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

Question

I have severe sagging in neck area. What would be best way to treat?

Thomas Wright, MD · Answer

Imetcalf Thank you for sharing your photos. From the photo you look like someone who would be a great candidate for MyEllevate non surgical neck lift. The MyEllevate is the perfect compromise for someone who does not need a full face and neck lift that can cost up to $100,000.  I would recommend the MyEllevate be combined with some jowl and jaw line liposuction and skin tightening .  Of course the maximum skin tightening would result from the face and neck lift, but usually that is reserved for older patients with more skin laxity.

Raffy Karamanoukian, MD, FACS · Answer

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

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

​A combination of non-surgical options like Kybella, PDO NovaThreads, Ultherapy and Thermage would do well in combination for skin tightening for the neck. VASER Liposuction (with ThermiRF, Renuvion and InMode FaceTite) is a great alternative for contouring and tightening the chin and neck and can be combined with a neck lift at the same time, if you're a candidate. I suggest getting a formal evaluation with a cosmetic dermatologist to develop a long-term treatment plan that works for you. Best, Dr. Emer.​

Sean Arredondo, MD · Answer

So many people want to improve the neck line. Fortunately, there are a wide variety of procedures available! They range from non-invasive treatments to full face/neck lift, more dramatic results are achieved with more invasive procedures. Morpheus8 combines microneedling with RF energy that helps to tighten the skin. This can also help even out some skin tones and thicken the the skin. Neck liposuciton and Renuvion can remove excess volume from the chin and jaw area while also tightening the skin. This will not have much effect on skin tone or dermal thickness, however. MyElevate is an exciting procedure for those with strong platysmal bands. These often prevent full retraction of the skin. The bands are cut during the procedure and the skin is tightened to enhance the angle between the neck and jaw using a permanent suture. This is often combined with neck liposuciton and Renuvion to tighten the skin even further. If you are considering a fully invasive surgery, a neck and face lift can be combined to achieve the most dramatic results. This is the only procedure that can fix jowling, or sagging skin around the jaw. During the procedure we can address the platysmal bands, tighten the skin around the neck and jaw to enhance the jaw line and chin and jaw angle, and restore volume to the mid face to give a more youthful appearance. As always it is best to schedule a consultation to discuss which options are best to achieve your desired results.

Michael I. Echavez, MD · Answer

Based on your photo, you appear to be a good candidate for a facelift.  This procedure would tighten the skin along the jawline and the neck.  If you didn't want to have a surgical procedure, there are some radio frequency treatments that could produce some tightening, but not to the same degree that surgery can.  Morpheus8 is a radio frequency micro needling treatment that is performed on the skin and can produce some tightening.  Face/NeckTite is another radio frequency treatment that delivers heat to the tissue under the skin, and this can also produce some tightening.

Lisa Vuich, MD · Answer

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!

Camille Cash, MD · Answer

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.

Derakhsh Fozouni, MD · Answer

Hello! There are many approaches you can take to improve the elasticity and look of the neck.
You can try a series of sessions with a resurfacing laser or microneeding with PRP. Topically you can also apply retinol cream and be super strict with an good SPF40+ or higher, reapplying every two hours.