Looking for less wrinkles and saggy neck area. Will dermal fillers help? (photo)

Doctor Answers 13

Treatment of Wrinkles and Sags

Several things contribute to wrinkles and sagging of the face and neck. Sun damage causes pigmentary abnormalities, dryness, thinning of the support tissues and wrinkles. Skin rejuvenation can reverse these problems and, frequently, with no other treatment, markedly rejuvenate the face. Deflation from loss of fat and support also causes wrinkles and sagging. Filling and lifting the face, particularly the cheeks, with a filler or fat can reverse this. Removing downward muscle pull with Botox can also reverse some sagging. Severe tissue sagging, especially in the neck, requires surgery to remove the excess skin. See a plastic surgeon who can evaluate all these contributing factors and offer what will help the most for you.

Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Fillers versus Facelift For Sagging Face

You will need more than fillers to help your skin texture and sagging.  You are a surgical candidate and should pursue this option for the best results.  If you want to feel and look "refreshed," fillers in certain areas of your face such as under your eyes, cheeks, and around the mouth will give good volume and contour.  Laser resurfacing will help your skin texture and tighten the skin around your eyes and mouth.  But nothing nonsurgical will give you the results you want for your neck/jowels and eyes.  I suggest seeking the advice of a cosmetic dermatologist and plastic surgeon.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 190 reviews

Analogy: Treating the Sagging neck is like Reupholstering Furniture ...

Hi Jcg57,

I agree with the other surgeons' answers, but I would like to expand the explanation more to help you to understand the issues from a surgeon's point of view, how we try to improve the neck area.

Dermal fillers will probably not give you the results you are looking for, unless you are looking to create a fuller neck with a double chin to help smooth out the wrinkles and reduce sagging in the center of the neck, by simply making the whole neck fuller and fatter.  I do see some horizontal wrinkles below the sagging skin and fat directly under your chin.  If you think that reducing these horizontal wrinkles directly below the sagging area, then dermal fillers may help those wrinkles 10-20%.  The sagging fat and skin in front of the wrinkles may be too much for the filler to hide unless you use a many syringes of filler, which would then be cost prohibitive and not cost effective.

Fillers add volume to the area you want to treat.  If you are treating lines, wrinkles, and deflated areas, dermal fillers are very effective.  The neck area is not a typical area to treat with dermal fillers.

What are we trying to achieve as face and necklift surgeons?

A youthful neck is typically contoured and the profile is angled from the smooth area under the chin transitioning to the angled neck area.  A typical necklift result will have a before photo which shows the neck starting from wrinkle under the chin (where the wrinkle forms from a double chin) and go to the base of the neck in a straight line.  The after results typically have a smoother flatter (a line somewhere within 0-15 degrees of horizontal) for a couple of inches before transitioning to the neck.

A necklift result does not change the appearance of the person since it is focusing on the neck area.  Patients report that friends and family have a hard time telling that they had any plastic surgery performed, but instead think that they may have lost weight, because their neck appears thinner.  But often times their weight has not changed from before the surgery, and some times a couple pounds heavier, yet they appear slimmer because their neck looks thinner.

The typical necklift patient has sagging of the neck which they can pinch with their fingers.  If the patient has a full double chin, and fat neck, then they would get better results if they lose some weight first to allow the neck circumference to get smaller, and allow the skin to hang down first prior to proceeding with a necklift.  It is possible to liposuction a very full neck while performing a necklift, however, this may increase the possibility that not enough skin is removed during this procedure, because liposuction requires a lot of local anesthesia injection to liposuction the fat first, but this also causes more swelling which results more difficulty in matching the skin removal when the neck is so swollen.  It is much easier when the neck is thinner, and less liposuction and less local anesthesia injections are needed perform the necklift.  With less fat, and less injection of local anesthesia fluid, the neck is thinner when the skin removal is performed.

