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.

You can use micro-needling with radiofrequency, like Secret, plus Renuvion to help tighten neck and facial skin. It does work well for many women.