The Ultimate Guide to Neck Treatments
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Exuding strength and sensuality, the neck has shaped centuries worth of art—from the portraits of Modigliani, who elongated and arched subjects’ necks to surreal effect, to the words of Ephron in her iconic exploration of wattle and bands.
In recent years, our fascination has only deepened, with in-demand plastic surgeons and dermatologists routinely elevating ordinary necks to veritable works of art, and exhibiting their masterpieces—born of syringes and scalpels—across social media for all to appreciate.
Or, perhaps, covet. As we compare before to after (or us to them), it’s hard not to be influenced.
In her famous essay on the subject, Ephron pinpointed 43 as the age at which “the neck starts to go.” But according to the doctors we interviewed, the neck can begin to show wear and tear much earlier—and even the youngest of patients are eager to reverse it. In the past, “the aging neck wasn’t even brought into the conversation until the mid- to late-forties, but now I have 25-year-olds who are like, What is going on with my neck? Why do I have all these lines?” Divya Shokeen, a board-certified dermatologist in Manhattan Beach, California, says.
What causes neck aging?
While horizontal neck lines, like so many beauty-related grievances, are largely genetic, they can be exacerbated by modern-day habits (like staring down at devices) as well as weight changes, sun damage, and, of course, time. “As the skin thins and the muscles drop with age, any creases that were there when your neck was nice and firm start to reveal themselves in a more obvious way,” board-certified New York City dermatologist Robert Anolik explains.
Laxity in the platysma—the sheet-like muscle spanning the neck, from jawbone to collar bone—can also manifest as bulging neck bands. In youth, these bands might rise up only when we’re talking, straining, grimacing, or otherwise animating, but as we get older, they can become permanent fixtures, giving the neck a tense, sinewy look, which becomes increasingly evident when the overlying tissues wear thin, exposing the intricacies of the muscle below.
Beyond stocking up on turtlenecks, what can we do to feel better about our necks? Injectables have become go-tos for certain complaints. And doctors frequently pair them with devices to boost the effects or address multiple issues at once. The fact remains, however, that despite the abundance of cosmetic treatments at our disposal, the aging neck is notoriously tricky to treat nonsurgically. Still, if going under the knife isn’t an option for you, it’s important to know where shots and machines shine (or come up short), when aiming for an enviable neck.
Concern: Vertical Neck Bands
Neuromodulators, like Xeomin and Botox, are commonly used off-label in the neck. Being muscle relaxers, these toxins work best on hyperactive bands that surface when the platysma contracts. “If you see a band fluctuating in appearance during dynamic movement—speaking, smiling, laughing, frowning—we can place a neuromodulator throughout the band to have it relax and not lower as much,” Anolik says. Since the platysma wraps around the jaw, injections along the lower edge of the mandible can also relieve the downward pull of the muscle to make the jawline look a bit crisper. (The effect is modest, mind you, so keep expectations in check: “We can do pretty amazing things with neuromodulators in the neck, with just a few pinches of a needle,” Anolik notes, “but we still cannot deliver a surgical neck-lift result.”)
Hanging or static bands are far less amenable to treatment with neurotoxin. There are occasional exceptions, however. If the bands are just starting to stick around and the skin overlying them is fairly tight and elastic, “we can sometimes flatten them out with toxin and prevent future skin sag in the area,” board-certified Boston dermatologist Papri Sarkar says. Limiting the bands’ stretch on the skin can protect collagen and maintain the skin’s integrity to an extent. Generally speaking, though, “once the platysma is clearly lax, loose, and wavy, adding toxin is not going to make those neck bands go away,” Jason Bloom, a board-certified facial plastic surgeon in Bryn Mawr, Pennsylvania, tells us.
While a neck lift is the gold-standard fix for major bands, he adds, a newish minimally invasive treatment called MyEllevate can serve as a happy-medium type solution for some. During the procedure, with the patient awake and numb, a surgeon passes a lighted rod through tiny incisions under the chin and behind the ears, lacing a braided suture throughout the tissues, to lend corset-like support and subtle definition to the jawline and neck.
Concern: Horizontal Neck Lines
“Improve not remove” is the name of the game with these necklace-like creases, Bloom says, so again, you’ll want to reality-check your expectations if treating this super-common concern.
In Anolik’s experience, a soft hyaluronic acid (HA) filler injected superficially into the dermis can help to “mask some of the depth” of these lines, but you’ll likely notice upon close inspection—when shifting or stretching the skin—that the etched lines persist post-shot.
