Kay Durairaj, MD, FACS, is a Head & Neck Surgeon in private practice in Pasadena, California, out of Huntington Memorial Hospital. She is a clinical professor at Olive View/ UCLA Medical Center, and enjoys a busy cosmetic practice. She can be reached for questions at http://nosedoc.net/

Rejuvenation of the Aging Neck

The long, slender neck is a symbol of youth, beauty and elegance. When the aging process hits the neck and lower face, it creeps silently upon us, until suddenly, one day, we notice significant neck sagging, jowling and textural skin changes. Luckily, we have new advances in the treatment of the aging neck that can add a nice, step-wise approach to neck rejuvenation for patients of all ages.

Beginning in their thirties, patients experience the slow breakdown of collagen and elastin fibers of the skin that is responsible for the gradual sagging and loss of tone in the neck. This leads to the gravitational fall of important suspensory ligaments that hold fat in its proper location. With collagen breakdown and gravity working against youth, it is just a matter of time before the first changes of jowling and flabbiness begin to appear in the lower face and neck.

When textural neck changes occur, it is best to begin an anti-aging regimen that encourages the stimulation of collagen production with a non-irritating retin-A based product. These vitamin A derivatives- including gentle retinol, stronger retinoic acid and Retin-A itself, are the only proven cosmeceutical ingredients that have been studied and proven to stimulate collagen production and thus prevent and reverse fine lines, wrinkles and textural changes of the skin. The potency of Retin-A, however, also makes it quite irritating to the sun-sensitive neck. One product that has made a big improvement in my practice for treatment of aging neck skin is Nectifirm, made by Revision Skin Care. While I sell this line in my office, I have no financial benefit from advocating their products. With that said, many of my patients have noticed beautiful and significant improvements in their neck crepiness and texture while using it. Its active ingredients include lipopeptide, tripeptide, ceramides, glucosamine, bamboo and botanical extracts, as well as anti-oxidants, and collagen stimulators. With twice-a-day use, patients notice a terrific improvement in their skin appearance and degree of tightening within just two months. A skin care regimen that protects the skin from sun damage is also essential, to protect from the harsh UV light that beats down on the neck and decollete, causing poikiloderma, sun damage and a leathery appearance.

Platysmal bands which cause tenting of the neck skin, and neck folds can be treated with Botox. The injection of the neurotoxin into the platysmal bands and abutting the submandibular border helps to release the heavy tethering of the lower face and jowls by the strong platysma. This gives a nice lift, and in combination with Botox to the Depressor Angular Oris muscles, relaxes the muscles which create the downturns at the corners of the mouth and lifts the appearance of the mouth grimace. Neurotoxins around the Orbicularis Oris itself and within the lipstick lines help to soften the mouth, and reduces lines that create chronic vertical lip creases.

Once stretching of the skin has created some jowling and sagging, patients come in wanting tightening and a lift. However, many patients want a non-surgical intervention. In this society, solutions with no down time are in high demand. For these patients typically those in their 40’s to 60’s, Ultherapy is an excellent option. Using the power of ultrasound energy, the Ulthera system precisely directs ultrasound waves below the level of the skin, to affect tightening of the underlying dermis and platysma muscle layers. This can improve the appearance of the face from the zygoma to down below the mandible for early nasolabial heaviness and jowling; and also the appearance of the submental area, where there can be sagging; and the lower neck, where thinning, sagging tissues create laxity that improves with excellent tightening, often with one to two treatments. Patients like the option for a noninvasive treatment, with no down time, only mild-to-moderate procedural pain and gradual improvement. While full changes may take 6 months to see, an immediate tightening is commonly felt and noticed.

Slightly more invasive, and able to address the issues of fatty deposits in the neck, as well as the neck “wattle”, double chin or turkey neck, is the option of cervical liposuction. Liposuction of the lower face and neck has been around for decades. It has been an excellent, relatively minimally invasive way to give patients with fatty necks improvement. Fat deposits can be vacuum aspirated, causing a manual debulking of fat, and the liposuction cannula, as it scrapes the dermis, causes contracture and tightening of the dermis as healing occurs, thus tightening lax neck and cervicofacial tissue - often to the degree we  can see in surgical results. Newer forms of laser liposuction are also becoming popular, for their faster healing. Laser lipo uses small fiber lasers threaded inside of cannulas, to melt the neck fat and coagulate bleeding during the liposuction procedure, while the act of passing the cannula still etches the dermis and causes the skin to tighten, like conventional lipo. This gives much better ability to perform surface contouring- essentially liposcultpturing

Some patients present with too much skin and fat to realistically have a noninvasive treatment. They are candidates for the gold standard in neck rejuvenation, which is the necklift or combination facelift /neck lift. Using precise plication of the platysma and SMAS muscles gives the underground lift and support required for a natural and lasting lift. The inelastic skin is able to be tightened directly and trimmed. Often, an anterior submental cervical plication is recommended to simultaneously give a corseted tightening of the submental area, and to ensure a nice cervico-mental angle which matches the ideal of 105 degrees. The facelift and necklift in combination give a powerful result with excellent tightening and the precise ability to tailor the skin with directional lift. Regardless of the options you choose, the options for treatment are all safe, reliable and successful. With careful selection and a step-wise approach, the neck can defy gravity and look eternally thin and smooth. For questions, please contact Dr. Kay Durairaj at (626) 316-7033 or www.nosedoc.net.

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