Crepey, Saggy Neck at 39, What Are My Options?

I am 39 years old, generally slim and youthful in appearance. I am 5'5 and 124 pounds, and have two children. I gained and lost about 50 pounds in each pregnancy. My neck skin is extremely wrinkly, crepey, and saggy. My face and body look 35, but my neck looks like it belongs to a 55-year old. I KNOW I have some sun damage there from some severe burns I got in my teens. I am also wondering if the weight gains and losses of pregnancy contributed to the sagging. What can I do?

Doctor Answers 32

Saggy Neck Skin Fixes

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Thanks for including your picture.  It appears to show some neck bands and the excess skin that you mention.  Weight gain and loss will contribute to this problem along with genetics and sun damage. The neck is an area that many women look at and say they do not like.  While we do not have a lot of great options, there are a few that would work for you

Non-surgically there is:

·        Micro-needling.  While a slow approach because it will take a few treatments spaced out a month apart, this can be very effective if the needling is aggressive enough. 

·        Chemical peels can also be effective but the skin of the neck is a little more delicate and caution is advised with peels in this area.

There are a number of other treatments like radio frequency and lasers but these have not shown good results that have any longevity in treating the skin.

Surgically, a neck lift would give you very nice results and deal with your concerns.  A neck lift can be done with minimal or short scar incisions and the recovery can be as short as a few days (with makeup and a scarf you can be out doing most things in just a few days).

I hope that helps and if this answer was of benefit please take a moment to up vote it on the “respond” button on the top right.

Best regards.

Kirkland Plastic Surgeon
4.9 out of 5 stars 66 reviews

Neck Lift Will Correct Crepy Saggy Neck Skin

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Thank you for your question.

Certainly weight gain and loss will cause loose skin under the neck.

From your photo you appear to have loose skin, some residual fat and lax neck muscle.

A Neck Lift with repair of the muscle through a small incision under your chin, and tightening of the muscle and removal of loose skin through incisions behind the ears should give you a very nice result.

Neck rejuvenation options

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Thanks for sharing. Current neck rejuvenation treatments:
  1. Surgical Neck lift with a lower facelift would be the gold standard and get you the best results
  2. Surgical Neck lift would be the next best procedure
  3. Neck liposuction and or laser lipolysis if only fat removal is required, typically in a younger patient
  4. Ultherapy is an FDA approved non invasive tightening using ultrasound technology
  5. Kybella is a new FDA approved injection that melts fat under the chin

Raymond E. Lee, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 100 reviews

Loose skin at 39 looking at Face Lift and Neck Lift

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 I have performed Face Lifts and Neck Lifts for over 20 years and at 39 you have more loose skin that typical.  This, IMHO, is most likely due to the substantial weight gain and loss as you described.  Your choices, to remove, this amount of skin are limited and would include a formal Neck Lift or some smaller variation of excess skin excision under the chin.  The limited surgery would not make the neck completely smooth like the full neck lift, so the decision, of how smooth, you'd like your neck would dictate what procedure is best for you.

 IMHO, you should not rely on sutures, threads or suture suspension procedures to tighten and lift your loose neck skin.  These procedures, IMO, are all limited by the fact the threads are more stiff then the tissue within which they are placed.  This creates a "wire through cheese" type effect that will cause the threads (sutures) to move towards the surface, of the skin, or loosen which allows the skin to once again sag.  This degree of loose skin will require an incision, tissue dissection and skin removal.  RF or Laser treatrments, IMO, tighten the skin a couple of mm's and would not be able to remove 2 inches of skin, like the Neck Lift.

You should have a few consultations with Face Lift surgeons with good reputations to discuss your best options.  Hope this helps and good luck.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Crepey, loose neck skin needs a facelift

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While your photos aren't perfect, even at your age, your weight gains and losses have taken away your skin elasticity and it will never return.  No non-surgical treatments are worthwhile in my opinion to make any real difference for you.  The only way I know to dramatically improve what you have is to do,a facelift (cheek and neck lift).  On rare occasions these are needed even in folks under 40 if they have the right anatomy.

