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Take the Plunge

By Catherine Winters
Posted On Sep 02, 2016
Take the Plunge

New You reveals the deep secrets of age-defying décolletage.

By Catherine Winters

Bye Bye Neck Lines


Injectables and fillers are the mainstays of neck and décolletage rejuvenation. For example, to minimize horizontal neck lines and those cord-like platysma bands, Dr. Z. Paul Lorenc, M.D., an aesthetic plastic surgeon in New York City, uses a tiny needle to inject a neuromodulator, such as Botox, Xeomin, or Dysport, along each line or band after first numbing the area with a topical anesthetic. “It relaxes the underlying muscle so there is less contraction and wrinkling of skin,” he explains. The number of injections varies but the procedure takes about 10 minutes, with no down time to follow. Results, visible within a few days, last three to four months. Risks include bruising and infection but if done properly by a well-trained, board-certified plastic surgeon, they’re “extremely rare,” says Dr. Lorenc. The cost varies, depending upon the number of injections and where you live. Dr. Lorenc, for instance, generally charges from $750 to $1,000 to treat the entire neck.


He may also fill in horizontal lines with injections of Belotero Balance, a hyaluronic- acid-based filler. “Those transverse lines respond very well to these injections,” he says. Each line may require 10 to 20 tiny injections, and a topical anesthetic is used to numb the area. Results are immediate and recovery is fast. “You might have swelling for 24 hours, but that’s it,” says Dr. Lorenc. The cost is about $500 to $800 per syringe (typically one to two are used per treatment) and results last about a year.


Another option for the chest is Sculptra aesthetic filler, made from poly-L-lactic acid, to stimulate collagen production. Within four to six weeks, the skin will be “firmer, smoother, and more elastic,” says Dr. Lorenc. “It gives a very nice, natural look.” The procedure, which costs from $850 to $1,250, takes about 25 minutes to complete and the results last up to two years.


Resurrecting the Chest


To resurface neck and chest skin, doctors rely on fractional lasers, which treat both the topmost layer of the skin (the epidermis) and the middle layer (the dermis). That’s where you’ll find collagen, a protein that gives skin its structure and keeps it wrinkle-free. The laser or combination of lasers your provider will use depends upon the condition of your skin. “There’s lots of judgment involved,” says Dr. Moelleken. “But each laser fills a gap and does something different.”


Dr. Moelleken starts with fractional carbon dioxide (CO2) and erbium lasers. “These are safer on the delicate skin of the neck and chest,” he says. The erbium laser is best for improving skin tone and treating fine lines and wrinkles. The more powerful CO2 laser goes well into the dermis, targeting fine lines and sun spots. Both lasers simulate the production of new collagen, so “skin becomes healthier and stronger,” says Dr. Moelleken.


Another type of laser, the Advanced Fluorescence Technology (AFT) laser uses a broad band wavelength of light to remove red and brown spots and sometimes, when combined with levulinic acid, very early cancers.


Generally, laser treatments take 45 to 90 minutes. Recovery time ranges from a day to two weeks and results are visible within three weeks. “Often, a single treatment will make a noticeable, sometimes remarkable, difference,” says Dr. Moelleken. The cost ranges from $1,000 to $4,000, depending on the treatment. And while burns and pigment changes are possible risks, they’re rare.


To erase signs of age from the chest and neck, Dr. Gelber’s go-to tool is broadband light treatment (BBL), the latest generation of intense pulsed light treatment (IPL). “Research has found you can use it anywhere on the body and slow down aging to the point where it not only seems to stop, but also it seems to go backwards,” she says.


After applying ultrasound gel to the area being treated, she moves the BBL device over the skin. “You’ll feel a little heat as the light activates cells in your skin,” she says. “But the heat cools down within minutes.” To ease any discomfort, Dr. Gelber has patients take a pre-treatment ibuprofen and she numbs the treatment area with lidocaine.


Over the next seven to 14 days, red spots fade and “sun-damaged brown areas in the dermis percolate to the skin’s surface like a splinter and fall off, leaving you with healthy skin and more even skin tone,” she explains. The BBL is “best in its class for color and aging,” says Dr. Gelber. Do it two to four times a year and you’ll even build collagen. The average cost is $400 to $600 per treatment.


For even better results, Dr. Gelber will treat the neck and chest with Halo, a hybrid fractional laser, combining ablative and nonablative wavelengths. Ablative wavelengths destroy skin’s outer layer, removing signs of aging like age spots and fine wrinkles, and tighten collagen fibers in the dermis. Non-ablative wavelengths damage collagen.


Over the next two weeks, “very subtle bumps of old collagen will come to the surface and fall off,” says Dr. Gelber. Eventually “stretched-out collagen fibers are replaced with new, springy collagen,” she adds. What’s more, “skin is brighter, with more even color,” she says. Additional or more intense treatments tighten skin and reduce fine lines and wrinkles. The number of BBL and Halo treatments you’ll need will depend upon your skin and age. “If you’re young, you may need one treatment,” says Dr. Gelber. “If you’re in your fifties and sixties and are a sun worshipper, you might need four to six.” The cost of the BBL runs about $400 to $600. The Halo costs about $1,000 to $2,000 per treatment.


Maintenance Is Key


Turning back the clock is only part of the picture. The cosmetic surgeon may have worked his or her magic, but ultimately, you are responsible for maintaining the results. “It is not a one-shot treatment but a continuum of care,” advises Dr. Lorenc.


“Once skin is where you want it, the effects don’t go away, but you continue to age,” says Dr. Gelber. Each physician may suggest a different timetable for maintenance. For example, Dr. Gelber recommends one Halo treatment per year for patients under 40; two to three per year as people age and collagen loss accelerates. And it goes without saying: You need to be scrupulous about protecting your skin from the sun and wearing sunblock with an SPF of at least 30 whenever you venture outdoors.


While the rejuvenation process sounds like a commitment of time and money, the result is worth it. “Some of the results you get with these procedures are simply incredible,” says Dr. Lorenc. Dr. Gelber agrees. “So many people have given up hope but when they see the results, they are over-the-moon happy!”