38 y/o female who lost about 94 lbs. Skin on neck looking more lax - Do I need a facelift? (Photos)

This is a great question, and it’s not uncommon for patients in their late 30s to begin noticing signs of skin laxity—particularly after significant weight loss. First, congratulations on your incredible transformation and maintaining such a healthy weight.
From what you’ve described, the laxity in your neck skin could be influenced by several factors, including genetics, natural aging, and prior weight fluctuations. While straining during heavy lifting may accentuate neck muscles, it's unlikely to be the sole cause of loose skin.
In terms of treatment options, there are both conservative and surgical paths to consider:
Non-surgical options like Morpheus8 (a combination of microneedling and radiofrequency) or other skin-tightening technologies may offer some degree of improvement in skin firmness. These can be good initial approaches, especially for mild laxity, but the degree of lift and long-term results tend to be modest when compared to surgical methods.
For more significant and lasting improvement, especially when there’s moderate to pronounced skin laxity, a surgical neck lift—particularly a deep plane neck lift—can provide excellent, natural-looking results. When performed meticulously, with careful attention to skin closure and scar care, this procedure can achieve a refreshed and youthful appearance with minimal visible signs of surgery.
Of course, the most appropriate option can only be determined after a proper clinical examination of your neck and facial anatomy. But based on your age, weight history, and concerns, you're at a point where it's completely reasonable to start exploring these options—whether conservative or surgical.

Given the visible skin laxity and sagging in your neck area, the most effective and long-lasting solution would be a neck lift surgery. However, for a more harmonious, youthful, and aesthetically pleasing result, I recommend combining the neck lift with a facelift procedure. This combination allows for comprehensive rejuvenation of both the face and neck, ensuring a more balanced appearance. That said, the photos you’ve provided are insufficient for a thorough evaluation; to accurately assess skin quality, the degree of laxity, and underlying muscle structure, a physical, in-person examination is absolutely necessary.

First of all, congratulations on your impressive 94-pound weight loss and for maintaining your results—truly an achievement to be proud of. It's not uncommon to notice increasing skin laxity in areas like the neck after significant weight changes, especially with age-related collagen loss.
Since you've uploaded photos, they do help clarify the situation. In your case, there appears to be a noticeable degree of excess skin, which suggests that the most definitive and effective solution would be a surgical neck lift. This procedure can directly address both skin laxity and any underlying muscle banding for a smoother, firmer neck contour.
That said, if you prefer to avoid surgery for now, there are still non-surgical or minimally invasive options that may offer modest improvement:
Radiofrequency treatments (e.g., FaceTite, Morpheus8): Tighten the skin by stimulating collagen at deeper layers.
Ultrasound-based treatments (like Ultherapy): Help lift and tone over time without downtime.
Microneedling with RF: Can improve surface texture and mild sagging.
While these methods can’t match surgical results, they can be a good interim option if your priority is minimal downtime.
I hope this helps you better understand your options. A consultation with a provider experienced in both surgical and non-surgical neck rejuvenation would help tailor the best plan for your goals.
— Güray Yeşiladalı, MD

Contrary to the old practice where Facelift or Necklift cases were in older patients (from 55-60 years old) we currently know that in many cases like yours where there were weight changes, they can benefit greatly from this type of surgery, achieving even better results than in older patients.

Congratulations to your weight loss! The wish for less invasive procedures is understandable, but none of those will replace a well done necklift. With a necklift, the redundant skin, the neck bands, the platysma, enlarged glands and some remaining fat deposits can be addressed. This is not possible with any other technique. Often energy based devices compromise blood flow in the skin and cause underlying scarring, and irregularties , making future surgeries more difficult. The results might be limited and complications can increase. I hope this helps

What age is right for a facelift? While 38 is on the slightly younger side for a facelift, we do find when patients experience significant weight loss as you have then often surgery is the best option. Since you are on the younger side, you could consider starting with less invasive options such as Ultherapy or radio frequency skin tightening. I recommend you see a provider that offers both surgical and non-surgical options to understand the pros and cons of each route.

In my opinion you don't need a facelift as you don't have jowling that I can see in these photos. I can see skin laxity and some platysma bands on your neck appearing. Instead of a facelift, a neck lift would be the most effective procedure and give you long term results to address your concerns.

A neck lift to tighten the platysma centrally and laterally would correct this. You can extend this to the face to improve deep nasolabial folds or lines around the mouth.

Congratulations on your weight loss and maintenance of your weight. As you are 38 years old, your skin has snapped back reasonably well from your weight loss. You do have some minimal banding of your platysma muscle in your neck in addition to the looseness of your neck skin. There are a number of energy base systems, which are non-invasive, which report to tighten the skin of the neck and improve the neck contour. The results of these are modest, but there is essentially no downtime with them. Depending upon how much you wish to improve your neck appearance, you may also consider having a mini facelift/necklift, which can be done under local anesthesia, that gives you the added benefit of being able to tighten and smooth the platysma muscle of your neck and smooth and tighten the skin of your neck far more than the non-invasive techniques. Have a detailed discussion with your plastic surgeon about which may work best for you.

Hello! Congratulations on your incredible weight loss and maintenance—it’s a major achievement! At 38, it’s understandable to notice some skin laxity, especially in the neck area, after such a significant transformation. The skin's ability to retract after weight loss varies based on genetics, age, collagen quality, and how quickly the weight was lost. Neck straining during heavy lifting can emphasize or temporarily worsen the appearance of looseness but likely didn’t cause the laxity itself.

From the photos you have provided and knowing you are only 38, you likely do not need a facelift just yet. There are several non-surgical and minimally invasive options that can help tighten and lift the neck area:

Radiofrequency Microneedling (e.g., Morpheus8, Scarlet) – This combines collagen-stimulating microneedling with heat-based tightening, improving skin laxity and texture over time. It’s one of the most effective non-surgical options for neck rejuvenation.

Radiofrequency-based tightening (e.g., Thermage) – Thermage delivers uniform heat to deeper layers of the skin to stimulate collagen production and gradually tighten and contour the treated area. It's well-suited for mild to moderate laxity and works particularly well for early skin sagging.

Injectable biostimulators (like Sculptra or Radiesse) – These can be used in the neck to improve skin thickness and firmness gradually over several months.

Skin boosters or dilute Botox (a.k.a. “Nefertiti Lift”) – These improve fine lines and tighten the platysmal bands, which can soften the appearance of aging in the neck.

Laser treatments (e.g., Fraxel or CO2) – Useful if skin texture and crepiness are an issue, though best combined with collagen-stimulating procedures.

If non-invasive options don’t give you the desired result, there are minimally invasive surgical options like a mini neck lift or liposuction with skin tightening devices (e.g., FaceTite) that can offer more dramatic results without the full downtime or cost of a traditional facelift.

You’re still young and have great skin, so you may respond well to conservative treatments—starting sooner can help slow down progression and may delay the need for surgical intervention. It’s best to consult with a board-certified facial plastic surgeon who can assess your skin quality and recommend a tailored plan.

Best of luck!
Genie Alexander, RN BSN
for Anna Petropoulos, MD FRCS
Center for Classic Beauty
Boston & Danvers, MA