Best procedure to fix sagging neck skin? (Photo)

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!

39 is to young for a facelift. However, there are excellent non-surgical options available.
Patients with moderate skin laxity of the lower face and neck are ideal candidates for the Endolift Laser which is FDA approved and used throughout Europe. I brought it to the Connecticut area to offer my patients an alternative to a surgical facelift. When used in combination with PDO Threads and possibility facial fillers, the results are ideal and the downtime is minimal.
You may also benefit from selective facial fillers: Radiesse, RHA or Restylane to contour your jawline and cheeks. This will support lax skin and muscle of the lower face.
The combination of the Endolift Laser, PDO Thread Lift and selective Facial Fillers is the choice for patients who wish rapid recovery, have moderate laxity of facial and neck skin and wish a natural and rejuvenated appearance.
Botox will not assist sagging skin but when appropriate can diminish prominent neck bands or muscles.

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