How to Correct Thin, Sagging Skin on Mid to Low Neck Area? (photo)

Question

The skin on my mid to lower neck is very saggy. It does not match the skin on my face. Why is this? What is the best treatment to firm the skin. Is there a neck lift? I will do anything and go anywhere to correct this.

Jason Emer, MD · Answer

"For a double chin, InMode FaceTite with VASERlipo would give you the best result.

With significant neck sagging you would need a facelift / neck lift with muscle tightening (platysmaplasty). At the same time, I would recommend lasers (Fraxel, CO2, Halo, or Erbium) and microneedling RF (Fractora, Morpheus8, PiXel8, Intensif) to improve the crepey skin and wrinkles. Overall, the neck can be treated with a combination approach:

1. Microneedling and laser treatments for texture
2. Botox, Dysport, Xeomin or Jeuveau to help platysmal bands
3. Intensif, Fractora, PiXel8, or Morpheus8 microneedling RF for crepey skin and lifting
4. Injectable fillers like Belotero, Restylane Silk, Versa, and Juvederm Volbella to improve lines and folds
5. Face/neck lifting if sagging is prominent or premature, with or without platysmaplasty (muscle tightening)
6. Renuvion (J-Plasma), ThermiRF, and InMode FaceTite/AccuTite 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 formal evaluation and to develop a personalized treatment plan based on your individual situation and goals. Best, Dr. Emer"

Jed H. Horowitz, MD, FACS · Answer

It is best to begin by consulting with a board-certified surgeon in-person. The presence of banding down the front of the #neck, and, amount of excess skin and condition of your skin are among some factors which determine if you are a #candidate for #rejuvenating the neck. Chin deficiency with the neck and jawline are also taken into consideration. A weak #chin implies a lack of chin support for the skin along the neck line. As a stand-alone procedure, chin augmentation can be performed in the office under local #anesthesia. For individuals with signs of aging in the neck, a chin implant added to one of the recommended procedures above, will provide optimal results. 
Patients who desire facial rejuvenation that is affordable, quick, and effective should also consider the Lite-lift™. Like the Life-Style™ facelift, this is a modified facelift, individualized for each patient, that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.
A board certified plastic surgeon should evaluate both your anatomical features and aesthetic goals to suggest which procedure best suits your needs. In some cases there may be more than one option to choose from. If you are not a candidate at the time of your #consultation, your board surgeon can recommend non-surgical alternatives to address your concern.

Kenneth Hughes, MD · Answer

Loose Skin in the neck can be elevated during a face and neck lift and the redundant skin removed from the incision lines.

Benjamin C. Marcus, MD · Answer

Patty

	 

	This issue is probably the #1 cosmetic concern I see in my clinic. When I see this loose skin in the lower neck I like to take a two step approach. First I think a deep plane neck lift (different from a standard lift) allows me to reposition the muscles and deeper structures. This help create a more taut base for the skin to re-drape over. Then about 1-2 months later I begin a series of laser treatments to further tighten and smooth the tissues.

	 

	Its always best to be seen in person to be evaluated but I hope that the information above is helpful to you in understanding my approach.

Kevin M. Robertson, MD, FACS · Answer

Patty

	As more opinions pour in, you will see two basic concepts.  One is that the skin of the neck is influenced by the underlying platysma muscle, and therefore attempts to reposition the platysma via a necklift or facelift will be valuable.  That's the basis for rejuvenating the neck (as well as jowls and midface), especially in patients who show that dominant set of anterior bands that create those two cords running down the middle of the neck.  You picture does not show that as the primary problem.

	The second concept is that the thin skin of the neck can lose it's inherent elasticity, creating a dry, hanging, inelastic look to the skin.  That looks more like what you have going on.  The reason it often shows up first in the neck is because the neck skin is thinner, and lacking some of the structures that are more prevalent in face skin. Truthfully there is no surgery in the world that can pull the skin so tight with a necklift or facelift to totally restore a more taught and elastic drape to the skin surface.  Lifts might help, but patients tend to still be bothered by the persistent skin surface.  This leaves a couple of tools to try to improve the skin, all of which we have here in the office.  One is skin tightening technologies using ultrasound or radiofrequency or infrared energy to try a non surgical tightening.  All helpful, but not so much that it would return to normal, and not to a degree of change comparable to a surgery. The other is any form of skin resurfacing, whether it be chemical peel, laser, or fractionated laser resurfacing.  All have pros and cons, but help to tighten the skin to differing degrees as well.  Of course you can do combination treatments or sequential treatments to accentuate the final results too.  

	The key to matching technology to expectation is communication.  Just make sure that you fully understand what each surgery or technology is going to do, and not do, since there is no single modality that resolves what your picture implies.

David Hansen, MD · Answer

Neck lifts are surgical lifts that pull the loose skin up and back and can be done under local tumescent anesthesia for roughly $6000. Some patients may need the addition of a platysmaplasty ($4500) if the looseness is under the chin as well. The crepy skin is often lasered or chemically peeled to enhance the results. Sincerely,

	David Hansen,MD

Toby Mayer, MD · Answer

Thin sagging neck skin treatment depends on many factors such as thickness of the skin and the amount of skin, elasticity etc. A necklift can markedly improve this but the incision needs to go back farther to remove the low skin excess. See a very experienced facelift surgeon for the best result. I can make it better but not like when we were 20.

William Portuese, MD · Answer

A neck lift only tightens the muscle and removes fat, it does not address any skin removal in the neck. The only way to remove excess skin is with a lower face/neck lift. A lower face/neck lift is the required operation to rejuvenate the neck by tightening skin, muscle, and removing any residual fat at the same time. The incisions for this are inside and behind the ears, and place with in the temporal hairline.

Joseph Campanelli, MD · Answer

Nonsurgical options for a sagging lower neck include Ultherapy and CO2 laser  resurfacing.  Because these are skin level treatments, they will not address problems  such as platysmal bands and jowling. Neck lifts are great for addressing the jowls and the bands and do an excellent job of rejuvenating the upper neck. For the mid to lower neck, you tends to not  see as good of results.

	I would recommend that you seek someone who can offer all three of these treatments to help you select the best one in your situation.

Todd C. Miller, MD · Answer

From the picture that you provided it appears that a neck lift would most effectively address the sagging muscle and skin in your neck. This typically entails a small incision under the chin as well as incisions behind the ears. The muscle is then anchored both on the sides and in the midline and provides a nicely defined chin and jawline. If you also have sagging jowls, then a facelift may be a necessary addition to the procedure to ensure you get the results you are looking for. These procedures can be done under local anesthetic, conscious sedation, or general anesthesia. Get multiple opinions from qualified and experienced facial plastic surgeons.

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