Crepey neck skin at 37 - neck lift, laser, or fat? (Photo)

Question

What options do I have for the crepey skin on my neck? It looks worse with movement. Already did 2 Morpheus 8 treatments with little success.

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Laurie A. Casas, MD, FACS · Answer

Thank you for your question.  It appears that you have normal aging of the neck, but an in person consultation is always best.  For neck rejuvenation, we recommend Ultherapy to help stimulate collagen and tighten the skin of the neck.  We also recommend fractional laser to help improve the skin quality, texture and tone.  Using Alastin Regenerating Skin Nectar before and after treatments helps improve your result and decrease any downtime that you my experience.

Georges Kaado, MD · Answer

Hello and thank you for your question! Thank you for the photos with and without movement that definitely helps when giving suggestions. You may consider a Nefertiti neck lift. This is achieved with regular injections of Botox or the use of tiny injections of diluted Botox (mesobotox or microbotox) throughout the platysmal muscle area and/or in general on the neck area which might be causing this texture difference during movement. If that improves the look this may be something to incorporate in your regular Botox schedule. For further improvement, I would do a consultation for an ablative laser such as a CO2 to further improve skin texture and tightness as well as PDO Threads for even more improvement is collagen stimulation. I wish you luck on your journey to correct this!

Jason Emer, MD · Answer

FaceTite can internally tighten the skin in the lower face and neck. After all the skin has been heated and contracted, we shape the neck with liposuction to give definition and remove stubborn pockets of fat. In one quick treatment, we can tighten skin, remove fat, and contour the lower face, jawline, and jowls with only a weekend of downtime. Keep in mind that combination approaches will give you a more significant improvement as opposed to a single procedure. I recommend getting a consultation with a board-certified cosmetic dermatologist and facial sculpting expert. Best, Dr. Emer

Lisa Vuich, MD · Answer

Thanks for your question. There are several very effective treatment options for treating your degree of neck skin laxity. In non-surgical aesthetics, skin tightening is going to be "all about heat delivery". This is because the microinjury of heat is needed to stimulate collagen and elastin production in the skin, which happens during the healing response to the treatment. Results from any of these procedures are not instant but rather develop gradually over the course of 3 to 6 months:
1.	Sofwave- utilizing microfocused ultrasound to deliver heat to the deep dermis at a depth of 1.5mm, generating new collagen and elastin in the skin. The number of pulses delivered is important- the more laxity there is, the more important it is to do the ‘advanced protocol’ with 4 full passes. Most will need 1 to 2 sessions spaced 4 or more weeks apart. You should have either ‘full face and neck’ or at least ‘lower face and neck’ to get the best result for the jawline. Sofwave has no effect on fat cells as the energy cannot reach that level. Numbing for he procedure is primarily topical. 
2.	Morpheus8- utilizing RF energy delivered at the tips of micropins. With this approach you get the collagen stimulation of the heat PLUS the collagen stimulation of the microneedling, so you can potentially get more result per session, but at the expense of 'some downtime'- puffiness, faint redness for a day or two, potential bruising. The needles can also be set deeper in certain regions so that they will destroy unwanted fat cells- such as in the jowls and the “double chin” zone. Most will need 3 sessions- can be spaced 4 or more weeks apart. ‘Full Face and Neck’ is the ideal approach. Numbing for this procedure is primarily topical but nerve blocks (injection numbing) is very helpful also.
3.	FaceTite- this procedure involves placement of a probe just under the skin to achieve full thickness heating. The probe is introduced  through some simple needle pokes- considered ‘minimally invasive’. Most require a single session. Results typically last 5 years. Numbing for this procedure requires lidocaine injection.

I hope that helps!

Camille Cash, MD · Answer

You can consider FaceTite which can tighten skin of the neck and lower face with no general anesthesia needed.  You can also consider other options such as SkinPen or InMode treatments.  Learn more by visiting my website or a provider near you.

Dmitriy Schwarzburg, MD · Answer

A variety of options can be used to address common skin problems including PDO threads. In order to tighten and firm your skin, I would suggest combining Secret RF with Fraxel. Botox and fillers are also wonderful options when appropriate. Please contact a qualified provider or a board-certified physician with extensive experience in these procedures.

Timothy Abrahamson, MD · Answer

There are several different approaches for crepe neck changes.   I someone has mottled pigmentation, then IPL (intense pulse light) will reduce pigment changes.   If looking for a non-invasive option to tighten the skin over 5-8 sessions, then the Concept Venus Legacy can offer a nice option by using multipolar radiofrequency and magnetic pulse technology to tighten the skin and stimulate collagen.  Advantages of Venus Legacy include no downtime and increased benefit with repeat sessions to continue to stimulate more collagen formation.
In very atrophic skin, thin skin due to chronic steroids, genetics, or sun damage; then fillers may also have a roll.   Hyaluronic acid filler such as Restylane can provide bulk.   If looking for fillers with most lasting benefit, Radiesse (>2 year duration) or Bellafill (>5 year duration) are biostimulants to encourage collagen formation.  The longest term filler is Bellafill.
Going further down the ablative front (destructive procedures with downtime), fractional CO2 is still the gold standard.  There are other ablative devices that may also work and over the next few years we will have more data on Plasma therapies (also destructive) but white papers and published data on Plasma therapy as lacking at this time (3/2020).

Shalini Gupta, MD · Answer

Hi there.  Based on your photos I think a noninvasive skin tightening procedures such as RF microneedling, fractional lasers, or RF or Ultherapy skin tightening could help along with Botox to relax the platysma muscle.

Johnson C. Lee, MD · Answer

Thank you for your photos. It appears that you have thin skin with little fat on your neck. This can prematurely age your neck. If you have a lot of extra skin, then a necklift can benefit you. If you do not have extra skin but rather your skin quality is poor, then you can improve the skin quality by fat grafting into the area. Lasers and energy based devices can complement these options however are not the best alone. Hope this helps!Johnson C. Lee, MD 
Board-Certified Plastic Surgeon

Crepey neck skin at 37 - neck lift, laser, or fat? (Photo)

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