What to do in the neck. 2020 options.

The aging neck is just. so. hard. to. treat.

We have all sorts of nice things for the face- Botox, fillers, fat grafting, peels, products. But for the neck? very little. I have written blogs before about the neck, but thought I should do a refresh on it here.

NONSURGICAL

• Products. Things like RetinA should help skin quality. It isn’t that these do nothing- but it isn’t going to fix most neck issues in those in their late 40s and older.
• Botox. Also called the Nefertiti Lift, this is using Botox injections into the superficial muscle bands (the platysma) to get it all to lie down flat.  PRO: easy, no downtime. CON: doesn’t work great for everyone, need a fair amount usually of Botox, and it goes away.
• Peels. I use a TCA Blue peel. It will help smooth out some of the skin issues. PRO: little downtime or risk. CON: usually a mild change.
• Kybella. This is for when you have poor neck definition, especially under the chin, due to fat. It is an injection done in the office which melts the fat. May require more than one session. PRO: noninvasive. It works. CON: It isn’t no downtime- you tend to swell. It is expensive if you require multiple treatments, You need good skin tone or else it may not retract. Ideal patient? A young person with fat and poor neck definition.
• Coolsculpt. Again, for issues of fat in the neck. It can do the entire jawline more safely than Kybella. PRO: noninvasive. Good for fat. CON: Cost, and relies on skin retraction.
• Ulthera. I likely diverge from some of my colleagues on this one. It is supposed to noninvasively tighten skin using ultrasound. It works for some. My issues with it: many see a small change if any, the results are always temporary, the cost, and my big issue: it permanently removes some of the subcutaneous fat, which I think  hurts the skin quality. Once your skin on your neck looks old, your neck will look old even if the contour is okay. Read my blogs on fat grafting, stem cells, and why I spend so much time getting fat into the face as you age.
• Microneedling. This is something I have not researched well. I would guess this causes little change. My hesitancy with it is not knowing its effect on the subcutaneous fat.

SURGICAL

• Liposuction. Old school, but effective. I usually use ultrasonic liposuction (some use laser) to try to assist with skin tightening. Only good for those with fat and good skin tone.
• Radiofrequency. Mildly invasive, this involves using a wand which tries to tighten the skin from the inside and outside. This is something I have not researched well, though I would worry about issues of the subcutaneous fat loss and future skin aging.
• Nanofat transfer. I do this when I do my fat grafting to the face. Nanofat is where I break up the fat and inject it into the wrinkles in the neck. I don’t want the fat volume. I want the stem cells. As with all things fat grafting, there is a variable result. But I have gotten some amazing results with this, and there is no incision/scar.
• Facelift. This is still the gold standard. Many people will call it a necklift, lower facelift, mini facelift- most of those are just differences in semantics. A true facelift helps the jawline, jowls, and neck. There are differences on how it is exactly done, but usually most involve a two layer repair- the lower layer called the SMAS, and the upper layer which is the skin. As I said, it remains the gold standard. But it is a real surgery, with scarring, risks, and downtime. The PRO: It works, and the results last.

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