I suggest consulting with an experienced surgeon to discuss your aesthetic goals and your concerns. If you're generally uncomfortable with surgical procedures, there are non-surgical skin tightening options for the neck that you could consider: - Microneedling and laser treatments for texture- Botox, Dysport or Xeomin to help the Platysmal bands - Microneedling RF (Intensif or Fractora) for crepey skin and lifting - Injectable fillers like Belotero, Restylane Silk, and/or Juvederm Volbella to improve lines and folds - Renuvion, ThermiRF, and/or InMode FaceTite for internal tightening - Ultherapy and Thermage for external tightening - regular Venus Legacy, Exilis Ultra, or InMode Forma treatments with facials to maintain tightness - PDO NovaThreads or Silhouette InstaLift cone threads for lifting and long-term collagen productionOf course, with significant neck sagging, a necklift / facelift with muscle tightening (platysmaplasty) would produce the most significant improvements. At the same time, lasers treatments (Fraxel, CO2, Erbium) or microneedling RF (Fractora, Intensif) can be performed to improve crepey skin or wrinkles. See an expert for a full evaluation and treatment plan. Best, Dr. Emer