Need Advice for Treatment Worsening Neck Cords? (photo)

I am a 48 year old woman, slender and in good health, Had Ultherapy in April and was NOT IMPRESSED with results. Thought skin would become more taut and minimize cords/bands. Was clear about my expectations and told I was a good candidate but NO CHANGE 1 Would Botox help? 2 Would a skin tightening laser tx (like (palomar icon laser) help? 3 Am I candidate for mini necklift? I fear so, but big concerns are cost, downtime (missed work), and needing to maintain privacy about having had surgery.

Doctor Answers 10

Need Advice for Treatment Worsening Neck Cords?

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You need a mini neck lift. A small incision is made under the chin. Fat and soft tissue will be removed (but no skin removal). Your platysmal bands will be cut or removed. This should give you a nice result.


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Neck Lift (Cervicoplasty / Platysmaplasty): restoring elegance to the face

Though it is not technically part of the face, a neck with loose, sagging skin can age the face dramatically. A neck lift is a standard part of most facelift surgeries, as the neck skin is mobilized in continuity with the lower face.

Immediately under the skin of the neck is the platysma muscle, which you can easily see in a mirror when you clench your teeth and tighten your jaw. In youth, this paired muscle meets in the midline below the chin. With age, the right and left sides of the platysma often separate, producing vertical 'cords' in the anterior neck. The platysma can be divided anteriorly and tightened during neck lift cosmetic surgery to permanently eliminate these 'cords' and improve the neck contour. One tightened in the midline below the chin, lateral traction on the platysma then creates a 'sling' which elevates the soft tissues below the jawline.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Neck Cords?

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Based on your photos, you are a candidate for a Facelift.  A facelift is face and neck.  Botox will not help your problem.  I recommend you consult with a Board Certified Plastic Surgeon, certified by the American Society of Plastic Surgeons ( ASPS) to discuss your concerns and expectations.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 61 reviews

Neck Banding/Cord Treatment

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It is not surprising that Ultherapy  did not improve your muscle cords as it only penetrates the skin and subcutaneous fat and should not be expected to improve your underlying neck muscles. Botox can help but is temporary and has to be repeated 3-4X/ year. Direct approach is best - minifacelift for jowl and jawline improvement, and platysmaplasty to correct platysma banding.


Need Advice for Treatment Worsening Neck Cords?

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  A lower face and neck lift would improve the neck, the jowls, and sharpen the jawline.

Kenneth Hughes, MD
Los Angeles, CA

Neck Contour--Cause and Effect

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The most important thing is to  get a good explanation from your surgeon about the cause of your neck webbing.  There can be several factors, and each might require a slightly different approach.  My opinion is that Ultherapy or other IPL or ultrasound type treatments just create a very minimal improvement in skin tightening. Most patients desire more of a change.  Depending on what your consultation showed, you might benefit from liposuction of any extra fat under the chin and along the jawline and/or tightening of the platysma muscles on the front of the neck, both of which can be done through a small incision under the chin.  If you have loose skin on the neck, then you might require an actual neck lift to tighten the skin, which is performed through an incision behind the ear.  So the first step is to define the problem, and then your surgeon can recommend the best option for you.

Richard G. Schwartz, MD
West Palm Beach Plastic Surgeon
5.0 out of 5 stars 32 reviews

Treatment of Neck Cords or Bands

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I'm sorry to hear that you were not pleased with Ultherapy treatment of your neck cords.  I also have chosen not to use this treatment in my practice, as I, too, feel the results have been less that impressive.  I agree that you would be a good candidate for a necklift in which a platysmaplasty is preformed to address the neck cords or platysmal bands.  A less expensive and non-surgical option would be to try an injection of Botox.  In more minor banding Botox can help but the injections would need to be repeated ever 3 to 6 months.  Best wishes.

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.7 out of 5 stars 63 reviews

Neck bands

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I chose not to purchase the Ultherapy machine.  This first generation of the technology is a good idea, but I was unimpressed with the results I saw, too subtle for the price.  Subsequent generations of the machine will hopefully be more impressive.  

Yes, Botox or Dysport to the bands can help.  Sometimes Pelleve with will help.  From your photos it looks like a platysmaplasty (tightening of the muscles under your chin) might help.  I would be happy to see you in our Stoneham office.  


Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon

Options after Ultherapy

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I have seen several patients in the last year unhappy with ultherapy. 


I think it is imperative that patients do their homework and meet with at least 3 board certified plastic surgeons when considering facial rejuvenation.   I ask patients to see doctors that both offer and do not offer their desired nonsurgical enhancement and ask the pro's and con's of the procedure.

I would recommend a short scar face and neck lift.   This would allow correction of your jowling and neck laxity/banding.  The advantage is that the procedure works and has a longevity of 10-15 years in nonsmokers who follow a good skin care regimine.   The downside is 2 weeks of bruising and swelling, followed by 4-6 weeks a mineral makeup for camouflaging.


I hope this helps.


Dr. Gill

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

Facelifts are what is needed for excess skin and jowls.

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As you have found out Thermage and treatments that "contract" the skin are quite not worth it. To improve your cords, jowls and excess skin you need a facelift.  That is why I and other plastic surgeons have facelifts themselves!

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

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.