Loss of chin and neck definition from skin looseness and sagging of the neck becomes noticed in most individuals starting around the late 30’s and early 40’s, if not sooner. It is not unusual for me to see much younger patients come in complaining of a double chin and an ill-defined jaw line that is inherited. These individuals are especially concerned as they see older family members with the same characteristics and they “don’t want to look like that”. Loose neck skin can be worse than facial wrinkles in making someone feel old. As you age, the taut skin and angular neck that you may or may not have had with youth drops. The skin and muscles sag, oftentimes associated with bulging fat under the chin. With phone video chatting, the area is magnified, regularly noticed, and looks worse from the phone angle. These days, injections for wrinkles of the face are commonplace, but the loose neck skin is always a giveaway, no matter how smooth your face is. Turtlenecks and scarves may work well in cool climates, but are not tolerated during our hot Las Vegas summers.
There are many options for facial wrinkles, but the aging jaw and neck are a challenge. The skin along the neck is thin and crepey with underlying sagging muscles, so the aging neck is difficult to treat. When drooping muscles and fatty deposits are a big part of the problem, topical skin treatments and surface work doesn’t help. Botox, fillers, and resurfacing procedures work great for the face, but they don’t work so well for the neck.
Botox may be an option for what is called “platysma-banding”. These are the edges of neck muscle that start to sag and look like cords. You need to start sooner rather than later for any sort of temporary result with Botox, (30’s), and results may soften those muscle bands slightly. Expect treatments as frequently as every three months, which can cost up to $2400 per year. Risks of Botox in that area can be difficulty swallowing, so needless to say, most patients aren’t so keen to have it done.
Resurfacing the neck skin with lasers or chemical peels is problematic, as neck skin is entirely different than face skin. It doesn’t contain the sebaceous glands that repopulate and heal after a resurfacing procedure, so that any treatment must be very conservative. So results are subtle if at all, time frames for healing are prolonged, and risks are much higher.
Liposuction of the chin and neck works well in patients with a discrete fatty deposit of the neck, or double chin. Liposuction doesn’t tighten the skin, so the best candidates have good overlying skin tone and elasticity. Irrespective of the technique used (smart lipo, laser lipo, ultrasonic lipo etx), mild skin retraction occurs as a result of someone’s inherent tissue tone. If your skin is loose and wrinkled, liposuction is not going to be a satisfactory treatment, no matter what liposuction technique is used.
Augmentation of the jaw line with chin implantation or any of the fillers available can be a great way to improve jaw line definition and the appearance of the neck. Adding volume along the jawbone tents up the neck skin to a degree and can rejuvenate the entire lower third of the face.
The next level of treatment involves skin-tightening surgery, namely Neck-lift, Face-lift, Mini-facelift, Platysmaplasty, Lifestyle-lift, etx. People are often adverse to the term “face-lift”, so we have all of these other made up terms that you can use to make you feel better about it. There is no standardization of terms, and every plastic surgeon has their own way of doing things and labeling them. Call it what you want; surgery involves tightening neck muscles and pulling skin upwards toward the ears—we all do this maneuver in the mirror and love the results. Redundant skin is removed, with incisions hiding around the contours of the ears. Surgery can involve the neck alone; however most patients embarking into middle age are happy to see improvements along the lower face and jowl area too. All of the skin and muscle tightening surgeries for the neck and face are all quite similar, the variations depend on the incision lengths and the amount of dissection over the neck and up onto the cheek.
Although advertised non-surgical options for neck rejuvenation sound appealing, most do not deliver appreciable, consistent, and predictable results. Fancy devices such as Thermage, Ulthera, Titan, Lasers, Ultrasound, Infrared, and Radiofrequency are heavily marketed as the latest and greatest in skin tightening. They need to be mass marketed because the devices are so expensive and generally don’t work for the majority of patients. Most of us plastic surgeons are skeptical of these trendy devices because the energy delivered and tolerated by the patient is generally not enough to have a substantial effect. Results can be variable, if at all, and multiple treatments may be required. Discomfort during the procedure can be a major issue. Short-term results will never be as good as a skin-tightening surgery, and the data is simply not there whether there is any sort of long-term result.
Regardless of what treatment you choose for facial and neck rejuvenation, the key to looking youthful and healthy is what you do on a daily basis. Using medical grade skin care products, avoiding smoking and tanning, getting enough sleep, eating healthy, and exercising regularly can have a profound effect on how you look and how you age. So do your part in conjunction with whatever your board certified plastic surgeon recommends.
Dr. Hayley Brown MD, FACS
Board Certified Plastic Surgeon
Desert Hills Plastic Surgery Center – Henderson and Las Vegas, Nevada