When patients of mine notice signs of aging, the neck is one of the most common areas of concern. Whether it’s a double chin, sagging skin, horizontal wrinkles and creases, vertical muscle bands, or hanging excess skin (aka a “turkey neck”), many people see signs of aging in the neck area. Fortunately, there is a variety of options for neck rejuvenation that these patients can turn to.
First of all, why do signs of aging show in the neck?
As with many physical characteristics, there are genetic, inherited components to the appearance of a patient’s neck, such as skin thickness and distribution of fat under the skin. External factors including sun exposure and smoking also have a significant impact on how quickly signs of aging develop in the neck. The skin on your neck is generally thinner, which causes it to be one of the first areas to show signs of aging.
At what age will you begin to see these changes?
Younger patients usually first complain of having a double chin (submental fullness). This can show up as early as your 20s. Older patients, on the other hand, are more concerned about loss of jawline definition and contour due to either thin, crepey skin or significant excess skin and fat deposition.
Women may notice their neck skin starting to thin and lose elasticity once they reach their 40s. Men, who have thicker skin and can camouflage the appearance of their jawline and neck by growing stubble or a beard, may be into their 50s before noticing loose neck tissues.
Heavy necks with significant amounts of excess skin and fat are usually seen in older patients in their 60s or older, whereas patients who have lost a significant amount of weight may find that they have very loose hanging face and neck skin even as young as their 20s.
What are day-to-day changes you can make to help your neck look its best?
As with the skin on all exposed areas of our bodies, you should apply sunscreen to your neck on a daily basis. Since the skin on our face and neck is generally thin and may be more sensitive than skin on other parts of the body, special sunscreen designed for the face and neck should be used.
You should also keep your skin well-hydrated by drinking plenty of water and using moisturizing lotions and creams (plus additional moisturizer in harsh weather, such as cold, dry, or windy conditions). Using daily retin-A cream will also help skin turnover and minimize wrinkle formation. If you find the prescription form too irritating, you can opt for milder forms of retinol. Mild exfoliation and peels may also provide rejuvenation when used intermittently in addition to the treatments noted above.
Something else that we don’t often think about but which affects the state of your neck? Excessive downward gazing—at our cell phones, tablets, laptops, etc. This may exacerbate transverse wrinkle formation in the neck, resulting in the “tech neck.” In order to prevent this, you can make an effort to spend less time looking down.
How about non-invasive treatments?
There are several in-office, non-invasive treatments that can address each of the different aspects of an aging neck.
Microneedling with platelet rich plasma (PRP)
This is one of the most effective and best-tolerated methods for mild skin-tightening. Microneedling leads to new collagen and elastic formation, which means smoother, tighter skin. When this is combined with PRP injections that contain concentrated growth factors, the effects are even more noticeable.
When injected into the platysma muscle bands, Botox helps relax the muscles and smooth out the appearance of the neck. In some patients, this may lead to a significant improvement in neck contour and better jawline definition.
Hyaluronic acid (HA) fillers
The use of HA fillers such as Juvéderm may be helpful to minimize wrinkles in the neck. When placed along the front of the jawline and chin, HA fillers can also improve the contour of the neck.
A more permanent alternative to fillers—which usually dissolve after several months—is to use a patient’s own fat in the form of fat grafts or fat injections. Fat injections achieve the same filling and contouring effect but also contain stem cells which are beneficial to overall skin texture and tone.
In terms of more recent non-invasive technologies, radiofrequency and focused ultrasound (e.g. Ulthera) may be of benefit in some patients. However, the results are temporary and somewhat unpredictable, requiring several months to be seen. Plus, some patients experience a great amount of discomfort from the treatment itself. Radiofrequency may be performed concurrently with microneedling using certain combination devices.
Other types of skin rejuvenation treatments include chemical peels such as lactic acid, glycolic acid, and TCA peels. Some types of lasers, such as fractionated CO2 or erbium lasers, may also provide an improvement in overall skin tone, but they must be used cautiously in order to avoid problems with uneven skin pigmentation, burns, and scarring.
What are more invasive fixes and when do you recommend them?
Surgery remains the most effective way to achieve the utmost rejuvenation of the neck and serves as the standard for comparison of other treatment options. One of the best minimally invasive surgical methods to improve both jaw contour and tighten neck skin is called “microsuction.”
Microsuction uses a tiny cannula that passes through the fatty layer below the skin through imperceptible incisions. It sculpts the neck by reducing jowls, smoothing out the jaw, removing excess fat, and promoting skin tightening. Younger patients with good skin elasticity, localized neck fat, and minimal skin excess are the best candidates for microsuction.
A full neck lift would be a better choice for women and men who are middle-aged or older, since they have more significant neck skin laxity, excess skin, and thick, hanging muscle bands in the neck. Younger patients who have lost 50 lbs or more may also benefit from neck lift surgery.
Some patients opt for a surgical neck lift after having undergone some of the non-invasive procedures. Neck lift procedures are tailored to address each patient’s individual concerns and provide noticeable, immediate results that last for years and help patients look and feel significantly better.
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