Looking for less wrinkles and saggy neck area. Will dermal fillers help? (photo)
Doctor Answers (12)
Treatment of Wrinkles and Sags
Looking for less wrinkles and saggy neck area. Will dermal fillers help?
Fillers versus Facelift For Sagging Face
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Analogy: Treating the Sagging neck is like Reupholstering Furniture ...
I agree with the other surgeons' answers, but I would like to expand the explanation more to help you to understand the issues from a surgeon's point of view, how we try to improve the neck area.
Dermal fillers will probably not give you the results you are looking for, unless you are looking to create a fuller neck with a double chin to help smooth out the wrinkles and reduce sagging in the center of the neck, by simply making the whole neck fuller and fatter. I do see some horizontal wrinkles below the sagging skin and fat directly under your chin. If you think that reducing these horizontal wrinkles directly below the sagging area, then dermal fillers may help those wrinkles 10-20%. The sagging fat and skin in front of the wrinkles may be too much for the filler to hide unless you use a many syringes of filler, which would then be cost prohibitive and not cost effective.
Fillers add volume to the area you want to treat. If you are treating lines, wrinkles, and deflated areas, dermal fillers are very effective. The neck area is not a typical area to treat with dermal fillers.
What are we trying to achieve as face and necklift surgeons?
A youthful neck is typically contoured and the profile is angled from the smooth area under the chin transitioning to the angled neck area. A typical necklift result will have a before photo which shows the neck starting from wrinkle under the chin (where the wrinkle forms from a double chin) and go to the base of the neck in a straight line. The after results typically have a smoother flatter (a line somewhere within 0-15 degrees of horizontal) for a couple of inches before transitioning to the neck.
A necklift result does not change the appearance of the person since it is focusing on the neck area. Patients report that friends and family have a hard time telling that they had any plastic surgery performed, but instead think that they may have lost weight, because their neck appears thinner. But often times their weight has not changed from before the surgery, and some times a couple pounds heavier, yet they appear slimmer because their neck looks thinner.
The typical necklift patient has sagging of the neck which they can pinch with their fingers. If the patient has a full double chin, and fat neck, then they would get better results if they lose some weight first to allow the neck circumference to get smaller, and allow the skin to hang down first prior to proceeding with a necklift. It is possible to liposuction a very full neck while performing a necklift, however, this may increase the possibility that not enough skin is removed during this procedure, because liposuction requires a lot of local anesthesia injection to liposuction the fat first, but this also causes more swelling which results more difficulty in matching the skin removal when the neck is so swollen. It is much easier when the neck is thinner, and less liposuction and less local anesthesia injections are needed perform the necklift. With less fat, and less injection of local anesthesia fluid, the neck is thinner when the skin removal is performed.
Patients who are otherwise thin but have a sagging wattle of skin directly hanging down the center of their neck will have the most dramatic and best results. Full face and still full neck patients will have an improvement, but not as dramatic or ideal as the thinner patients.
Some patients feel that prior to weight loss, the sagging of the neck was better and they also saw less horizontal wrinkles than prior to the weight loss. This is due to the fat making the whole neck much fuller. Instead of a neck circumference of 14 or 15 inches, the neck circumference may be 16-18 inches. When there is that much more fat, the skin will not sag in the middle and the extra fat will improve the wrinkles.
If this is your goal to reinflate the neck then dermal fillers potentially can reinflate your neck and recreate a double chin which will help with the sagging in the middle of the neck and potentially some of the wrinkles.
Now for the Reupholstery analogy. If you have an arm chair where the seat is overstuffed when it is new, the seat fabric is nice and tight to the overstuffed seating. Over time, when sitting on the overstuffed seat, the stuffing can flatten out. The fabric will not contract to hug the reduced stuffing, and it can look loose and wrinkling instead of fully inflated and tight to the stuffing. I personally do not like overstuffed seating, and let's say that now that the stuffing has flattened out, I actually prefer the flatter seating, but I don't like the fact that the upholstery fabric on the seat is loose and saggy. I can take the seat to get it reupholstered using the existing fabric and have them simply release the fabric under the seating and tighten the fabric and potentially removing some of the extra fabric.
