Which procedure would be best for correcting my turtle neck? Is a lift the only option? 41 y/o, 128 lbs (photos)

Question

I had 3 rounds of Kybella over the course of 2021 and 2022 and while there was improvement, I still have a terrible turtle neck, especially when I look down. Wondering what my options are here. Is a neck lift the only option? Is the issue just excess skin or also muscle? I am 41, 5'5" and 128lbs, and my weight has always been between 125 and 135 (except at my most active at age 24 when I was around 120 lbs, and even then I had this issue).

Jeffrey S. Rosenthal, MD · Answer

The Endolift Laser is FDA cleared to tighten lax skin and stimulate your collagen.  The procedure uses a thin micro-fiber place through tiny pin holes to pass below the skin and target the cells that rejuvenate the face and neck. Fat below the chin can also be contoured using the Endolift Laser.

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

Jason Emer, MD · Answer

"For a double chin, InMode FaceTite with VASERlipo would give you the best result.

With significant neck sagging you would need a facelift / neck lift with muscle tightening (platysmaplasty). At the same time, I would recommend lasers (Fraxel, CO2, Halo, or Erbium) and microneedling RF (Fractora, Morpheus8, PiXel8, Intensif) to improve the crepey skin and wrinkles. Overall, the neck can be treated with a combination approach:

1. Microneedling and laser treatments for texture
2. Botox, Dysport, Xeomin or Jeuveau to help platysmal bands
3. Intensif, Fractora, PiXel8, or Morpheus8 microneedling RF for crepey skin and lifting
4. Injectable fillers like Belotero, Restylane Silk, Versa, and Juvederm Volbella to improve lines and folds
5. Face/neck lifting if sagging is prominent or premature, with or without platysmaplasty (muscle tightening)
6. Renuvion (J-Plasma), ThermiRF, and InMode FaceTite/AccuTite for internal tightening
7. Ultherapy and Thermage for external tightening
8. Regular Venus Legacy, Exilis Ultra, or InMode Forma treatments with facials to maintain tightness
9. PDO NovaThreads or Silhouette InstaLift cone threads for lifting and long-term collagen production

See an expert for a formal evaluation and to develop a personalized treatment plan based on your individual situation and goals. Best, Dr. Emer"

Ryan Welter, MD · Answer

For tightening the skin and improving overall neck contour, Ultherapy is a proven non-surgical option. This ultrasound-based treatment stimulates collagen production by delivering energy deep into the skin, which gradually improves skin elasticity and firmness over a few months. If you're looking for something slightly more intensive but still minimally invasive, Accent Prime, which combines radiofrequency and ultrasound, can address both skin laxity and fat reduction. This dual-action approach helps contour the jawline and improve the overall appearance of the neck.

If you’re open to injectable treatments, Botox could be used strategically to relax prominent platysmal bands. For volume restoration and mild lifting, PRP (Platelet-Rich Plasma) injections can enhance skin quality by boosting collagen production naturally.

For more advanced cases of laxity or persistent fat under the chin, FaceTite or Renuvion procedures might be worth considering. These minimally invasive techniques utilize radiofrequency energy to tighten skin and target small fat pockets effectively. Unlike traditional surgery, these options involve minimal downtime and avoid large incisions.

Each of these treatments offers unique benefits depending on the degree of laxity, skin quality, and your overall goals. A consultation with a qualified provider will help tailor the approach to your specific needs, ensuring natural and satisfying results. Let us know if you'd like to explore these options further!

Lisa Vuich, MD · Answer

Thanks for your question. There are several very effective treatment options for treating 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. 
4.	EmbraceRF- this is a combination procedure pairing Morpheus8 externally with the FaceTite procedure. Ideal for the more advanced skin laxity, for skin laxity that is accompanied by surface wrinkles or crepiness, and/or when there is unwanted fat to be destroyed. If the fat collection is substantial, this can be combined with targeted liposuction. Numbing for this procedure requires lidocaine injection. 
I hope that helps!

Connie Hiers, MD, FACS · Answer

You can start with noninvasive micro-needling and radiofrequency like Secret. Renuvion is minimally invasive with 3 small incisions that works well for the neck. The last option is a min-facelift or full face lift.

Camille Cash, MD · Answer

From your photos it appears you would be a candidate for FaceTite/AccuTite.  This procedure uses RF technology to tighten skin.  There is no general anesthesia required either!  Many patients elect to add Morpheus8 treatments to optimize their results.  See my website to learn more about this treatment!

Which procedure would be best for correcting my turtle neck? Is a lift the only option? 41 y/o, 128 lbs (photos)

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