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)

Question

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.

Kenneth D. Steinsapir, MD · Answer

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.

Jed H. Horowitz, MD, FACS · Answer

It's best to begin by consulting with a surgeon in-person to discuss your options. 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 what treatments will best rejuvenate your neck . During your initial examination, your chin will be evaluated along with the neck and jawline. A weak #chin implies a lack of chin support for the skin along the neck line. In younger individuals a chin implant alone is usually all that is needed to improve the appearance of the neck. Subsequently, it will also improve the overall #balance of the face and can create the illusion of a smaller nose. 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.If you are not a candidate at the time of your #consultation, your board certified plastic surgeon can recommend alternatives to address your concern. Consulting with a board-certified plastic surgeon who specializes in #neck lift procedures is important to ensure you are receiving the best advice, care, and surgical experience possible.

Ron Shelton, MD · Answer

Although temporary, Botox can be used off-label to make the muscle bands bow outwardly less. Otherwise surgery, a platysmaplasty can provide a more significant improvement than Botox. Ultherapy has caused some improvement in some of my patients for this condition but it is not consistent for muscle bands.

	 

	The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

Larry S. Nichter, MD, MS, FACS · Answer

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.

Michael A. Persky, MD · Answer

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

Misbah Khan MD, FAAD, FACMS · Answer

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

Daryl K. Hoffman, MD · Answer

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.

Toby Mayer, MD · Answer

Well you can thank your parents for giving you bands at an early age. The things you mentioned really won't help much and you are wasting your time and money with botox, etc. The treatment for excess skin and muscle bands is their removal=necklift. Wait until you are ready to do this and do not participate in the "learning curve".

David Hansen, MD · Answer

Botox will help but not make a significant difference.  A platysmoplasty is a simple neck procedure under local anesthesia where the 2 neck bands are cut and sutured together from a small incision hidden under the chin with almost no down time and for roughly $4500 to permanently fix your problem. Sincerely,

	David Hansen,MD

Michael Law, MD · Answer

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.

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)

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