Patients who are otherwise thin but have a sagging wattle of skin directly hanging down the center of their neck will have the most dramatic and best results.  Full face and still full neck patients will have an improvement, but not as dramatic or ideal as the thinner patients.

Some patients feel that prior to weight loss, the sagging of the neck was better and they also saw less horizontal wrinkles than prior to the weight loss.  This is due to the fat making the whole neck much fuller.  Instead of a neck circumference of 14 or 15 inches, the neck circumference may be 16-18 inches.  When there is that much more fat, the skin will not sag in the middle and the extra fat will improve the wrinkles.  

If this is your goal to reinflate the neck then dermal fillers potentially can reinflate your neck and recreate a double chin which will help with the sagging in the middle of the neck and potentially some of the wrinkles.

Reupholstery Analogy:

Now for the Reupholstery analogy.  If you have an arm chair where the seat is overstuffed when it is new, the seat fabric is nice and tight to the overstuffed seating.  Over time, when sitting on the overstuffed seat, the stuffing can flatten out.  The fabric will not contract to hug the reduced stuffing, and it can look loose and wrinkling instead of fully inflated and tight to the stuffing.  I personally do not like overstuffed seating, and let's say that now that the stuffing has flattened out, I actually prefer the flatter seating, but I don't like the fact that the upholstery fabric on the seat is loose and saggy.  I can take the seat to get it reupholstered using the existing fabric and have them simply release the fabric under the seating and tighten the fabric and potentially removing some of the extra fabric.

Tightening the existing fabric would be equivalent to a "necklift", since the excess fabric (skin) is removed and the fabric is tightened over the existing volume or padding so it is smooth.  

Now for your original question.  Let's say, you actually liked the "overstuffed" chair when it was new, and that is really how you want it to look.  A small opening in the corner of the seating fabric can be opened and padding/stuffing can be pushed into the small hole to "reinflate" or cause the seating to fill up so that it becomes overstuffed again.  This way you do not need to open up all of the seating fabric only to tighten it and secure the perimeter of the fabric.  It is less work than reupholstering the entire seat.  

To turn this analogy back to sagging necks and wrinkles, if you like your neck fuller and it match your body, then adding fillers and volume can help you to achieve that result.  The main drawback is that the fillers are not permanent and per 1 cc of volume of dermal filler, will be very expensive, since it may need 10-30+ cc's of volume to "blow up" the neck enough to hide any sagging in the center of the neck.  more than 5-10 cc's of dermal fillers will be cost prohibitive and a necklift may end up be less expensive and not need periodic refilling over the years.

A necklift is paired with a lower facelift, since the neck is adjacent to the jawline.  When the necklift is performed to get the best and most natural results, a lower facelift can help to transition the smoother lifted neck to a smoother and lifted jawline.

Energy based Non-surgical Skin tightening

A recent topic of interest is the non-surgical skin tightening procedures which do not require any incisions to treat the neck.  These procedures typically use Radiofrequency (Thermage) or Focused Ultrasound (Ultherapy) to melt the fat in the neck without using liposuction.  The radiofrequency energy or ultrasound energy is aimed at the tissues under the skin and heat up the skin and tissues enough to cause the fat to melt.  If the fat melts, the neck will look slimmer  For younger patients (under 45), the results of these non-surgical skin tightening procedures are very similar to liposuction under the chin and jawline for since the skin on these younger patients contract and does not leave more sagging and wrinkles.  For older patients (over 45), it can also work, but there is a higher risk of causing vertical neck bands or more loose skin under the chin, although a profile view may appear to be better.  If you look closely at these non-surgical results, you may see that the skin is looser because there is simply less fat to make the skin smooth, but because there is less fat, the profile can look improved.  

Interestingly, for some patients, they will be happy with these non-surgical results, if the profile bothers them more than loose crepey skin, and vertical muscle bands.  For other patients who are complaining of sagging crepey skin, may find the profile improvement not worth the trade off for even more loose skin and exposed vertical muscle cords.

