Is Botox better for crepey neck skin than RF treatment when the patient has very little neck fat and mild bands? (photo)

I just want to make sure you are understanding the botox is not going to give you improvement in  skin texture on the neck although i don't really see that in your picture. I do use Botox to relax the bands but you actually have a beautiful neck and perhaps just doing great skin care with a medical aesthetician will give you the improvement you desire. Best of Luck. 

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.
Best,
Dr. Karamanoukian
Realself100 Surgeon

Thank you for your question and picture submitted. It is important to differentiate between skin, fat and muscle issues as they impact the appearance of the neck. You seem to have nice skin and the issue likely a muscle banding issue. For that Botox/Dysport would be the best to try initially.