The aging neck is a common complaint of many women – and men – when they see their cosmetic dermatologist or cosmetic surgeon. Often times, a dermatologist will hear “It’s like my face is melting and my neck is falling!” There could be many different reasons for an aged neck – ranging from genetics to excessive sun exposure, skin thinness, and poor inherent neck anatomy – but when it comes to this vulnerable part of the body, we’re working with a weaker baseline. The skin on our necks is thinner than our face and it’s not anchored to underlying muscle or bone, making it more susceptible to extrinsic factors of aging and gravity.
Skin changes within the delicate tissues of the neck are often the most prevalent as we age, and the results may manifest as a multitude of things: spots, pigmentation, neck lines or wrinkles, skin laxity, crepey-ness, or platysmal bands (vertical lines at the borders of the platysma muscles). The aging neck can also be exacerbated by “tech neck” – the head down posture we readily assume when using a smartphone – making matters a lot worse. But the news isn’t all that bad as it’s officially fall and its turtleneck weather! Jokes aside, there is a plethora of neck rejuvenation and contouring procedures with varying techniques that address the clinical consequences of aging.
The anatomy and physiology of the neck
First off, the skin of the neck is very thin, especially the dermis. The thickness of the neck skin is comparable to, but thicker, than that of our eyelids, which measures approximately 0.5 to 0.66 mm in thickness.[1] There are also fewer dermal appendages or adnexal structures such as sebaceous glands, pores, sweat glands, or hair follicles present in the skin of the neck. It’s naturally oil-free, unlike our face, which is protected and lubricated by sebum.
In order to understand how the neck ages, it is important to review the role of the platysma muscle. It’s a long quadrangular muscle that is spread subcutaneously like a sheet from the mandible (jawline) to superior parts of the pectoralis major and deltoid muscles, and intertwined with nerves and connective tissue.[2] Over time, this muscle loses tone and is pulled laterally (to the sides), resulting in a splaying of fibers.[3] When this happens, vertical bands start to appear and this may contribute to a “turkey neck” appearance under the chin area. These bands can also protrude with contraction of the neck over time.
Gravity can also play a significant role in the physiologic changes observed in the aging neck, in addition to intrinsic aging and photo aging. The neck is primarily comprised of connective tissue, known as fascia, and there is no deeper structural support, thus making it particularly susceptible to gravity. This constant pull can further aggravate an aged appearance. However, individuals with thick skin and a strong jawline and chin projection are more resistant, overall, to gravity, than those with heavy, short necks, and poor mandibular (jawline) support.[4]
Neck Rejuvenating Tips, Procedures and or Treatments
The anatomy and physiology of the neck is unequivocally complex. It’s not only important to understand the anatomic and physiologic processes involved, but how to correctly identify what aspect of the neck anatomy is contributing to the perceived concern. One must seek out a trusted specialist, such as a board certified dermatologist, to design an appropriate treatment plan.
Day-to-day tips:
Aside from your face, always wear sunscreen with an SPF of at least 30 on your neck and chest.
Use a mild retinoid product (our Retinol + Bakuchiol Power Serum 2.5x works well) in conjunction with a neck cream, such as our SMD Neck Restore Neck creams are often thick and luxurious and pack a punch in terms of ingredients and formulation design. Always remember to use upward strokes when applying product.
Refrain from looking down at your phone. This repetitive movement can worsen neck lines.
To improve skin quality & alleviate wrinkles:
- Hydrafacial – a highly customizable hydradermabrasion treatment works wonders to reveal brighter and more rejuvenated skin. It exfoliates and vacuums pores while simultaneously infusing active ingredients into the skin.
- Droplet Botox – a technique that injects small doses of Botox throughout the neck to smooth out texture.
- Belotero (filler) – a Hyaluronic Acid based filler that helps reduce the appearance of lines and folds in the skin.
- Micro-dilute Radiesse (filler) – a calcium based filler used to correct deeper (more severe) lines and folds and works to uniformly thicken the dermis. It also stimulates the body’s own collagen production over time.
- Microneedling (with PRP) – a minimally invasive collagen-stimulating treatment to improve the appearance of static fine lines and for general skin rejuvenation.
- Microneedling with Radiofrequency – a minimally invasive collagen-stimulating treatment to improve the appearance of static fine lines and for general skin rejuvenation. The addition of radiofrequency energy to procedure helps to further stimulate the body’s natural collagen and healing processes.
- IPL or Intense Pulsed Light – a type of light therapy, also known as a photofacial used to treat brown and red discoloration, or Poikiloderma of the neck, which is caused by chronic sun exposure over the years.
- Ultherapy – a non-invasive lifting and tightening treatment that uses ultrasound energy to encourage the skin’s natural healing process and stimulate collagen production.
- Radio Frequency – a widely used technique in dermatology for non-ablative skin rejuvenation via a thermal effect.
- Fraxel Laser – a non-ablative laser that targets hyperpigmentation or sun damage, wrinkles, and acne scarring.
- Active FX C02 Laser – an ablative, fractional laser for resurfacing of the neck and or face; improves the appearance of moderate to severe wrinkles.
Help reduce sagging or “turkey” neck (platysmal bands):
- Botox for platysmal bands – as a thickening and protrusion of the platysma muscle is common, Botox can soften and relax these cords, which are, after all, contracting muscles.
- Kybella – a Deoxycholic Acid injectable that dissolves submental fat (under the chin).
- Coolsculpting for submental fat (under the chin) – a non-invasive fat reduction treatment that freezes and breaks down fat cells.
- Lower Rhytidectomy, also known as a neck lift – an invasive procedure that targets the platysma muscle and will smooth, tighten, and tone the skin.
- Neck liposuction for submental fat (under the chin) – an invasive procedure that will create new collagen “tunnels,” which help contour the neck.
Written by Maya
Reviewed by Ashley Smith, MD
[1]Perez, Maritza. “An Anatomic Approach to the Rejuvenation of the Neck” Dermatologic Clinics. Volume 19, Issue 2. April 2001. (https://www.sciencedirect.com/science/article/abs/pii/S073386350570276X). Accessed 28 Oct, 2020.
[2] Agur, Anne & Lee, Ming. (1999). Grant’s Atlas of Anatomy. (10th ed., p 640). Hagerstown, MD: Lippincott Williams & Wilkins.
[3] Perkinds, Stephen W.; Shadfar, Scott. “Anatomy and Physiology of the Aging Neck.” Facial Plastic Surgery Clinics of North America. Volume 22, Issue 2. May 2014. Accessed 28 Oct, 2020.
[4] Perkinds, Stephen W.; Shadfar, Scott. “Anatomy and Physiology of the Aging Neck.” Facial Plastic Surgery Clinics of North America. Volume 22, Issue 2. May 2014. Accessed 28 Oct, 2020.