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 27

Neck Lift Will Correct Crepy Saggy Neck Skin

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.

Saggy Neck Skin Fixes

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.

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 62 reviews

Neck rejuvenation options

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 86 reviews

Loose skin at 39 looking at Face Lift and Neck Lift

 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
4.6 out of 5 stars 24 reviews

Necklift with platysmaplasty and fractional CO2 resurfacing

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 49 reviews

Crepey, loose neck skin needs a facelift

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.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Neck Lift before 40

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

Neck lift is best option

Hello.  Based on your photo, I believe a neck lift will rejuvenate your neck the best and create a better harmony between your face and neck.  Make sure you consult with a board certified facial plastic or plastic surgeon.  Take care.

Kenneth Yu, MD
San Antonio Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

My neck makes me look old. What to do.

 There have been many studies which have looked at the appearance of one's neck contrasted to their overall appearance. Reliably and reproducibly the appearance of one's neck  is a more powerful driver of age appearance then a patient's cheeks or face. To that end a loose envelope of skin or wrinkly skin on the neck will dramatically age a patient's appearance. 

 To counter this many patients seek the advice of physicians to help them rejuvenate or turn back the clock on their neck. First of all it's important to a determine what led to this loose skin in the first place. Some patients have loose skin due to massive weight loss other patients have loose skin due to their jovial are happy nature which leads to excessive animation of the platysma muscle and therefore The skin becomes stretched out and send from the excessive animation. Early intervention with Botox can minimize the animation deformity and therefore delay or even prevent the onset of these wrinkles. However once they have developed the next step of consideration in the aesthetic ladder is to evaluate whether or not the skin is amenable to tightening through non-invasive techniques such as topical creams to help thicken the dermis or lasers and Fraxel treatments to help thicken the dermis and tighten the skin.when seeking a treatment algorithm that involves nonsurgical options it is helpful to consult a physician who has a broad spectrum of treatment algorithms in there armamentarium. Focusing on a physician who only has nonsurgical options may result in minimal interventions and some frustration. The reason for this is that in some cases nonsurgical options are not satisfactory and delivering results which deliver the intended change. Therefore moving up the aesthetic latter surgical procedures such as Precision TX or even neck lift and facelift may be  necessary to achieve the desired results. These more invasive procedures are often performed by plastic surgeons who have years of experience and can deliver not only nonsurgical options but also the full spectrum of surgical treatments. When consulting a plastic surgeon asked to see before and after photographs of patients whom they have treated to help you determine whether or not their aesthetic EYE matches your vision for your rejuvenation.

R. Brannon Claytor, MD, FACS
Bryn Mawr Plastic Surgeon
5.0 out of 5 stars 41 reviews

Wear and tear

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,

DrC

Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 10 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.