So I'm in my Mid Thirties and I'm Pretty Thin So my Neck Has Really Been Making Me Look Older, What Can I Do for This? (photo)

As Nora Ephron once wrote: "I feel bad about my neck" All the time actually because my face doesn't have any lines. It's my one mark that shows age. Would a high percentage of retina help with the horizontal lines and would botox help with those two striations? I don't think I'm ready for a 'neck lift' for another decade. Please advise.

Doctor Answers 15

There Is No Substitute For A Real Consultation But The Choices Are Bewildering In Los Angeles.

Nora Ephron also wrote in that same piece that she and her girl friends were afraid of getting facelifts because it seemed that no matter how famous the surgeon, they did not seen to understand how to operate on human beings.  She lived in New York CIty.  However, in Beverly Hills, the West Coast capitol of cosmetic surgery, the City of Beverly Hills has a cut up torso on Rodeo Drive as the ideal of beauty.  I think this artist was trying to make a similar point as Nora Ephron.  So the real question is what do you personally need to look better?  Simple, safe, reliable fixes are best.  If botox would work, that is great otherwise either a platysmaplasty or a lower facelift is needed to iron out these lines.  The punishment should fit the crime.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Platysmaplasty for Neck Bands

Neck Lift (Cervicoplasty / Platysmaplasty): restoring elegance to the face

Though it is not technically part of the face, a neck with loose, sagging skin can age the face dramatically. A neck lift is a standard part of most facelift surgeries, as the neck skin is mobilized in continuity with the lower face.

Immediately under the skin of the neck is the platysma muscle, which you can easily see in a mirror when you clench your teeth and tighten your jaw. In youth, this paired muscle meets in the midline below the chin. With age, the right and left sides of the platysma often separate, producing vertical 'cords' in the anterior neck. The platysma can be divided anteriorly and tightened during neck lift cosmetic surgery to permanently eliminate these 'cords' and improve the neck contour. One tightened in the midline below the chin, lateral traction on the platysma then creates a 'sling' which elevates the soft tissues below the jawline.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

Neck Improvement by Treatment of Platysma Bands

What stands out most is your platysma muscle bands. They can be handled by Botox every 3 months plus or minus or with a platysmaplasty - a procedure that can be performed in the office or under IV sedation using an incision in your chin crease line to hide it. 

See a board certified plastic surgeon or facial plastic surgeon for advice and options.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Best Treatment Options for Mid-Thirties Nora Ephron "I Hate My Neck"

Hi Margot,

Nora Ephron's book, "I Hate My Neck" says it all for many women. I would recommend non-invasive treatment of your "mid-thirties" neck.  I would treat your anterior neck platysmal bands with appropriately dosed and placed neuromodulator (Botox or Dysport), and then use Ulthera (micro-focused ultrasound) to lift and tighten the muscles and skin of your neck non-surgically without any downtime.  I agree that surgery in your case can be delayed for some time. Nora would have loved this treatment.  Good luck and be well.

Michael A. Persky, MD

Encino, California

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Neck bands in a 30 year old.

By the limited evaluation of a single photo it appears that the most direct approach for your concerns is an anterior neck lift which consists of a small incision under the chin and manipulating the muscle bands that are visible under the skin.


A less invasive approach is Botox/Dysport injected into the bands and non-invasive skin tightening using radiofrequency such as Reaction by Viora. There are several other types of skin tightening modalities, but I don't have first hand experience like I have seen with Reaction.


I would suggest getting an opinion with a surgeon who offers multiple modalities so you can chose which fits you best. If the surgeon only has one treatment, then that is all he/she can offer. Good luck.

Brian J. Lee, MD
Fort Wayne Plastic Surgeon
5.0 out of 5 stars 12 reviews

Anterior Neck Bands

Unfortunately you have inherited these bands of platysma muscle at a very young age. Botox may give temporary improvement but this will only last 3-4 months. Muscle treatment and possibly a neck lift will be necessary to give you the result you want with long lasting results.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

So I'm in my Mid Thirties and I'm Pretty Thin So my Neck Has Really Been Making Me Look Older, What Can I Do for This?


  Aesthetically speaking, if this picture is at rest and not of you contracting the neck muscles...there is significant anterior banding of the Platysmal muscle as well as loose skin.  A consultation would be best to deicde the most prudent course of action of the three possible solutions IMHO.

  1. Botox injectiuons to soften the muscle bands.
  2. A formal Neck Lift but this would possibly also need to include some skin removal along the front of the ears to avoid pleating (this can be determined during a consultation with manipulation of the lax tissues).
  3. Botox combined with excess skin excision under the skin.

 Hope this helps.


Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

So I'm in my Mid Thirties and I'm Pretty Thin So my Neck Has Really Been Making Me Look Older, What Can I Do for This?

Yes what you seem to be describing are the "platysma banding effect. As the majority of expert posters have written USE BOTOX first until ready for neck lift surgery. As for Uthera therapy or even Thermage I would be VERY careful to expect any improvement for $'s spent. Be careful out there! 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Platysma bands

Botox is a temporary fix for these bands. a better rather lasting option would be a platysmaplasty which is a rather invasive procedure.

Misbah Khan MD, FAAD, FACMS
New York Dermatologic Surgeon
4.9 out of 5 stars 28 reviews

Necklift is more effective than botox

Necklift is more effective than Botox for neck bands. It's easy to try Botox and see what it can do. Nonsurgical treatments are appealing but often don't give enough improvement.

Daryl K. Hoffman, MD
San Jose Plastic Surgeon
4.6 out of 5 stars 16 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.