As a leading cosmetic dermatology practice in the New York City area, we receive countless questions from our patients regarding their various skin concerns and treatment options, especially for the neck. Many of our patients come to us seeking ways to reduce neck wrinkles, skin laxity, neck lines, and more. Dr. Jennifer MacGregor is a board-certified dermatologist at UnionDerm with expertise in dermatologic surgery, injectables, laser procedures, skin tightening, sclerotherapy, body contouring, and more. She is often invited to speak at the most prestigious dermatological societies about the the latest and most innovative skin tightening, neck and jawline rejuvenation treatments. Using her advanced knowledge and expertise, Dr. MacGregor is able to treat, and improve, the delicate skin of an aging neck for many different types of patients.
Dr. MacGregor is an Alpha Omega Alpha national medical honor society graduate of Georgetown University School of Medicine. She completed her dermatology residency at Columbia University Medical Center in New York City, followed by a prestigious laser, cosmetic, and dermatologic surgery fellowship at SkinCare Physicians in Boston. She is also a Fellow of the American Academy of Dermatology, the American Society for Dermatologic Surgery, and the American Society for Laser Medicine and Surgery. She currently holds an appointment as Assistant Clinical Professor of Dermatology at the Columbia University Medical Center.
We have compiled your most-asked questions regarding treatments for an aging neck for Dr. MacGregor to answer. Please read below for her informed and thorough answers.
What are the main concerns patients seek to address regarding an aging neck?
When it comes to an aging neck, there are various concerns that patients seek to address. These may include the following:
Skin Laxity: Refers to the loosening of skin over the jawline, causing it to drape down over the jawline at the upper neck. The appearance of heavier skin or folds at the upper neck is often called ‘skin sagging’ or ‘turkey neck’ but is usually related to more than just the skin.
While it’s true that we lose collagen, elastin, and other components of a healthy skin matrix with time, other changes lead to this appearance as well. The finger-like neck muscles that cover the neck extend up over the jawline and enmesh with the skin as well. The bones of the jawline (mandible) and face frame also shrink with time, and we lose healthy fat in the face and neck as the skin thins. All of these factors, along with skin quality, can lead to the appearance of skin sagging or ‘jowls.’
Skin Quality: Changes over time with aging and sun exposure, leading to thinner skin, uneven texture, fine crinkling, or pulling in the front of the neck when turning the head.
Bumpy Skin Texture: Can appear like goose bumps (or ‘chicken skin’) along with brown spots, patches, or permanent redness from sun damage.
Vertical Neck Bands (called Platysmal Bands): Are visible strands of muscle along the front and sides of the neck that can look like strings or finger-like projections pulling down or popping out under the jawline. These neck lines can also sometimes be known as ‘tech neck.’
Fullness Under the Chin (called a double chin): Can be caused by fat deposits under the skin or muscle. This can also occur because of loose skin, loose muscle bands, and even enlarged salivary glands.
Loss of Jawline Definition or Low Cervicomental Angle: Refers to the angle created between the chin and the neck when viewed from the side profile. People often notice that their neck angle seems to become less acute and more obtuse when they see a side-angle photograph. While all the same factors contribute, this can also occur because of genetics and the position of the hyoid bone at the top of the neck falling lower under the tongue and palate.
Horizontal Creases or ‘Necklace Lines’: Run across the neck and are usually present from childhood but get deeper as the skin loses thickness and elasticity.
Dark Skin Discoloration or Red Patches: Are more common on the sides of the neck where UV rays hit. There may often be a lighter patch under the chin where the skin is more protected from the sun.
What causes common signs of an aging neck?
There are various factors that can contribute to the most common signs of an aging neck such as neck wrinkles and sagging skin. These include genetics (anatomy and heredity), intrinsic aging, UV radiation, and lifestyle factors (such as smoking, diet, and exercise), which can lead to neck skin and soft tissue aging. Hormonal shifts and illnesses (or the treatment of illness like radiation for cancer) can impact or dramatically accelerate these changes.
