and Profhilo for the neck; its authors declare no conflicts (El Hawa et al., 2025). Vanaman et al. found "little literature" on combining procedures (Vanaman et al., 2016).
Evidence: Limited.
Does Botox work on neck lines or neck bands?
For horizontal neck lines, botulinum toxin did worse than HA filler plus mesotherapy in the one randomized trial. Expert consensus favors toxin mainly where muscle contraction drives the problem.
Li et al. note in their background that energy devices and toxin can help laxity and platysmal bands but have "limited efficacy" on horizontal neck lines (Li et al., 2022). The Global Aesthetics Consensus Group says toxin use has extended to the neck. It recommends toxin as a primary treatment when excessive muscle contraction is the main cause (Sundaram et al., 2016).
Microbotox means tiny intradermal droplets of toxin. A review of 20 articles found results usually appeared after 5 to 14 days and lasted about 3 to 6 months, mostly in face studies. It called microbotox suitable for neck rejuvenation, especially in older people with marked laxity (Iranmanesh et al., 2022). For aftercare, see skincare after Botox.
Evidence: Limited.
Do microneedling, radiofrequency or ultrasound help neck lines?
No study in our sources tests these devices on horizontal neck lines alone. The data are reviews that mix face and neck.
- Microneedling: El Hawa et al. discuss it for the neck but give no outcome numbers in the abstract (El Hawa et al., 2025). See skincare after microneedling.
- Radiofrequency (RF): A systematic review of 121 articles found RF improved laxity, elasticity and wrinkles, with face and neck combined. RF was safe apart from one patient who developed a neck fistula, an abnormal opening (Austin et al., 2022).
- High-intensity focused ultrasound (HIFU): A 2025 review calls results "promising" for the face, neck and cleavage but notes complications can occur (Welc et al., 2025). In Renga and Ryder's study, 8 women with the most severe lines got HIFU plus filler (Renga & Ryder, 2022).
- Red light (LED): At-home and in-office LED is sold for neck lines too; we review the wrinkle trials in does red light therapy work for wrinkles.
Evidence: Limited (face and neck combined).
How long do neck line treatment results last?
Filler for neck lines peaked at 1 month and settled lower by 3 months, holding to 6 months in one study. Only the timings below come from studies; anything else you're quoted is clinic convention.
Study-supported timings for neck lines
- 5 to 14 daysMicrobotox onset
Results usually appeared, mostly in face studies (Iranmanesh 2022).
- 2 weeksEarly moisturizer changes
Some changes with a vitamin A palmitate oil (Rawlings 2013).
- 1 monthFiller peak
Peak benefit (Rongthong 2023); 92% improved 1+ grade (Renga 2022).
- 3 monthsFiller dip
Significant decline from the peak (Rongthong 2023).
- 84 days (12 weeks)Cream study endpoints
Endpoints for Young 2023 and Rawlings 2013.
- 3 to 6 monthsMicrobotox duration
Typical duration, mostly face data (Iranmanesh 2022).
- 6 monthsFiller plateau
Results held from 3 to 6 months (Rongthong 2023).
- 10 monthsLast head-to-head visit
HA plus mesotherapy still ahead of toxin (Li 2022).
- Every 9 to 12 monthsRepeat filler
Repeats gave progressive gains (Renga 2022).
Evidence: Early / preliminary.
Where the evidence stops
- No cause studies. No source tests why horizontal neck lines form, including posture or "tech neck."
- No young participants. No data on teenagers; the youngest enrolled were 20.
- No large trials. The biggest randomized neck-line trial had 48 people.
- Funding unclear. Abstracts don't state funding for most studies.
- No neck data for peptides, tretinoin or sunscreen.
- No device trials on lines alone. RF and HIFU data mix face and neck.
FAQ
Why do I have neck lines at a young age?
