Best approach to 35yr old with vertical neck line? (photo)

Question

I’m a 35yr old healthy non-smoker, 5’6 & 150lbs - so a healthy BMI. But over the past year i’ve developed a vertical line of loose skin on my neck. I’ve had a nefertiti botox lift but that made no difference at all. It’d be great to hear some opinions on how to go about eradicating or softening it.

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

Thank you for your question. As we age the skin sags there is nothing you can do that but try preventative treatments or get a neck/facelift earlier in the aging process. There are numerous options and some can be used in combination to get best outcomes but you need a consultation with an expert.
Options include for skin tightening :
1. thermage radio frequency to heat skin and tighten it over time and prevent the aging process2. ultherapy high intensity ultrasound to contract muscle and tighten the face and neck and prevent the aging process3. PDO nova threads or instalift threads for immediate lifting without surgery and long term collagen production4. sculptra injections for collagen production to areas of the face and neck with crepe skin or early sagging5. btl exilis ultra, venus legacy, and thermi250 for constant collagen stimulation monthly with facialsfacelift/necklift with fat grafting/fillers if you need a big improvement5. ThermiRF or J plasma or Inmode bodytite internal heating and tightening to long term internal heating and tightening with or without surgery6. Platysmaplasty to tighten the muscles of the neck long term and create contour7. Facial implants or fillers to contour the jawline and chin to improve the appearance of the neckBest,
Dr. Emer

Pradnya Apte, BDS · Answer

Thank you for your question.
It is well documented how challenging the neck area can be to treat, but the
good news is that there are a range of options available for you to try. The
treatment I would particularly recommend you investigate is Silhouette Soft, a
non-surgical skin lift, which can lift sagging neck skin (and lower face).  The results are instant, however they
continue to improve over the coming 3 months as the treatment also stimulates
the body’s own collagen production, improving the lift still further and
improving the quality of the skin. I often use Silhouette Soft in partnership
with Botox in the neck area, and I would suggest it would certainly enhance the
treatment you have already had. Once the threads have settled you could have a
Endymed 3Deep radiofrequency which can maintain the tightening effects of the
Silhouette Soft whilst also using an excellent neck cream. One of my personal
favourites is IMAGE MAX Stem Cell Lift cream – amazing for tighter skin.

Victoria Manning, MD · Answer

The neck, is notoriously hard to treat
non-surgically however, there are non-surgical options available to you which
would be more effective. From
your picture it looks like you have a prominent platysmal band which is a
strong muscle that creates the turkey neck appearance. A simple treatment is to
relax the muscle using Botulinim Toxin, a few injections are made down the
band. The band will soften at about 2 weeks, but the procedure will need to be
repeated after 3-4 months. We would also recommend you consider
Silhouette Soft – this provides a skin lift which
combines an immediate mechanical lift of the neck skin, as well as a biological
lift by stimulating the natural production of collagen in the months that
follow treatment. The results are immediate, but what’s even better is that
after three months, the Silhouette Soft induces ‘neo-collagenasis’ – a process
by which the body produces collagen, the skin’s natural tightening factor. This
begins the process of the biological lift, where patients will notice that
their skin is firmer and tighter than when they were initially treated.  It also improves the texture of the
skin.  Treatment is, of course, subject
to a clinician confirming your suitability, but I would suggest this is
something you enquire about.

Anteneh Roba, MD · Answer

Although you had a Nefertiti neck lift I still think injection Botox directly into the bands is worth trying.

Randy Dean, MD - Account Suspended · Answer

Hi and welcome to our forum!
The band you demonstrate did not respond to botox, suggesting that it is not a muscle band, but a accumulation of loose skin. Age 35 is a bit young, but you may require a cervical lift to achieve eradication of the band. 
An in-person evaluation is required to verify the nature of the band.
Seek a board certified plastic surgeon for evaluation.
Best wishes...

Diane Bowen, MD - Account Suspended · Answer

How long ago did you do the Nefretti lift?  Typically this is a diluted botox inject into the areas surrounding the platysma bands.  I would encourage you to have botox injected directly into the band to relax it.  The band that is seen in the picture is over stretched and would benefit from botox. 
I would encourage you to go back to the office that did the Nefretti lift originally (if it wasn't too long ago) to voice your concerns and see if they can re-treat.  Another option is another plastic surgeons office who has experience with administering botox into the platysma bands that are over stretched.  
Best wishes for a flawless neck

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