The neck is a problem area for many patients. It has thin, delicate skin that can age faster than other areas. This difference often creates a stark contrast between a youthful face and a sagging neck.
Fortunately, there are numerous options to improve the appearance of the neck. Patients can choose from a wide array of surgical and non-surgical procedures. However, each of these treatments is only useful in specific situations. The wide variety of options means patients must carefully consider the risks, benefits, and costs to find the best fit for their treatment goals and lifestyle.
Cosmetic surgery is an art, not a science. As a result, there isn’t one “right” way to treat a sagging neck.
How Cosmetic Procedures Improve the Appearance
In youth, people are like a well-fitted suit of clothes (skin and muscle) draped on a frame (body). However, the “clothes” stretch and enlarge with age, which causes them to sit poorly on the body. These changes can make it appear as if the body has lost volume because the “clothes” look too big for the body. Instead, the clothes are now a size or two larger while the frame has stayed the same.
Cosmetic procedures either, 1.) increase body volume to make the stretched skin fit better, or 2.) reduce the “size” of the clothing. Keep this analogy in mind to help understand how cosmetic procedures can improve the appearance of the neck.
Injectable fillers like Juvederm, Restylane, and Sculptra work by adding volume to certain areas of the body. At the early stages of aging, these fillers can make the skin fit better by increasing the size of the underlying frame. However, fillers can make patients look puffy or over-inflated if the skin has sagged too much.
Dermal fillers last no more than six to 12 months. This temporary nature is both a blessing and a curse. If a patient likes the outcome, they will have to get further injections to maintain their appearance. But, if the patient is unhappy with the result, they only have to wait a relatively short time before it fades.
Another injectable therapy that can improve the neck is botox. This substance is a toxin that helps relax the vertical neck bands. As a result, it quiets the downward pull of neck muscles and reduces the aging neck’s rope-like appearance.
Botox is even more temporary than dermal fillers. It only lasts three to four months. Another shortcoming of this treatment is that it can paralyze large areas if used too extensively. The result is often a plastic-looking face that moves oddly when making facial expressions.
However, botox is an inexpensive solution that can be effective when used in the early stages of aging.
Laser Skin Resurfacing
This rejuvenation technique uses heat from lasers to stimulate collagen production by the inner layer of the skin. The procedure involves either an ablative (wounding) or non-ablative (non-wounding) laser. Wounding lasers remove the top layer of skin, while the non-wounding lasers do not.
Both ablative and non-ablative resurfacing can be done with a fractional CO2 laser that treats only certain skin areas. Fractional laser therapy shortens recovery time and reduces side effects by leaving columns of untreated skin.
This technique uses injectable deoxycholic acid that breaks down fat cells under the chin and upper neck. Kybella is particularly good for treating double-chins. However, removing fat from the neck can sometimes expose sagging skin that the fat had disguised. In this situation, Kybella should be paired with a skin-tightening therapy to produce the best result.
Uses ultrasound to stimulate the subcutaneous (inner) Layer of skin to produce more collagen. This structural protein helps improve firmness and elasticity of the skin. Ultrasound therapy bypasses the surface layers, which makes the procedure painless with few side-effects.
A typical Ultherapy session lasts 60 to 90 minutes and patients can immediately return to their normal activities. While some patients can see flushed skin and redness after treatment, these effects will typically disappear within a few hours.
However, ultherapy doesn’t give immediate results. Most patients will have to wait two to three months before seeing improvement in their neck.
When patients reach later stages of aging, surgical options provide more dramatic improvement of the neck. Cosmetic surgery can address deeper layers of muscle, skin, and fat that non-surgical techniques can’t reach.
Traditional Neck Lift
The time-honored approach of cosmetic neck surgery involves either tightening or removing the platysma muscle that runs from the chin to clavicle. Known as a platysmaplasty, this technique addresses the rope-like appearance many patients develop as they age.
This procedure often includes removing excess skin (cervicoplasy) and using liposuction to remove fat.
Often called the “mini” lift, the Single Incision Minimally Invasive (SIMI) technique provides most of the benefits of a traditional neck lift while using only one incision under the chin. This approach gets rid of the incisions behind each ear used in a typical neck lift, which reduces surgical pain and limits scarring.
Deep-Plane Neck Lift
This approach involves altering deeper layers of muscle than the traditional neck lift. It avoids the “pulled skin” look that can happen in the traditional neck lift, and provides a much more natural outcome. However, the deep-plane lift requires more extensive knowlege of neck anatomy because it can come close to nerves that control facial movement and sensation.
The deep-plane lift excels at helping patients unhappy with their outcome from a traditional neck lift (revision surgery).
Consulting With a Plastic Surgeon
A skilled facial plastic surgeon can produce drastic improvement through well-considered use of these techniques, but it isn’t a one-size-fits-all job.
The surgeon should explain the available options to a prospective patient, which should include the benefits, risks, and expected cost of each procedure. The surgeon must carefully weigh the patient’s condition, age, and resources to craft an individualized surgical plan that best meets their cosmetic goals.
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