Synergistic Approaches to Neck Rejuvenation and Lifting

November 2015 | Volume 14 | Issue 11 | Original Article | 1215 | Copyright © November 2015

Allison P. Weinkle BS,a Bryan Sofen MD,b and Jason Emer MDc

aUniversity of California, San Diego, La Jolla, CA
bRush University Medical Center, Chicago, IL
cThe Roxbury Institute, Beverly Hills, CA

There is an increasing trend shifting the aesthetic focus downward from the face with a significant number of new treatments aimed at the aging neck and below. Clinical characteristics of neck youth include clear skin texture and tone without laxity or fat, in addition to a well-defined cervicomental angle and distinct mandibular border. Similarly to treating facial aging, the neck requires a comprehensive assessment of all factors involved in the aging process – loss of volume, increased skin laxity, worsening texture and clarity, and crepe skin/wrinkling – as each requires a combination approach for improvement. It is essential to address each above factors for more than minimal improvement. A multitude of options including neuromodulators, energy based devices, surgery, and injectable agents for fat reduction are available in our armamentarium and understanding these options solo, or ideally in combination, is essential for best practice and optimal results. Herein, we describe synergic approaches to the treatment of neck aging.

J Drugs Dermatol. 2015;14(11):1215-1228.


The aging process is dynamic and contains a significant number of anatomical and physiological changes that occur throughout a person’s lifetime affecting their appearance. As we know, skin changes common with aging can have a major and direct psychological impact, affecting all aspects of a person’s life. In the past, the cosmetic focus has been on the face with the majority of studies and treatments dedicated to improvements of this area alone. Neglect of “off-face” improvements led to a population of aging individuals with necks, chests, and hands indicative of their true age despite young looking faces. This is no longer the standard as trends shift to more natural and conservative anti-aging enhancement. Further, solo facial treatments are rare, as there is a significant increase in demand for treatments below the face starting at younger ages as prevention for more global improvements rather than ones that are static and lacking dimension. Unfortunately, satisfactory treatments for neck rejuvenation remain only mildly sensational in solo; whereas, combination procedures in succession lead to more dramatic improvements. Very few studies have truly examined combinations or synergistic approaches, when in reality this is how aesthetic medicine practices daily. Thus, the majority of claims from case reports and individual experiences and trials are a true reflection of the type of improvements that can be obtained. Aesthetic advances require astute innovative physicians undergoing trials and tribulations, despite lack of medical evidence, to promote and stimulate medical advances – this is the current state of neck rejuvenation procedures.
In our present era, patients are increasingly seeking “age prophylaxis,” a term indicating the desire to prevent or delay the need for surgical intervention. With proper use of both surgical and nonsurgical or noninvasive therapeutic modalities early in the aging process, one can dramatically delay the need for surgical intervention or prevent it all together. Sun protection and smoke avoidance are standard precautions, but beyond these basic measures, technological advancements targeting specific aspects of neck aging – loss of volume, increased skin laxity, worsening texture and clarity, and crepe skin/wrinkling – is required in a combination/successive approach for dramatic improvements. Solo therapies have minimal improvements long-term or only address a single focus and take away from the global improvements we are currently seeking as specialized aesthetic physicians trying to delay the inevitable process of aging.
Current treatment options include radiofrequency and ultrasound therapy for skin tightening/laxity, and numerous liposuction techniques/devices and injectable cytolytic drugs for the reduction of submental fat. Fractional lasers and radiofrequency devices, chemical peels, microneedling, intense pulsed light (IPL), injectable fillers, pigment and vascular lasers, as well as liquid nitrogen therapy address superficial dyschromias and rhytides/crepe skin; whereas, neuromodulators can improve platysmal banding. These treatment options are best used in combination to replace or enhance more invasive surgical approaches.
A thorough understanding of neck anatomy and skin physiology in regards to the process of aging in this area is fundamental to strategically apply appropriate treatment