I'm 38 and have noticed vertical, crepiness, fine lines on my neck, particularly when flexing. (Photo)

I'm not sure what the cause is, although I've lost about 20 lbs over the course of 6 months, have had 2 children, and weight fluctuation of about 20 lbs over the course of 5 years. Is there a non-surgical option I have to reduce or eliminate, these lines? It was difficult to get a good photo, but the appearance is that of crepe paper. Thanks!

Doctor Answers 9

Fine lines on neck

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You appear to have visable anterior platysma muscle bands in your anterior neck. You cold try Botox to see if it improves the banding. If it works, it will need to be done every three or four months. If you want surgery an anterior platysmaplasty could be performed under local or with minimal sedation. The scar would be under the chin and heals well.


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I recommend a combination of Pelleve and Nectifirm cream to address skin laxity in the neck region. You will need 4-6 Pelleve treatments and you will need to use Nectifirm twice a day for at least 2 months.

By best,
Sheila Nazarian

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Non-Surgical Approach To Skin Tightening

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Surgery is unnecessary at this stage, topical radio frequency treatments are your best bet. ThermiSmooth can be used on the surface of the skin to, as the name implies, "smooth" wrinkles and encourage collagen production. Having microdermabrasion treatments regularly can also help retain youthful skin in this area.

Edward E. Dickerson, IV, MD
Fayetteville Facial Plastic Surgeon
4.7 out of 5 stars 127 reviews

Neck lift for management of "vertical, crepiness, fine lines on neck" (a.k.a. Platysma bands)

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Neck-bands are usually the initial sign of neck aging. These physical findings are secondary of loosening of the neck muscle (plastysma muscle). Non-surgical options of for neck improvement (laser, radiofrequency) usually address just the skin and the fat layer of the neck, but not the muscle. Neck-bands requires tightening of the platysma muscle through minimally invasive surgery (performed through very small incisions behind the ear and sometimes underneath the chin). At our practice, neck lift procedures are performed under strict local anesthesia with minimal discomfort or pain (= no IV sedation nor general anesthesia) which means faster recovery while maximizing safety). Patients with neck-bands should undergo evaluation by a board certified plastic surgeon specialized in neck-lifts.

John Mesa, MD
New York Plastic Surgeon
4.9 out of 5 stars 141 reviews

Neck Lift and Loose Skin

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There are many different methods of dealing with loose skin of the neck. First you have to define "loose". If there is excess skin present with muscle laxity, the only way to improve this problem is with a surgical neck lift. 

For loose and 'crepey' skin, this is a problem with the skin's elasticity and not muscle laxity. which may be improved upon with a series of non-surgical procedures such as: Thermage or Viora Reaction, IPL Therapy (Intense Pulse Light Therapy), Laser Resurfacing or a series of medium depth Chemical Peels. 

It is best to be evaluated first and book a consultation with a board certified physician to determine what the most appropriate procedure is for your situation. 

Lawrence M. Korpeck, MD, FACS
Palm Beach Plastic Surgeon

Mild Vertical Neck Lines

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Certainly, I would not recommend neck lift surgery given the rather mild nature of your complaint. Starting with non-invasive skin tightening (Ultherapy is best) possibly in combination with Dysport or Botox may provide you with meaningful benefit. Of course, the physical examination and appropriate planning and execution are paramount.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 48 reviews

Nonsurgical options

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It appears that your neck is still quite youthful and the lines you're concerned about appear to be mild. Botox can relax the platysma bands and a laser skin tightening technology may help firm up loose skin to some extent.

I have noticed vertical crepiness, fine lines on my neck, particularly when flexing.

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If you are looking for nonsurgical options to improve the appearance of your neck, you could consider a skin resurfacing procedure and injections of botox into the muscles. The skin resurfacing will improve the quality of the skin and the botox injections can reduce the cording or muscle ridges.

Suzanne Kim Doud Galli, MD, PhD, FACS
Washington Facial Plastic Surgeon

Early crepiness and neck laxity and a 38-year-old

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I agree that you should not consider a neck lift at this early point in your life.  Certainly your fluctuations in weight have contributed to the appearance of loose skin.  Unfortunately the vertical bands are most likely muscle laxity and eventually would require surgery to correct them, but it is too early for you now.

Nonsurgical methods such as Ulthera and Thermage can achieve about 22% of the tightening that a lift will provide.  I am not sure that they're worth the significant expense of these procedures because they cannot reach or effect the muscles under the skin that are causing the bands that you see.

Please consult a plastic surgeon who is certified by the American Board of Plastic Surgery, very experienced in neck lift procedures, and who has an excellent reputation in your community for a consultation.

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.