Laser or surgery for crepey neck? (photos)

Question

I am a 53 year old with a crepey neck that has not been improved with filler, botox or microneedling. I am wondering if there are any other non-surgical procedures that might help before i do pursue surgery. I will just have a hard time getting two weeks + off work, so surgery is my last resort. Thanks!

Lucian Ion, FRCS · Answer

Thank you for your question and for submitting your photograph.

In general, the degree of improvement achieved by non-surgical treatments is relatively modest on laxity and relatively thin neck skin. This is because the ability of the skin to recover following the trauma of treatments is much less in the neck region compared to the face, where stronger treatments can be used successfully.

Depending on the degree of improvement that you wish to achieve, it sounds like the neck lift intervention is most likely the treatment of choice.

Jonathan Kulbersh, MD · Answer

Thank you for providing a photo along with your question. Based on your photo, your degree of skin laxity may not be addressed with one procedure alone. Perhaps, you may benefit from a combination of treatments, including Botox, dermal fillers, Profound RF (RF microneedling), and lasers. But of course, an in-person consultation with a reputable board-certified facial plastic surgeon is the best way to determine the best procedure(s) for you and ensure the best possible results. If the non-surgical approach won’t suffice, you may be a candidate for a neck lift, which will revitalize the appearance of your neck and throat. Compared to a mini-lift or traditional facelift, this neck tightening surgery is considered less invasive as it requires smaller incisions and targets the neck alone. You’ll find out the best approach once your surgeon does a proper evaluation of your skin and profile.

Richard G. Schwartz, MD · Answer

Based on your photo, I don't think fillers or Botox would help improve your neck appearance.  Microneedling might but you have already tried that.   There are other non-surgical treatments that offer subtle  tightening of neck skin and soft tissue due to heating the collagen, such as Ultherapy or Thermage, et.al..   Personally, as the photo indicates loose skin, I think the most improvement would be obtained with a standard necklift.

Zoran Potparic, MD · Answer

Based on this single photo, you seem to be a candidate for neck, possibly lower face/neck lift. Your skin is paper thin and wrinkling will be evident even after tightest neck lift. Additional treatment with RF devices may improve this condition to a certain degree. Good luck.

Jason Emer, MD · Answer

A combination approach would give the most improvement. Nonsurgical options such as Kybella, PDO NovaThreads, and Ultherapy do well in combination for skin tightening, but the results are mild compared to surgical options.

I would recommend a VASER Hi-Definition Liposuction with ThermiRF, Renuvion (J Plasma) and InMode BodyTite to contour and tighten the chin and neck. A neck lift can be performed at the same time, if you're a good candidate. I suggest seeing a board-certified cosmetic dermatologist to develop a personalized treatment plan that works for you. Best, Dr. Emer.​

Tanveer Janjua, MD · Answer

A combination of 3 things
1. Resurfx for skin surface
2. PRP for skin surface
3. Thermitight for loose skin
REgards
Dr. J

Michelle Copeland, MD, DMD · Answer

Thank you for sharing your photo! While it is difficult to say without an in-person examination, you may benefit from Thermage and a Threadlift. 
 
Non-surgical options such as radiofrequency (RF) cosmetic procedure are clinically proven to help smooth, tighten and contour skin for an overall younger looking appearance. This can treat sagging skin, loose jowls, lack of definition in the jaw line, sagging neck skin (“turkey neck”), wrinkles and fine lines, and lack of definition in the lips. Thermage® uses radiofrequency technology to heat the deep, collagen rich layers of your skin. The heat helps tighten existing collagen and stimulate the formation of new collagen, which reduces sagging, renews contours, and improves the smoothness and texture of the skin’s surface. When combined with a Threadlift,  a non-surgical face-lift that is minimally invasive and addresses signs of aging in the face, including droopiness of the skin of the brow, cheeks, jowls, and neck without incisions or scars. Threads are inserted painlessly under the skin to lift and contour the tissues, providing an immediate tightening. The procedure can be performed using local anesthesia, and most patients can return to normal activities the next day.
Thermage and Threadlift  combination treatment delivers natural looking results with little to no downtime —on all skin colors, on and off the face, all in a single procedure. Fast and easy, you can even come in during your lunch break and return to work after! I suggest you make an appointment with a board certified plastic surgeon to discuss what treatments are right for you.

Barry M. Weintraub, MD, FACS · Answer

As a board certified plastic surgeon, I am asked questions like yours all the time. Patients often want the quick fix, the non-surgical solution -- but this is often based on a misunderstanding of how long it takes to recover from actual surgery. I see that you have already had microneedling, and I’m guessing that it might have been with radio frequency. Filler won’t do anything to fix crepey skin, and neither will Botox. My best advice is that you might need a combination of laser resurfacing and a neck lift. The laser resurfacing addresses the crepey texture of the skin. The surgery addresses the excess skin that contributes to the problem. The best part of this is that you will not need two full week off of work. If you have a desk job, one week could suffice. Be sure to consult with a board certified plastic surgeon to discuss your concerns and expectations.

Patrick Flaharty, MD FAACS · Answer

One of the hottest technologies for crepey neck skin is Radiofrequency (RF) combined with microneedling. There are several companies that make these devices but the most popular is the Morpheus 8 by Inmode. This adds the RF heat energy to the microneedling technique and has shown nice results with crepey neck skin. Morpheus 8 treatments are usually done as a series of three treatments separated by one month. There can be some redness and swelling after the treatment but you can function normally regarding work and activities. As with any procedure you want to consult with a physician highly experienced in this technique as experience can make all the difference.

William Portuese, MD · Answer

A full set of facial photographs from all angles are going to be required to make a determination about how best to proceed.  From the one limited photograph, you have extensive loose and elastic skin in the neck, platysma muscle cords, and a small amount of fat deposits in the submental area in the neck. The lower face and neck lift procedure can give significant improvement all three of these issues.