No study in our sources looked at neck lines in teenagers or people in their early 20s, so we can't name a cause. The neck-line studies we found enrolled adults, starting at age 20 in a filler study and age 25 in a cream study. If your lines worry you or are changing, a dermatologist can assess them in person.
Is 'tech neck' from looking at my phone real?
It's a popular idea, but no study we found tested whether looking down at a phone causes neck lines. The one study that used the 'tech neck' label tested a neck cream for 84 days, not posture.
What's the difference between horizontal and vertical neck lines?
Horizontal lines run around the neck, while vertical cords are often platysmal bands, which reviews list as a separate feature of neck aging. They are treated differently, and one trial's authors noted that botulinum toxin has limited effect on horizontal lines.
Can creams get rid of neck lines?
The evidence is weak. One open-label study of 35 women reported improvement with no control group, a retinyl palmitate oil improved the neck least of five body sites, and a 5% glycolic acid cream did not significantly reduce wrinkles.
Does Botox work for horizontal neck lines?
In a randomized trial of 48 women, hyaluronic acid filler plus mesotherapy beat a single botulinum toxin session on horizontal line grades at every visit up to 10 months, though it caused more pain and side effects. A global consensus says toxin is the first choice mainly when muscle contraction is the main cause.
How long does filler for neck lines last?
In a 30-person study, results peaked at 1 month, declined significantly by 3 months, then held to 6 months. In a 50-woman study, repeat injections every 9 to 12 months gave progressive improvement.
Do peptides like Argireline help neck lines?
We found no study of Argireline or any other peptide on neck lines. Any benefit on the neck is untested.
What are red lines around the neck?
Redness is not the same as creasing, and none of the studies in our sources covers it. Red, itchy or changing marks on the neck are worth having checked by a dermatologist.
References
- Renga M, Ryder TJ. Treatment of Horizontal Wrinkles of the Neck Using a Hyaluronic Acid Filler: Results From a Prospective Study. Dermatol Surg. 2022. Prospective, uncontrolled, n=50 women, follow-up up to 30 months; funding not stated in the abstract. https://pubmed.ncbi.nlm.nih.gov/35093965/
- Rongthong A, et al. Efficacy and safety of hyaluronic acid filler on the treatment of horizontal neck lines. J Cosmet Dermatol. 2023. Prospective, uncontrolled, n=30, 6 months; funding not stated in the abstract. https://pubmed.ncbi.nlm.nih.gov/36575878/
- Lee SK, Kim HS. Correction of horizontal neck lines: Our preliminary experience with hyaluronic acid fillers. J Cosmet Dermatol. 2018. Retrospective chart review, 14 patients (28 neck halves), 2 months; funding not stated in the abstract. https://pubmed.ncbi.nlm.nih.gov/28726351/
- Li Y, et al. Hyaluronic Acid Compound Filling Plus Mesotherapy vs Botulinum Toxin A for the Treatment of Horizontal Neck Lines: A Multicenter, Randomized, Evaluator-Blinded, Prospective Study in Chinese Subjects. Aesthet Surg J. 2022. Multicenter, randomized, evaluator-blinded, n=48, 10 months; funding not stated in the abstract. https://pubmed.ncbi.nlm.nih.gov/34758056/
- Cai J, et al. Mechanical Micronization of Lipoaspirates for the Treatment of Horizontal Neck Lines. Plast Reconstr Surg. 2020. Single-center comparison, 28 SVF gel vs 22 toxin; funding not stated in the abstract. https://pubmed.ncbi.nlm.nih.gov/31985619/
- Noormohammadpour P, et al. Botulinum toxin injection as a single or combined treatment with non-cross-linked high molecular weight and low molecular weight hyaluronic acid gel for neck rejuvenation: A randomized clinical trial. Dermatol Ther. 2022. RCT, 19 participants (unclear whether total), 3 months; funding not stated in the abstract. https://pubmed.ncbi.nlm.nih.gov/35775872/
