My Saggy Neck Drives Me Bonkers. What Can I Do?


A lot of body parts begin the long migration south after a certain age, but it’s the downward march of the neck that’s causing me the most dismay. It’s not just me, of course. Even the least vain of us can be allowed a tinge of regret when a jawline that could once cut stone begins to look like a stretched-out sweater. Clothing and smart underwear choices can minimize sagging in most other body parts, but there’s no contraption that can hike up a double chin or turkey neck. Nora Ephron titled a whole book after this dilemma, I Feel Bad About My Neck, writing, “Our faces are lies and our necks are the truth.” That particular truth stings me more than it should, despite the fact that I’m quite content with everything else that aging brings.

The anatomy of the neck, jaw and chin is prone to a lot of changes as we age. “Structural changes such as jowling and sagging occur over time as collagen and elastin levels decrease, and with the loss of these crucial skin proteins, there’s a corresponding deterioration in skin quality,” says Blair Murphy-Rose, MD, a New York-based board-certified cosmetic and medical dermatologist at the Laser & Skin Surgery Center of New York. “As we age, bony resorption and downward movement of fatty tissues along and above the jawline can lead to a loss of the more youthful-appearing, well-defined jawline.”

That’s why noninvasive cosmetic procedures that target the chin, jawline and neck are so popular these days. Short of a full-blown neck-lift, which is a major surgery, there’s not much more that can be done to improve the appearance of that area when it begins its descent.

Of course, as Murphy-Rose explains, the causes of a sagging chin and neck are multifactorial and, as a result, require a multi-pronged approach. It’s not possible for one modality to fix the multiple changes happening all at once.

There are several noninvasive procedures on the market – including energy-based devices to boost collagen and elastin, injectables to melt subcutaneous fat, lipo to suction it out, and microneedling to stimulate collagen – that promise to do that and more. Many of them show mild to moderate results, but only on specific causes of submental fullness, aka a double chin. The key is to find a dermatologist who can correctly identify – and has the devices to treat – the main cause for you.

Even if they do have those devices, patients often find that the results are underwhelming. “Though many of these procedures claim to tighten, lift, and decrease fat, that is a lot to ask from a non-surgical technology,” says Manhattan double-board certified oculoplastic surgeon, Dr. Robert Schwarcz. In other words, expecting them to do the job of a neck lift is a sure path to disappointment.

Below, we review the pros and cons of some of the most popular treatments. Prices for each treatment vary greatly depending on the location, provider, and how many sessions each patient needs to see results.

1. Ultrasound-based therapies, such as Ulthera and Sofwave

This technology harnesses ultrasound waves to target tissues under the surface of the skin, prompting them to produce more collagen. “For both treatment and prevention of skin laxity, Sofwave is my favorite tool. It is excellent for tightening and lifting as well as building collagen in the skin to restore the structural support of younger skin,” says Dr. Murphy-Rose.

Ulthera, says Schwarcz, targets the deeper tissues, unlike Sofwave. But, he adds, “I have also seen in a number of cases where patients experienced facial fat loss, and I had to perform fat grafting procedures to correct fat loss to the face.” I have had two Ulthera treatments a few years apart; it is quite painful and hard to tolerate. Even after a topical anesthetic, my second (more powerful) session was so painful that I was immeasurably grateful when the machine stopped working mid-session. The results didn’t wow me either: I felt a very mild tightening of the laxity around my chin, but this wasn’t long-lived.

“Sofwave is in the epidermis, which is less painful, and less likely to metabolize fat,” says Schwarcz. He’s had some patients who were impressed with the results while others were underwhelmed. Generally speaking, if a mild tightening effect is what you’re after and the laxity isn’t too pronounced, it might be worth discussing this option with your provider.

2. Radiofrequency Microneedling, such as Morpheus 8 and Profound RF

RF Microneedling has become a popular tool for skin rejuvenation. It’s performed by creating controlled micro-injuries in the surface of the skin using fine needles that deliver radiofrequency waves to the underlying layers. That energy stimulates collagen and a tightening effect. “Radiofrequency is an effective procure for tightening and minimal lifting,” says Schwarcz, who offers Morpheus 8.

Ben Talei, MD, a board-certified plastic surgeon based in Beverly Hills, California, uses both Profound RF and Morpheus 8 in his office. In a YouTube video, he suggests one treatment of Profound RF, which lasts four to five years. But, he’s careful to note in the video, these treatments aren’t replacements for face lifts, and instead improve skin quality and offer tightening.

3. Kybella

A Kybella treatment involves injecting deoxycholic acid, a molecule that breaks down fat, into the area beneath the chin. Over time, the fat cells are destroyed and do not come back, though multiple treatments are required to reach the desired result.

Murphy-Rose says Kybella works when deployed on the right patient. “For submental fullness due to fat tissue, Kybella is a great injectable option,” she says. Patients who have fat in deeper areas of the chin anatomy would not be good candidates.

Schwarcz does believe Kybella works, but it’s painful, causes considerable swelling and has downtime, which he thinks is not ideal for a less-invasive procedure. For patients willing to go a little further, he recommends neck liposuction, which delivers Kybella-like results and more, and only needs to be performed once with a similar downtime.

4. Injectables, such as Fillers and Botox

Fillers and Botox are both used strategically to improve the appearance of chin laxity, with each performing very distinct functions.

“Botox temporarily paralyzes the bands, relaxing them and letting them set back and be less obvious,” says Schwarcz. He considers this to be a reliable procedure that can be repeated without any detrimental effects. “The downside is it wears off in three months and can become costly over time, but it should definitely be considered,” he says.

Aging not only affects our skin and muscles, but also our bone structure. The scaffolding that provides a solid foundation for the muscles to stretch taut over slowly recedes with time, leading to droopiness. This is particularly apparent around the jawline. To combat that, “ I use injectable fillers to add volume, recreating a youthful scaffolding to redefine the jawline and improve the appearance of tautness,” says Murphy-Rose. Typically, fillers that have more heft, and are denser, such as Juvéderm Volux Xc, are used for this area.

Whether you settle on one, more or none of these procedures, it’s worth keeping in mind these general rules, which is not to expect a) for your neck to go back to its younger self without a surgical neck lift and b) non-surgical treatments will not give you a surgical result. By no means am I advocating for surgery, but setting realistic expectations is the key to being happy at the end of this journey. Chin up!



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