Hi Diva411,I know the area which you are referring to. In general, I think this is caused by a loss of fat directly under the skin of the neck. This small amount of fat loss makes the skin of the neck thinner than it was in youth, and in certain positions the neck skin on the throat and decolletage area can appear quite crepey. The worst positions are when the chin is down and the shoulders are pushed together. This causes the skin in the front of the neck to not be on any "tension." This crepiness is often times not seen on before and after photos, and only in certain non-standard positions. Standard photographs in good posture and looking straight will not show the crepiness you are referring to.I have seen many patients who have had non-surgical skin tightening treatments to the front of the neck (throat) area, and they report that it looks great for about 2 weeks after the initial treatment due to the swelling from the treatment, only to look even worse after the swelling is gone. I take their comments with a grain of salt, since they are getting the treatment to this area of the neck, there must have been some problem for them to agree to the treatment. I suspect the non-surgical skin tightening treatments, which are ultrasound, infrared, or radiofrequency based, are melting the thin layer of fat directly under the skin (i.e. subcutaneous fat.) This is why it actually looks great when there is swelling. The swelling makes the subcutaneous layer of fat thicker from swelling, but later it may have inadvertently melted some fat which in turn makes the subcutaneous fat even thinner than it was prior to the non-surgical skin tightening treatments. With an even thinner fat layer, this will make the skin even crepier than it was before the treatment.These treatments are designed to tighten the skin, by making the surface skin temperature reach 39.5-41.5 degrees Celsius, then the deeper tissues will heat up to 50-55 degrees Celsius. The hope is the the skin tightening is greater than the fat loss, but if the skin tightening is very minimal to nothing, and the heating of the fat to 50-55 degrees actually causes more fat loss than skin tightening, it could very well, make the skin look even crepier after the treatments. Some doctors who don't have the non-surgical skin tightening devices, can improvise with lasers to heat the skin to the requisite 39.5-41.5 degree Celsius mark and try to tighten the skin in a similar manner.I have also some patients who come from more tropical environments with severe crepiness and fat loss of the neck skin in the throat area. The amount of sun exposure in the tropics directly on the skin, I suspect can heat their skin up to the 39.5-41.5 degree Celsius temperature. This could be easily determined, by bringing a laser temperature thermometer to the beach and test the skin surface temperature. I suspect it does reach this temperature, and cause the fat underneath the skin to become damaged and thin out. This may be why men and women who are very tan are also the same people with very crepey neck, decolletage, arm, and leg skin.In general, after a face and necklift the main improvement is in the sagging of the neck/chin profile and jawline. In our before and after photos, the crepiness may appear improved, but if your ask these same patients to lower their chin and push their shoulders together, the crepiness will become apparent.No matter how tight I make the face and necklift, the crepiness is still there, once they position themselves so that their skin is not on any tension. I suspect the only way to truly improve the skin is to make the skin in these areas thicker. A similar area is the skin on the back of the hands. This area has been treated with fillers and fat grafting to make the skin there thicker and it helps to hide the veins and tendons on the back of the hand. It most likely also helps with the crepiness of the skin on the back of the hand.The aging process is more complex than most people and plastic surgeons realize. Although many of our results do show a significant improvement in sagging of the neck and jawline, crepiness of the lower neck is still an issue. Some crepiness of the lower eyelid skin can be improved with fat or fillers. Perhaps this is the direction where we are headed. The main issue is that the skin of the neck is very thin and a large area. Technically it would be difficult to create a perfectly smooth 1-2 mm layer of thickening of the neck skin across the entire front of the neck. I have done this for a smaller area of 3 by 5 cm for a small area of crepiness along a horizontal neck wrinkle, which improved the crepiness of this rectangular area. Very good question, but difficult problem to solve. Hope this insight helps.Good luck on your plastic surgery journey.Best,Dr. YangP.S. 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