Tightening the existing fabric would be equivalent to a "necklift", since the excess fabric (skin) is removed and the fabric is tightened over the existing volume or padding so it is smooth.
Now for your original question. Let's say, you actually liked the "overstuffed" chair when it was new, and that is really how you want it to look. A small opening in the corner of the seating fabric can be opened and padding/stuffing can be pushed into the small hole to "reinflate" or cause the seating to fill up so that it becomes overstuffed again. This way you do not need to open up all of the seating fabric only to tighten it and secure the perimeter of the fabric. It is less work than reupholstering the entire seat.
To turn this analogy back to sagging necks and wrinkles, if you like your neck fuller and it match your body, then adding fillers and volume can help you to achieve that result. The main drawback is that the fillers are not permanent and per 1 cc of volume of dermal filler, will be very expensive, since it may need 10-30+ cc's of volume to "blow up" the neck enough to hide any sagging in the center of the neck. more than 5-10 cc's of dermal fillers will be cost prohibitive and a necklift may end up be less expensive and not need periodic refilling over the years.
A necklift is paired with a lower facelift, since the neck is adjacent to the jawline. When the necklift is performed to get the best and most natural results, a lower facelift can help to transition the smoother lifted neck to a smoother and lifted jawline.
Energy based Non-surgical Skin tightening
A recent topic of interest is the non-surgical skin tightening procedures which do not require any incisions to treat the neck. These procedures typically use Radiofrequency (Thermage) or Focused Ultrasound (Ultherapy) to melt the fat in the neck without using liposuction. The radiofrequency energy or ultrasound energy is aimed at the tissues under the skin and heat up the skin and tissues enough to cause the fat to melt. If the fat melts, the neck will look slimmer For younger patients (under 45), the results of these non-surgical skin tightening procedures are very similar to liposuction under the chin and jawline for since the skin on these younger patients contract and does not leave more sagging and wrinkles. For older patients (over 45), it can also work, but there is a higher risk of causing vertical neck bands or more loose skin under the chin, although a profile view may appear to be better. If you look closely at these non-surgical results, you may see that the skin is looser because there is simply less fat to make the skin smooth, but because there is less fat, the profile can look improved.
Interestingly, for some patients, they will be happy with these non-surgical results, if the profile bothers them more than loose crepey skin, and vertical muscle bands. For other patients who are complaining of sagging crepey skin, may find the profile improvement not worth the trade off for even more loose skin and exposed vertical muscle cords.
As a facelift and necklift specialist, a significant number of my patients had multiple Thermage and Ultherapy treatments which they felt did not do very much to the overall appearance for most, who only had a single treatement, but for those who had multiple treatements, these patients felt that their neck skin became more crepey and looser after the treatments, which prompted them to seek a face and necklift. It is possible that the happy patients did not seek additional treatments, but based on the patients I have seen who have been treated with the technology, this is my impression of the new technology.
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Fillers are not a panacea for all facial aging
Face lift and Neck lift
The changes that occur with facial ageing include; descent of facial tissues, sagging and loosening of skin, wasting of soft tissues and laxity and looseness in the neck tissues. Dermal fillers therefore only address one aspect of facial ageing. They have a limited role in elevating tissues and do not tighten the skin or underlying supportive layers of the face. They work best in younger patients with tight skin and are ideally used for adjusting contours.
From your photo’s I would discuss with you the benefits of a face and neck lift. These procedures combined will address the most significant components of facial ageing and give you a substantial rejuvenation. For many patients surgery is a big step and for those who are new to plastic surgery trying the more less invasive techniques such as fillers is a gentle introduction.
You need to be aware that fillers are temporary and come with a moderate cost. Paying for multiple injections over many years can be expensive. The investment on your behalf in terms of financial and recovery time is more substantial for a face and neck lift initially but the results are long term and vastly superior to fillers.
The ultimate answer for long-term facial rejuvenation is that all modalities have their role. Maintenance over time is the key to the best outcomes. Combination treatments that resurface the skin, surgery to help elevate, reposition and tighten loose structures, neuromodulators to soften wrinkles and maintenance with dermal fillers are the keys to sustained rejuvenation. I suggest you consult a Plastic Surgeon who uses all of these modalities to give you the best opinion and a clear management plan.
Dr Guy Watts
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.