A sagging neckline is one of the most glaring indicators of advancing age. Reclaim your grace with new and noteworthy neck-tightening treatments.
BY BETH LANDMAN
“The neck is the first giveaway of aging—even before the eyes,” says Dr. Miles Graivier, a plastic surgeon based in the Atlanta metro region. “When people start to look for signs in the mirror, the neck is where they first focus.”
A range of issues can affect the appearance of one’s neck, largely depending upon a person’s age and weight. A combination of fat, muscle weakening, skin laxity, and sun damage can wreak havoc on a once elegant and angular jawline and neck. Even bone loss and the shortening of the cervical spine that accompanies the aging process add to wrinkling in the area. Thankfully, there are as many possible solutions as there are problems.
Neck issues can begin sooner than one might think. People in their twenties and thirties often have skin that could use a little firming and jaws that could stand a bit of strengthening. A host of non-invasive options can vastly improve the appearance of younger “turkey necks.” Machines that target collagen bundles in the dermis with heat, for example, not only cause an immediate tightening of the skin, but signal the body to produce more collagen over a period of months, making the skin appear younger. Because these treatments bypass the skin’s outer layer, there is no obvious redness or swelling, and no downtime.
Among the most popular machines are Exilis (which uses radio frequency to produce heat, and costs between $2,000 and $3,000 for a series of several treatments) and Ulthera (which uses ultrasound and costs between $3,000 and $4,000). While Ulthera is the strongest in the current artillery, and takes only one session, it can be painful due to the heat sensation that can build up over the course of the treatment. “This is the third generation of Ulthera, and while it’s not completely pain-free, it’s definitely the most effective and considered the standard now,” says Manhattan dermatologist Paul Jarrod Frank. “It attacks from the muscle all the way to the epidermis, and, like seeing a baby with an ultrasound, you can visualize what you are tightening.”
According to Dr. Jason Pozner, a Boca Raton plastic surgeon, tightening the muscle and skin with devices that induce heat can produce between a 15- to 30-percent improvement in the neck’s appearance without surgery. The only real risk of taking this route is potentially getting a burn if the treatment is done improperly. “A lot of doctors are masters at rejuvenating the face, but the neck is trickier,” observes esteemed New York City dermatologist David Colbert. “Recently, people are paying more attention to it. If you want your neck to be flawless, you can combine different tighteners.”
For sun damage and creped skin, ablative fractional resurfacing (deep skin resurfacing), combined with Intense Pulsed Light (IPL), is a good solution. The laser resurfacing removes some tissue as it creates columns of heat to stimulate collagen production. There is redness, but with a little makeup designed for sensitive skin, heading to a movie and dinner at a dim restaurant should be fine during the first couple of days. The skin quickly heals after this treatment.
Intense Pulsed Light also improves pigmentation and skin quality over the the course of time. “We followed a group of people over 10 years, using Forever Young BBL, a form of IPL, and they actually looked younger at the end than when they started the treatment,” says Dr. Pozner.
If your issue is fullness at the neck, there’s a noninvasive solution on the horizon; the injectable fatmelter deoxycholate, which has garnered enthusiasm among many doctors. “The first product from the company Kythera is about to go before the FDA,” says Zoe Draelos, a clinical research dermatologist in High Point, North Carolina. “We will be able to dissolve fat chemically, without surgery.”
If your issue is a weak jawline, it can be strengthened with injections. Dr. Colbert uses Radiesse, a calcium-based filler, which can replicate the look of bone structure. “As we get older, our bones shrink,” he notes. “Injecting Radiesse along the jawline supplements the diminished area.”
Yet, as we age, the mechanical devices and injections produce a less dramatic result. They are best used for maintenance. “In the mid- to late-forties and early-fifties, we begin to see more laxity and the acute angle of the jaw changing,” says Dr. Graivier.
Whether you are young and have fullness in the neck and jowls, or are beyond the point where noninvasive solutions are making enough of a difference, submental liposuction is the next step. This procedure not only removes fat, it tightens the skin. Dr. Draelos uses a cannula—a flexible sculpting tool—that lightly scrapes the underlying skin and creates small wounds, which produces collagen and encourages the skin to adhere to the underlying muscle.
Dr. Robert Silich, a board-certified plastic surgeonwho co-wrote the chapter on neck lifts in Cosmetic Surgery (LANGE Clinical Medicine), says the procedure delivers a powerful one-two beauty punch. “It can make you look not only younger, but 15 pounds thinner,” he says. “It’s the most popular procedure we do for men, and the best one if you don’t want anyone to know you had surgery.”
As people move into their fifties, they may notice the platysma muscles under the chin start to split and form ropey bands, often referred to as “turkey neck.” Botox and other neurotoxins can be injected to soften them without surgery. However, to remove them, the answer is a platysmaplasty, which surgically tightens the bands by cutting and repositioning the muscles.
In New York City, Dr. Sharon Giese has introduced the “Natural Lift,” an in-office procedure that takes about an hour, usually under local sedation with dissolvable sutures. “I do an incision in front of the earlobe and where the natural crease is behind the ear, grab the platysma, tack it to the strong fascia behind the ear, and trim a little skin from in front and behind,” says Giese. “You recover over the weekend. Usually women don’t tell their boyfriends.”
If skin is not lax, a chin implant may be enough to strengthen a jaw, along with a platysmaplasty. But for those with loose skin, a neck lift or lower facelift is the answer. “Incisions are small, and relatively imperceptible,” says Dr. Silich. “You can go home the same day.”
Of course, it’s key for a doctor to determine which procedure would be most helpful in each case. Says Dr. Draelos: “It’s very important to assess what someone’s real needs are by looking at the architecture of the neck and its elasticity. Selecting the proper procedure is critical to having the best outcome.”
According to Dr. Giese, the right combination of neck procedures—and a bit of cheek plumping with fillers—can maintain a fresh look. “Not only can you put off a facelift for a couple of years, but the strong contour of a jawline is one of the most basic signs of youth, power, and beauty,” she says. “Now, restoring it has become so simple.”