Sarkar has had decent luck treating these wrinkles with HA, provided they’re not too shallow, and attributes her success not only to the filler (she likes Belotero and RHA Redensity here), but to the action of the needle that delivers the gel. “Horizontal neck lines truly feel like scar [tissue] when you get in there with a needle,” she says. And injecting into these fine crevices can offer a subcision-like effect, freeing things up a bit to smooth the skin. Expect a fair amount of bruising along the length of the lines when going this route.
Shokeen also sees great results with RHA Redensity, especially in younger patients, but when neck lines are stubborn and the surrounding skin needs some love, she may complement injections with a round or two of radiofrequency microneedling. “The way that it helps to build collagen, improve skin quality and texture, and help the overall look of the neck—I have yet to see another device do something similar,” Shokeen tells us. While there are loads of machines under the RF-needling umbrella, she’s partial to the Secret RF and says patients typically find this treatment more tolerable than other popular radiofrequency microneedling devices.
When weighing your options, just bear in mind, “the degree of improvement in horizontal neck lines is going to be very minimal, whatever method you choose,” Anolik adds.
Concern: Loose, Crepey Skin
When the skin of the neck gets thin and crinkled and suddenly lacks snap, the goal is to increase protein production to thicken things up. The so-called biostimulatory injectables, Sculptra (poly-L-lactic acid) and Radiesse (calcium hydroxylapatite), when sufficiently diluted, can jumpstart collagen and elastin synthesis without imparting their usual volume, experts say, thereby improving the tone and texture of the neck, in one to three sessions, for up to two years.
Sculptra and Radiesse have been shown in studies (here and here, for instance) to improve neck laxity (though this is considered an off-label use for both). While complications are reportedly rare, these products do pose a risk of nodules, especially if not diluted properly. And since neither injection is reversible, if lumps do develop, they may have to be removed surgically. Massaging treated areas for five minutes, several times a day, for about a week after injections can help keep the particles from clumping up and forming nodules.
Bloom, who likes Sculptra for the neck, says that some people begin to see a change as early as six weeks following a single vial of the collagen-builder. Shokeen is also a Sculptra fan, but finds it works best for laxity when used alongside devices, like RF needling and ablative lasers, which take aim at different layers of the skin, for the most thorough rejuvenation.
When upgrading the texture of the neck, Anolik tends to lean on fractional resurfacing lasers (of varying intensities) more than injectables. “A lot of that crepiness comes from a weakening of the dermis,” he explains, “and these fractional lasers place thousands of microinjuries into the dermis, tricking the fibroblast cells to go through a healing phase and produce more collagen, which makes the dermal layer thicker and stronger for less visible crepiness.” In more severe cases, Anolik may tack on an ultrasound or RF treatment—the kind you pass over the skin’s surface, à la Thermage, Ultherapy, Sofwave—to target “the deeper fibers of collagen that swim through the subcutaneous terrain, from the dermis down to above the muscle,” he says.
Ellacor, which tightens by physically removing a percentage of skin, is also being used off-label in the neck. Anolik cautions that the neck is more sensitive than the face, however, so while Ellacor seems like a reasonable answer to mild neck laxity, the healing time, risk of scarring, and overall safety of neck treatments deserve careful consideration.
At the risk of sounding like a broken record, we once again urge you to respect the limitations of nonsurgical tools to avoid disappointment. “Once there’s obvious laxity in the neck muscle and skin, there’s not a huge benefit, in my mind, for noninvasive treatments,” Bloom says.
Concern: Double Chin
That little pooch under the chin—yeah, there’s a shot for that, too. Kybella (deoxycholic acid) can sometimes melt away a double chin, but it usually takes several sessions and causes hard-to-hide swelling following each appointment. For those who can’t tolerate it, submental liposuction can quickly contour the area in a single session with fairly minimal downtime.
But before shelling out for either fat-reduction technique, have a board-certified plastic surgeon, facial plastic surgeon, or dermatologic surgeon examine your neck to determine where the unwanted fat resides. Kybella and lipo can only reach fat that’s sitting just below the skin. But oftentimes people with full necks have deep fat hiding under the platysma muscle, which can only be removed surgically. What’s more, droopy muscles and large glands can also make the neck look wide or thick—and tailoring these structures requires a surgical neck lift.
Another fun fact about fat: It’s wildly underrated—and, in some cases, worth preserving. The superficial kind, in particular, can lend a very youthful vibe to the face and neck by concealing what lies beneath and providing a bit of structure as we age. “If the skin and muscle of the neck are starting to get lax, and you take away the fat, then you’re essentially left with a loose bag—hanging bands, sagging skin, and ultimately an older-looking neck,” Bloom says. (In his opinion, a significant loss of elasticity in the neck is the biggest indication for surgery.) Think twice before aggressively going after fat in the neck.
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