Sagging neck skin ("turkey neck"). What asurgical and non-surgical options are available to firm sagging neck skin?

Excessive sagging of the neck skin is usually a result of a variety of factors including:

Quality of skin
Skin redundancy
Laxity of the platysma muscle

Surgery, including a neck lift would improve the amount of skin redundancy and the laxity of the platysma neck muscles by sewing them along the midline. This can usually be accomplished through a small incision under the chin and two small counterincisions in back of the ear.
Alternative treatments that address the skin will generally not recreate the neck line or improve the laxity of the platysma muscle.

Great question- and this answer should really be dependent on a few things. 1- your age2- the amount of laxity you have3- your expectations or goals from the procedure (your desired results)For someone younger, with minimal laxity there are non-surgical options, currently I use the Protege Elite which uses Radio-Frequency to lift and tighten. As my background is surgical (oculoplastics), I am very weary to recommend non-surgical options for the wrong person. I think there is a lot of marketing from these companies and the results they show are their outliers. I would recommend having an in person examination to discuss what I mentioned above. Hope this helps. 

The neck is one of the most important components of facial aesthetics. A well defined jaw and neck line will improve your overall appearance and youthfulness. With most nonsurgical options, you need to have realistic expectations because they never are as powerful as surgical rejuvenation. However, if you have early aging and neck issues they can improve things without major downtime. The majority of these treatments use heat to tighten the dermis and some deeper layers. Ultherapy is one of the most popular treatments. This also targets the SMAS using ultrasound energy. Surgically, we make well hidden incisions around the ear to allow us to tighten the SMAS layer and remove excess skin. Depending on your individual issues we may also need a small incision under the chin to use liposuction to improve the overall contour. Seek a consultation with a board certified plastic surgeon to get a treatment option that is right for you and your goals. 

Surgical options for sagging neck skin can involve a necklift and lower facelift that tightens the neck skin and potential muscle while removing fat as well- this procedure may involve an incision underneath the chin as well

Nonsurgical options can involve noninvasive procedures such as coolsculpting, and other techniques that don't involve incisions/scars

For a turkey neck, the options depend on how much tissue and loose skin and fat there might be. If there is just a little fat under the chin and neck with good skin quality (this is often seen in patients in their 20s – early 40s), then you might consider liposuction of this excess fat. If the skin is of moderate quality and slightly loose, you could consider a minimally invasive procedure such as microneedling with RF (radiofrequency) which creates tiny channels in the skin to allow new skin to grow and stimulates collagen formation. However, if the patient has severe loose skin and fat (a definitive “turkey neck”), then a neck lift in combination with liposuction may be necessary to obtain the best result. For these procedures, I enjoy hiding all incisions in the crease behind the ear so that you can, if a female, wear your hair up or back without any telltale signs of surgery, or – for my male patients – scars would not be easily seen if the hair is short. Please be careful who you choose as your surgeon, and ask as many questions as possible. I have seen many patients who come to me for revisions from other offices who have visible, unnecessary scars that can extend toward the neck, as well as having obliterated earlobes due to subpar surgery. Please consult with a board-certified plastic surgeon to discuss your goals and expectations to see what procedure, and which surgeon, would be right for you.

Sagging neck skin can be due to several mechanisms:- volume excess combined with skin laxity- mostly skin laxity like after significant weight loss- Platysma bands and skin laxityDepending on whether the neck shape is combined with presence or absence of heavy jowls the best procedure may be a necklift or facelift and necklift. A necklift alone does not improve the jowls significantly, but can be suitable when the jawline is reasonably good.In most instances though, a combination of facelift and necklift is most effective.A less common procedure is direct removal of the excess skin under the chin, also referred to Z-Plasty or Direct necklift. 

The sagging neck is an area that can be treated surgically for substantial and long lasting results.  The platysma muscle is the muscle underlying the neck skin.  Sagging of this muscle is largely what causes the 'turkey neck' that you mention.  Our practice treats sagging necks with a Deep Plane Neck Lift that tightens and tones this muscle to reveal soft and smooth skin overlying it.  This procedure can result in long lasting treatment with a substantial improvement in the neck profile and neck skin.

A combination of non-surgical options like Kybella, PDO NovaThreads, Ultherapy and Thermage would do well in combination for skin tightening for the neck. VASER Liposuction (with ThermiRF, Renuvion and InMode FaceTite) is a great alternative for contouring and tightening the chin and neck and can be combined with a neck lift at the same time, if you're a candidate. I suggest getting a formal evaluation with a cosmetic dermatologist to develop a long-term treatment plan that works for you. Best, Dr. Emer.

There are many options for improving neck contour, both surgical and non-surgical - which is best depends on the degree of fat present, whether you have loose skin, and whether you have platysmal (muscle) bands and laxity. If you  have excess fat and are relatively young and have good skin quality then liposuction will give a good result - this is a simple procedure with quick recovery.For early skin laxity then there are a number of skin-tightening lasers such as Thermage, SkinTyte and Ultraformer III that improve skin laxity with minimal or no down-time. These however need to be continued for ongoing improvement.For more advanced skin laxity then surgery - lower facelift and necklift is the best option, giving you a long-lasting result

Neck firming options include surgical or non-surgical. Non-surgical options are for less severe neck laxity cases. Tightening machines can tighten but only to a certain extent and in a small patient population. For more moderate to severe cases surgery will provide more consistent results. Depending of the amount of loose skin or fat, a neck lift with liposuction may be necessary. If there is platysmal banding a tightening of the platysma may be necessary. 

The number of both surgical and nonsurgical treatments available for neck rejuvenation is astounding and there are too many options to even begin to list. So, let me just say that, in general, nonsurgical options are effective for only those patients with a very mild amount of sagging skin or excess fatty tissue in the submental neck. For patients with any degree of sagging skin or excess fat beyond mild, a surgical option is usually the most appropriate option. An in-person consultation with a board-certified facial plastic surgeon or plastic surgeon would be the most appropriate next step in the process.