As a facelift and necklift specialist, a significant number of my patients had multiple Thermage and Ultherapy treatments which they felt did not do very much to the overall appearance for most, who only had a single treatement, but for those who had multiple treatements, these patients felt that their neck skin became more crepey and looser after the treatments, which prompted them to seek a face and necklift.  It is possible that the happy patients did not seek additional treatments, but based on the patients I have seen who have been treated with the technology, this is my impression of the new technology.


Dr. Yang

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George Yang, MD
New York Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Facial sagging and fillers?

Facial fillers will not correct your problem. A full facelift with liposuction be a very experienced facelift surgeon is what you need. For 35 years we have used general anesthesia without incident and find our patients like this since they feel nothing. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Will fillers help a saggy neck?

Thank you for your question. In my opinion, based on the photo you provided, fillers will unlikely give you the result you are looking for. A neck lift combined with liposuction will give you better results.

I hope this helps. Best wishes. Dr Salameh (Plastic Surgeon, Bowling Green, KY)

Bernard S. Salameh, MD
Bowling Green Physician
5.0 out of 5 stars 17 reviews

Looking for less wrinkles and saggy neck area. Will dermal fillers help?

Yes BUT- the amounts needed to be injected would cost over $6,000 to show a slight improvement to the aged facial skin. Operative intervention is a better option for you.. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Fillers or facelift?

I think that based upon your photos fillers will not be enough. You probably need a facelift in conjunction with fat grafting or facial fillers. Best to be seen in person.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Help for face wrinkles and saggy neck

I specialize in non-invasive or non-surgical wrinkle treatments with lasers and other devices.  I am seeing good results with Fraxel Restore and/or Repair on the face and neck.  More specifically for you, Fraxel Restore for the whole face and neck, and Repair for your more wrinkly areas around the eyes and mouth.  Your neck seems to have a combination of fat deposition and wrinkles.  I would recommend 1-3 treatments with Lipodissolve first which would eliminate the fat and offer some skin tightening too.  This can also be done with tumescent liposuction which would be more efficient, working in one treatment, but more invasive.  After you have healed from Lipodissolve or liposuction and Fraxel Restore to the neck and if there is still saggy skin, then I would recommend a combination treatment with fractionated radiofrequency and the Yag laser.  I see the best results with this regimen as an alternative to surgery.  In addition, you would probably benefit from upper and lower eyelid blepharoplasty to eliminate the sags and bags.  I do this surgery with laser instead of a scalpel and I get less bruising and much faster recovery. 

Karen Stolman, MD
Sandy Dermatologic Surgeon
5.0 out of 5 stars 7 reviews

Fillers and excess skin

Fillers will not correct the excess skin on your neck.  Fillers are useful to fill out folds on the face, such as nasolabial folds and marionette lines (smile lines), but they are not useful in the neck.  The ONLY long term solution for your neck is a full facelift.  Hope this helps and best of luck!

Patrick C. Wilson, MD
Huntsville Plastic Surgeon
5.0 out of 5 stars 34 reviews

Fillers are not a panacea for all facial aging

You present a very limited photograph but it is sufficient to determine that your only option for effective face and neck rejuvenation is a facelift with Platysmaplasty (neck lift). There is evidence of significant sun damage or solar elastosis with marked soft tissue laxity and loss of turgor exceeding the stated age. I don't believe a mini-lift will suffice or last in your case. You may also consider having upper and lower blepharoplasty (eyelid surgery) at the same time or subsequently for optimal rejuvenation. Do not waste your money on fillers or Botox or any non-surgical procedures. After a deep plane, full face-lift, you will likely benefit from a fractional CO2 LASER resurfacing of the face and neck skin. Ultimately, sun damage is cumulative and at some point, only drastic measures (surgery) have a chance for adequate reversal of the damage. Protect your skin from Sun and Smoking.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon
4.4 out of 5 stars 20 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.