There are some cosmetic problems that seem to be almost universal, and are so bothersome to patients that I am asked about them daily. One of those is aging changes in the neck. Just like death and taxes, they affect us all. But thankfully, at least for the cosmetic problems, there are options. Now if only there were options to avoid death and taxes.

My patients say “I hate, hate, hate my neck. What can I do?” If you are saying the same thing or something similar with a few expletives thrown in for good measure, you are in good company so read on.

The neck is the most uniformly hated feature in people over 40. The skin on the neck is thin, with few oil glands and hair follicles to provide structural support. Unfortunately, necks are seldom protected from sun exposure by foundation and often not by sunscreen either. Fat pads under the chin and jawline drop, and fat accumulates. Gravity and muscle activity take a toll. And all of this while everything from above is falling down on top of the jawline. The result is a neck that is thickened, crinkly, loose, falling, with brown and red discoloration, wrinkles and a loose jawline. Just lovely.

Surgical treatments to remove skin and fat and to tighten the jawline are always an option. There is no question they provide the most dramatic results. At times a neck lift alone, liposuction under the jawline and chin can be performed either alone or in combination with good results. But often the results are not adequate without also having a facelift to remove and tighten the skin, fat and muscle that are falling down from above onto the jawline and neck. Kind of like putting on Spanx boy shorts, but having the muffin top spill over. For those patients who have early or moderate changes, or who don’t want a surgical option, some newer non-surgical treatments are being combined to offer improvement for the changes in the aging neck. These non-surgical options also address some of the changes that surgical options don’t, such as thinning crinkly skin, brown discoloration, and red blotchiness. When utilizing non-invasive options to treat the aging neck, often a combination of treatments gives the best results.

Non-Surgical Aging Neck Treatments:

• Topical Retinoids and Cosmeceuticals—prescription retinoids such as tretinoin in its various forms such as Refissa, Renova, and Retin-A are the most effective, but can be irritating on the sensitive neck skin. Non-prescription retinol, and various cosmeceuticals such as fruit acids, peptides, antioxidants, growth factors, stem cells, vitamins, and botanicals all help with prevention of aging neck changes and can give some improvement. All of these are used daily, and over time increase the skin’s ability to repair itself, give improved texture, some increase in collagen leading to less crinkliness, and some improvement in pigmentation. Daily use, combined with daily sunscreen also help slow down aging changes in the neck.

• Laser Resurfacing—fractional laser resurfacing with either an ablative CO2 laser (DEKA Smartxide DOT, Fraxel re:pair, Ultrapulse FX and others) or a non-ablative laser (Fraxel re:store and others) can give improvement in lines, texture and surface abnormalities. Ablative lasers additionally can give some tissue tightening, but must be used very carefully to reduce the risk of scarring on the neck, which has been reported. If you decide to incorporate ablative laser resurfacing into your neck treatment, be sure you see a board certified dermatologist or plastic surgeon who has extensive experience in laser neck treatment, to reduce your risk of scarring.

• Radiofrequency Tissue Tightening—radiofrequency energy treatments (Thermage and others) tighten skin on the face, jawline and neck. Results vary by patient depending on degree of tissue looseness, the amount and quality of collagen present, and the patient’s ability to make new collagen. It is done as a single treatment, which may be repeated at intervals for additional or ongoing results.

• Intense Pulsed Light Photorejuvenation (IPL)—a series of 3-5 IPL treatments improve brown and red discoloration and improve texture. Treatment should be done under the direct supervision of an experienced physician. That combined with scrupulous sun protection prior to treatment reduces the risk of an inadvertent superficial burn to the skin.

• Botox/Dysport/Xeomin Injections—Botox treatment softens vertical “cords” or “bands” that are actually muscle contractions.

• Sculptra—a new and exciting treatment option is a series of 3 or more treatment sessions of injections of Sculptra into the superficial tissue of the neck and upper chest. This stimulates your skin to make its own new collagen, improving crinkliness, looseness, wrinkles and thinning skin. Also very encouraging is the finding that when Sculptra treatments are given in conjunction with other non-invasive treatments the results achieved with those treatments are actually improved.

• Future treatments—because of the high demand for non-surgical anti-aging neck rejuvenation, there is much ongoing research and development in new treatments. Two that are reportedly in the development pipeline are a modification of currently FDA approved cryolipolysis fat reduction technology and not yet FDA approved mesotherapy injections. Both would aim to reduce fat at the jawline and under the chin. Additionally there are multiple new radiofrequency and laser devices under investigation. And of course we are always modifying protocols involving our current treatments based on new scientific studies.

• And don’t forget—apply sunscreen to your entire neck, including the sides and back, every single day. That helps prevent the sun induced collagen breakdown that loosens skin, and also causes red and brown discoloration. And seriously, it takes all of 10 seconds.

Treatment to improve the aging changes in the neck is challenging, but real improvement can be achieved, without surgery.

Oh dear, the lawyer sitting on my shoulder is bugging me to remind you once again: Electronic message exchanges to, from, or with Dr. Cook do not constitute medical advice, an evaluation, or consultation and must not be considered a replacement or substitute for a formal evaluation in the office. Information and correspondence in this blog does not form and will not result in a doctor-patient relationship. If you desire an evaluation or consultation, contact our office for an appointment. Recommended changes to your present treatment plan or therapy must be approved by your physician. Explanation and/or discussion of off-label services and/or products, if mentioned, do not reflect endorsement or promotion by Dr. Cook and must not be construed as such.

I wish he would get off my shoulder and go do the dishes. He is making my neck hurt.