Severe sagging in neck area - what would be best way to treat? (photos)

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. This is the one I would recommend based on your image.
I hope that helps!

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

For mild to moderate neck skin laxity FaceTite can be considered. For more severe skin laxity you will have the best results from a surgical neck lift. I encourage you to begin by visiting with a board certified plastic surgeon near you for an evaluation.