Necklift with platysmaplasty and fractional CO2 resurfacing

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Large weight fluctuations can contribute to the sagging.  There are non-surgical and surgical options for your neck but I think the combination will address each individual component.  The sagging skin is best treated by neck lift.  The platysmaplasty treats the sheet-like muscle in the neck that further contributes to the sagging.  The laser skin resurfacing will tighten the crepiness of the skin quality and must be done with caution and may be repeated.  A detail physical exam will be required to see if you are the right candidate.

Johnny Mao, MD, FACS
Orange Facial Plastic Surgeon
4.9 out of 5 stars 58 reviews

Solutions for crepey neck skin

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Crepey neck skin is one of the most common concerns for my patients.  You have three good options for improvement:

1. Ulthera - creates mild improvements and has no downtime 

2. Fractional Carbon Dioxide Laser - requires downtime, but has increased effectiveness

3. Neck Lift - requires surgery and downtime, but is most effective at improving crepey neck skin

Below is a great example of one of my cases where I used both a surgical neck lift and fractional carbon dioxide laser.  Good luck!

David Stoker, MD
Los Angeles Plastic Surgeon
4.8 out of 5 stars 60 reviews

When do you need a neck lift?

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You have described a problem faced by many women... the changes in weight can cause stretching of the skin and muscle that just don't snap back. 

A neck lift is the best solution for someone with significant skin and muscle laxity. Be sure to consult a Board Certified Plastic Surgeon to learn your best options.

Bharat Shah, MD, FACS
Springfield Plastic Surgeon

Neck Lift before 40

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Thank you for your question. Weight gain (whether from pregnancy or not) followed by substantial weight loss, can often result in undesirable laxity and looseness of the skin in the lower face and neck area. Unfortunately, as we get older, our skin loses the ability to tighten and "snap back up" to re-contour our jawline after losing weight (and therefore the fat under the chin). Granted, this is more commonly an issue for men and women in their 40's and above, but it can happen in younger patients as well--especially with a history of excess sun exposure, and a family history of early sagging in the neck.

Fortunately, there are a number of surgical and non-surgical options that exist today that can help address this issue:

1) Neck Lift: using an incision under the chin the remaining excess fat can be removed and the loose muscle (the platysma muscle) that is responsible for maintaining a youthful contour can be tightened. Small incisions behind the ears are usually made a well in order to remove some of the excess skin from under the neck in a way that hides the incisions.

2) Neck Lift with Lower Facelift: this is the most common procedure I perform for this type of issue simply because when most people notice significant sagging in their neck region, they tend to have some sagging and jowling in the lower face as well. In this case, in addition to the previous incisions described, an incision is made along the front aspect of the ear (camouflaged in the natural creases of the ear) which allows me to lift and tighten the lower face as well. The combination of lifting the lower face and neck can have a profound effect on rejuvenating one's appearance, while maintaing a very natural look.

3) Non-surgical options: there are a number of non-surgical options that are now available--some of which can have significant results when performed in the right situation. I personally have a great deal of experience with Ultherapy which tends to work well and more consistently in younger patients yourself. There are other options as well (such as Thermitight, Kybella, Instalift) which may also offer some benefit. However, the surgical options will certainly offer more consistent and comprehensive results.

I would encourage you to consult with a Facial Plastic surgeon who can offer all of these options in order to help you determine which one is right for you.

Hope this helps!

Best of Luck,

Dr. Y

Haresh Yalamanchili, MD
Houston Facial Plastic Surgeon
4.9 out of 5 stars 31 reviews

Wear and tear

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You hit it on the nose. The weight gain and loss combined with the sun damage has aged your neck skin and likely platysma muscle earlier than it would have aged if you lived a boring life. You have made the right decision though. Be happy and get happy.

For neck rejuvenation it is important to have a good physical exam to determine exactly what is going on. The sun damage and skin changes can be corrected with a laser. Likely low setting (because neck skin lacks deep dermal attachments) fractional ablation. The sagging with either radiofrequency devices or a plastymaplasty and/or necklift. That would be determined after a good facial analysis and physical exam.

Hope this helps.

Best of luck,


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 13 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.