my younger patients with neck sagging (and most of what you have Is sagging and not fat) do facetite + liposuction, threads, morpheus treatments every 2-4 months, and yearly thermage/ultherapy. however it appears you may need an early neck lift to get the result you are looking for.With significant neck sagging you would need a neck/face lift with muscle tightening (platysmaplasty). at the same time lasers (fraxel, co2 or erbium( or microneedling RF (fractora, intensif) can be . performed to improve the crepe skin or wrinkles. You need a formal consultation, as the neck can be treated with a combination approach: 1. micro needling and lasers for texture 2. botox, disport or xeomin to help platysmal bands 3. intensif or fractora RF microneedling for crepe skin and lifting 4. fillers like belotero, restylane silk, juvederm volbella to improve lines and folds 5. neck/face lifting if sagging is prominent or early starting +/- platysmaplasty (muscle tightening) 6. J plasma/Renuvion, thermiRF, inmode facetite for internal tightening 7. ultherapy and thermage for external tightening 8. regular Venus legacy, exilis ultra, or inmode forma treatments with facials to maintain tightness 9. PDO novathreads or silhouette instalift cone threads for lifting and long-term collagen production see an expert for a full evaluation and treatment plan based on your individual situation and goals. Best, Dr. Emer.