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Aging Neck – How to treat it effectively

Unfortunately, some of the earliest signs of aging can be seen in the neck. This may take the form of vertical bands running from the chin to the décolleté, skin sagging down in the jowls and neck, wrinkling of the skin, and development of a double chin. The good news is there are many different treatment options directed towards each of these problems. To appreciate why you see those signs of aging, a little anatomy lesson is in order.

Around the front of the neck is a large muscle, called the platysma. It starts around the ears and goes towards the collar bone, then comes forward and has fibers that join together the two sides of the muscle in the middle. This muscle then attaches to the overlying skin and depending on a combination of genetics, diet, and exercise, there may be a noticeable amount of fat both in front of (pre platysma) or behind (post platysma) the muscle. Below the jaw line on the sides are two glands that produce saliva, called the submandibular glands. These may or may not be visible, but they can be felt. Gravity also can pull these glands down creating fullness below the jowls. Finally, the way you bend your neck can create horizontal lines running across the neck. These lines begin to develop when you are younger and can become more pronounced with time. With this in mind, what can be done to improve the appearance of the neck?

The double chin, if present, is usually one of the first concerns that will lead people to seek treatment. There is a strong genetic component to this. The fat can develop in front of the platysma or behind it, which affects what can be done to treat it. Stress and weight gain can further exacerbate the appearance and the amount of fullness. The good news is there are several options. The most direct option is liposuction, either laser assisted or alone. Liposuction and direct removal of fat can be quite effective. It allows your surgeon to directly control how much is being removed with an immediate appreciation for the improvement. Liposuction can be effective for younger patients when performed as an isolated procedure. However, once you reach around age 35-40 the skin lacks the elasticity to tighten back up predictably, and if skin tightening is not also performed, you may change a double chin for a turkey waddle of loose skin.

Liposuction and direct removal of fat can be quite effective. It allows your surgeon to directly control how much is being removed with an immediate appreciation for the improvement. Liposuction can be effective for younger patients when performed as an isolated procedure. However, once you reach around age 35-40 the skin lacks the elasticity to tighten back up predictably, and if skin tightening is not also performed, you may change a double chin for a turkey waddle of loose skin. Non surgical treatment for the double chin can also be effective, but the results are best described as delayed gratification. One of the newer options on the market is Kybella ®. This is an FDA approved injectable product that is naturally found in the body and simply dissolves fat. Similar to liposuction, the fat that dissolves is permanently removed, and any future weight fluctuations will always leave the neck looking better than if it hadn’t been treated. Treatment with Kybella® is performed as a series of injections in the office. It takes anywhere from 2-4 treatments that are spaced about 4-6 weeks apart, and it is only approved to treat fat in front of the platysma muscle. The biggest benefit of Kybella is that there is no down time, and the treatment takes only a few minutes in the office. Another treatment option for the double chin is CoolSculpting ®. This involves the application of cold temperatures and suction on the double chin to physically kill the fat, and then the body absorbs it. Treatment takes anywhere from 35 minutes to an hour depending on the version of the device used. For heavier necks, multiple treatments may also be needed. There are other non invasive treatments out there that are approved for other parts of the body that may eventually gain approval for the double chin as well.

For those patients with loose skin being more of the problem, then liposuction, Kybella ®, and CoolSculpting ® would not offer much. For minimal skin laxity, especially in the jowl area, and for patients with good skin texture and tone, Ulthera ® can be effective. Ulthera ® works by using high intensity ultrasound to deliver heat energy to the deeper structures and effect skin tightening. It won’t address fat, but it can be combined with other treatments. Other technologies that are designed to improve the area include radiofrequency technology like Thermage ® and more invasive treatments like ThermiRF ®. To truly address the lax skin, a surgical neck lift may be the best and only option for some patient. This involves a small incision under the chin in a natural crease and a few incisions behind the ears into the hair to physically remove the excess skin and take out the slack. This can also be combined with liposuction to create very impressive results.

If vertical bands in the neck are more of the problem, then your options become a little more limited. Botox ® or another neuromodulator like Dysport ® or Xeomin ® may help to soften the bands. What these bands represent are the front edges of the platysma muscle. Neuromodulators are designed to weaken the muscle in that area so the band won’t stick out so much. The results tend to not be very dramatic, but they can be effective for mild bands. The other option is surgery which involves addressing those muscles. This is more invasive but produces a longer lasting and more dramatic result.

If the skin has appropriate tone but the texture is beginning to show mild wrinkles, then resurfacing procedures and even topical products may be all that is needed. It is important to realize that the neck skin is thinner and a different quality than the facial skin. Because of this, treatments used on the face may not be appropriate treatments for the neck. Topical products with low concentrations of vitamin A derivatives and light resurfacing treatments can work to improve these findings. For the more prominent horizontal bands there is no excellent treatment, but these options may help to soften the harshness of the line.

As it may be evident above, the gold standard for neck improvement is surgery. But surgery is not for everyone and everyone is not a surgical candidate. With that in mind, it is important to learn about all of the various ways to improve the different neck conditions. With all of the various treatment options out there, how can you decide what is best for you? The answer is you shouldn’t be deciding. It is a very complex area with many different options depending on your anatomy, your goals, your downtime available, and the time course you are hoping to get results. Because of this, it is always best to seek a consultation with a facial plastic surgeon to learn about the surgical and non surgical options for you. For some necks, surgery is the best and only option. For other patients, one or a combination of treatments will produce the best result with the least downtime. At your consultation you can learn about the expected outcomes, the treatment timeline, and what to expect during and after each treatment.

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For more information on this and other plastic and reconstructive surgery procedures, please contact:

W. Marshall Guy, M.D.
Facial Plastic & Reconstructive Surgeon
128 Vision Park Blvd Suite 150
The Woodlands, Texas 77384
832.956.1040 | drguyfacialplastics.com