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