How do I know which neck treatment is right for my specific concern?
As you can see from my lengthy answer to all the factors involved in the appearance of neck skin, this is more complicated than most people realize! Smoothing and firming the jawline and neck is highly individualized because one or more factors are usually contributing to your concern. What worked for your friend, coworker, or relative might not work for you. Even the same laser, device, or injectable can be delivered in infinite ways.
It is essential to have a consultation with a board-certified dermatologist who specializes in aesthetic treatments and is an expert at combination therapy using lasers, deep tightening devices, injectables, and threads. The simple exercise of looking at your photos from all angles with an expert eye usually results in an “AH HA!” moment. Looking at before and after photos, especially those over the course of years, can help you feel good about the proposed treatment plan and expected results.
What UnionDerm treatments do you recommend for:
Neck Laxity and Jowls
The best treatment approach really depends on each person’s anatomy and skin quality. This usually involves some combination of skin tightening and injectables. Radiofrequency and ultrasound energy treatments such as Sofwave, Ultherapy, and Thermage can be used to cause deep tissue contraction and skin thickening by stimulating collagen and elastin production and restoring a healthier skin matrix. One thing that people don’t realize is that diluted injectable fillers (combining extra saline fluid to spread out fillers like Radiesse) can be used like watercolor paint—not to fill or puff—but just to create a gentle layer to smooth and thicken the skin. The product layer obscures stringy neck bands and smooth neck crinkles but also stimulates new healthy collagen and elastin that lasts years! The other thing that hyperdilute filler does is prime the skin to respond much more dramatically to nonsurgical skin tightening devices in combination such that the tightening is exponentially better when 2-3 more subtle treatments are combined over the course of months to years. I would much rather see people benefit from effective, smart, and safe combinations over time instead of jumping into more intense procedures with recovery and downtime.
Muscle Bands, Necklace Lines, and Fullness Under the Chin
Other specific concerns can be addressed directly. Microbotox droplet injections can also be used to lift the jowls at the jawline if they are pulling down, smooth muscle bands, and smooth out skin texture where it wrinkles. Soft hydrating fillers can be injected along necklace lines and combined with lasers for skin texture. Muscle stimulation combined with radiofrequency, such as EMFACE treatments, can simultaneously tighten skin, build volume, shrink fat under the skin, and even raise the hyoid bone position to sharpen the neck angle under the chin. Another modality is temporary PDO threads. These temporary sutures can be more dramatic to contour and provide some lift; however, these can also be as thin and soft as little hairs and used in a mesh to smooth skin. They dissolve over 4-6 months as collagen production takes place in the areas where they are placed. Finally, lasers and RF microneedling can assist in smoothing skin and tone. If there is a pocket of fat under the chin, it can be reduced without surgery in combination with other tightening treatments for a more dramatic improvement.
Who can benefit most from non-surgical neck treatment options?
I think everyone can benefit from nonsurgical neck treatment options, especially if they desire modest improvement at first, with gradual and more dramatic results over time. Many of my patients are surgical neck lift candidates, and I encourage them to consider all of their options before moving forward with treatment.
Considering non-surgical procedures before surgical ones makes sense for most people since they can assess how they might look with more subtle changes and potentially minimize the need for extensive surgical intervention later on. There is also often a lower risk of complications with non-invasive and minimal downtime options.
How long do results from aging neck treatments typically last?
Following treatment, the improvements in the appearance of the neck are permanent but gradual. We are aging in a dynamic process such that most results require some smaller-scale treatment every 1-2 years to maintain. Many of my patients even improve and enhance their results over time so that their skin appears tighter and firmer, even over many years.
Schedule a Consultation
If you are unsatisfied with the appearance of your aging neck and have not seen the results you desire with the best neck firming creams or other over-the-counter solutions, schedule a consultation with Dr. MacGregor at UnionDerm today. During your consultation, you will have the opportunity to thoroughly discuss your unique aesthetic goals and ask any questions you may have regarding your treatment options for an aging neck.