- de Sanctis Pecora C. The gold protocol: A combined treatment approach for neck rejuvenation with calcium hydroxyapatite, botulinum toxin, and hyaluronic acid in the same session. J Cosmet Dermatol. 2024. Pilot, n=15, 90 to 180 days; funding not stated in the abstract. https://pubmed.ncbi.nlm.nih.gov/38566435/
- Young MB, et al. A Rejuvenating treatment targeting "tech neck" lines and wrinkles in Chinese women: A prospective, open-label, single-center study. J Cosmet Dermatol. 2023. Open-label, no control, n=35, 84 days; product and sponsor not stated in the abstract. https://pubmed.ncbi.nlm.nih.gov/36374589/
- Rawlings AV, et al. The effect of a vitamin A palmitate and antioxidant-containing oil-based moisturizer on photodamaged skin of several body sites. J Cosmet Dermatol. 2013. Randomized, grader-blinded vs no treatment, 12 weeks, n not given in the abstract; non-US-government research support, funder not named in the abstract. https://pubmed.ncbi.nlm.nih.gov/23438139/
- Humbert PG, et al. Topical ascorbic acid on photoaged skin. Clinical, topographical and ultrastructural evaluation: double-blind study vs. placebo. Exp Dermatol. 2003. Double-blind RCT vs excipient, 6 months, n not given in the abstract; funding not stated in the abstract. https://pubmed.ncbi.nlm.nih.gov/12823436/
- Thibault PK, et al. A double-blind randomized clinical trial on the effectiveness of a daily glycolic acid 5% formulation in the treatment of photoaging. Dermatol Surg. 1998. Double-blind placebo RCT, n=75, 3 months; funding not stated in the abstract. https://pubmed.ncbi.nlm.nih.gov/9598014/
- Sundaram H, et al. Global Aesthetics Consensus: Botulinum Toxin Type A--Evidence-Based Review, Emerging Concepts, and Consensus Recommendations for Aesthetic Use, Including Updates on Complications. Plast Reconstr Surg. 2016. Consensus statement and review; non-US-government research support listed. https://pubmed.ncbi.nlm.nih.gov/26910696/
- Iranmanesh B, et al. Employing microbotox technique for facial rejuvenation and face-lift. J Cosmet Dermatol. 2022. Review of 20 articles; funding not stated in the abstract. https://pubmed.ncbi.nlm.nih.gov/35064633/
- Vanaman M, et al. Neck Rejuvenation Using a Combination Approach: Our Experience and a Review of the Literature. Dermatol Surg. 2016. Literature review plus clinical experience; funding not stated in the abstract. https://pubmed.ncbi.nlm.nih.gov/27128251/
- Roy D. Neck rejuvenation. Dermatol Clin. 2005. Narrative review; funding not stated in the abstract. https://pubmed.ncbi.nlm.nih.gov/16039427/
- El Hawa M, et al. Non-Facial Skin Rejuvenation of the Neck, Chest, and Hands. Part One: Using Injections. J Cosmet Dermatol. 2025. Narrative review; authors declare no conflicts of interest. https://pubmed.ncbi.nlm.nih.gov/39548357/
- Austin GK, et al. Evaluating the effectiveness and safety of radiofrequency for face and neck rejuvenation: A systematic review. Lasers Surg Med. 2022. Systematic review, 121 articles; funding not stated in the abstract. https://pubmed.ncbi.nlm.nih.gov/34923652/
- Welc N, et al. High-Intensity Focused Ultrasound-Application, Effects and Complications. Australas J Dermatol. 2025. Narrative review; funding not stated in the abstract. https://pubmed.ncbi.nlm.nih.gov/40095285/
Disclosure: This article is for general information only. It is not medical advice. Peptide Skincare has no affiliate links in this article and received no payment from any manufacturer mentioned. Injectables and energy devices are medical procedures; ask a dermatologist or qualified injector, and talk to a prescriber about tretinoin.