Beauty Behind Closed Doors The New Secrets to Fix a Sagging Neck

·5 min read
Photo credit: Michael Stillwell - Getty Images
Photo credit: Michael Stillwell - Getty Images

Feeling bad about your neck? You are not alone. There comes a time when many of us begin to contemplate the viability of wearing a complementary scarf with every ensemble—and it’s happening earlier than ever. “The lower face and neck have become a real focus,” says Manhattan-based dermatologist Dendy Engelman, MD. “I don’t know if that’s because we’ve all bought in to doing the upper and mid-face and now our necks don’t match, or if it’s the zoom effect of being inundated with our reflections all day, or tech neck from spending hours on our phones, but I’m seeing much younger patients for neck treatments than I did historically.”

The good news for those who don’t feel ready to commit to a surgical neck lift is that there are now a number of non-invasive procedures capable of delivering visible improvements. “Non-surgical neck tightening relies on energy forms that can go deep into the skin, primarily radiofrequency and ultrasound,” says dermatologist Robert Anolik, MD, who practices at the Laser and Skin Surgery Center of New York. “What might work for one patient might do very little for another, so it’s great that we have several different modalities. Sometimes we need to try more than one thing, but we can find what’s right for every individual.”

MORE: The Best Creams to Tighten and Lift the Neck

The first step, says Engelman, is to identify the primary issue that’s affecting the appearance of your neck. “We see multiple things happening. You can have vertical bands from the platysma muscles, which stick out and blunt the angle under the jaw. You can have horizontal lines from sleeping or from bending over your phone. And you can have crepiness or texture changes in the skin. Some people might have all the above. But we begin by isolating the main problem and working from there.” Here, the most effective treatments to address the trifecta.

Microneedling with Radiofrequency

Engelman likes to use Genius MicroNeedling with RF to both improve the texture of the skin and stimulate collagen so that the skin will tighten over time. The device features gold-plated needles that penetrate the skin and emit radiofrequency at their tips. “The beauty of it is that you can focus the energy directly and deeply into the dermis, without affecting the epidermis” Engelman says. Because the melanocytes are bypassed, the risk of post-inflammatory hyperpigmentation is minimal, making it an excellent choice for those with darker skin tones. The treatment, too, is no-fuss: Numbing is required, but the procedure is painless, and results only in slight redness that can persist for one or two days. Results will begin to be visible after one month, with continued improvements for up to six months afterwards.

Laser Resurfacing

Ablative lasers such as Fraxel or CO2 technologies can be powerful tools to erase crepiness and restore smooth, supple texture to the neck. Anolik cautions, however, that there can be significant downtime after these procedures, and that there is more risk of prolonged redness or discoloration when they are used on the neck, where skin is ultra-thin, than on the face. For a gentler approach, he says, “we can still get results with non-wounding, or non-ablative laser resurfacing. It won’t lift, but it will help with crepiness, and you’ll only be pink for a few days.”

MORE: The 17 Best Treatments to Tighten Skin at Home


One of the most common off-label applications that dermatologists use for Botox is addressing platysma muscles in the neck. These muscles become more prominent with age, creating vertical banding under the jaw that can make the neck appear thicker. As the neurotoxin takes effect roughly a week after treatment, these muscles soften, and a smooth contour is restored. Anolik is also a proponent of pairing Botox injections with energy-based treatments to maximize the outcome. “I strongly feel that if someone is going to choose a non-surgical method of tightening the skin, like radiofrequency or ultrasound, Botox should be in effect on the neck during the months that follow treatment,” he says. “We are trying to stimulate a lift, and I don’t want to there to be any kind of counter-pull downward that would slow the lifting process.” He recommends syncing treatments up by getting Botox a week or two before RF or ultrasound procedures, and then following up when the neurotoxin begins to wear off three or four months later.


FDA-approved to lift the neck, chin, and brow, Ultherapy has been touted as a facelift alternative. While the effects are not actually that dramatic, the procedure can result in impressive collagen remodeling and overall tightening. The device focuses ultrasound energy into the skin, creating a heating effect that kickstarts collagen formation—and because it bypasses the surface of the skin it can be used on all skin types and there is zero downtime. It has a reputation for being painful, but newer iterations have significantly reduced the grit-your-teeth-and-bear-it aspect. For an even more comfortable experience, there is now Sofwave, a newer player in the ultrasound realm. “Instead of focused ultrasound, which Ultherapy uses, the sound waves pass in parallel, almost like a sheet of energy under the skin’s surface,” says Anolik. This means that the energy doesn’t penetrate as deeply, but it’s more diffuse—meaning it's less painful, and many patients report seeing results more quickly, within 10 days after the first treatment (most people need 2), as opposed to 2 to 3 months with Ulthera. In both cases, expect to see a major improvement in texture and sagging over time.

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