Neck Rejuvenation in 2017, what works, what is just hype and is it worth the cost?
Having loose hanging skin or having a bulky neck line can unquestionably give an aged appearance. Excessively full necks may even project being overweight even if the rest of the body is healthy. These are some of the reasons many individuals chose to alter the shape and or volume of their neck to feel more comfortable about themselves. As a result of this trend, the aesthetic industry has tried to tap into this market. In this article I will review a few currently marketed options for people to explore. I often say that for the consumer of aesthetic services it’s like trying to navigate the Wild Wild West to actually find what works. Unfortunately, many Mississippi “Snake Oil” salesmen occupy this space and are more than ready to hype and sell you potions, poultices, and fancy machines and LASERS that promise the fountain of youth but only deliver the spring waters of spoof. The Baby Boomers are aging and are kicking and screaming trying to be healthier than ever and therefore Medi Spas are popping up everywhere, often times staffed by untrained clinicians – so buyer beware.
Non-surgical volume reduction of unwanted fat in the neck.
Non-surgical options include a mesotherapy injection technique of fat dissolving salt solutions such as Kybella, which is now owned by Allergan. They have marketed this quite heavily in magazines and on the airways. Keep in mind that they spent a fortune acquiring this technology and are trying to recoup their costs. I have performed this technique on several patients and although it may reduce some unwanted fat and may create a small amount of skin retraction it requires multiple treatment sessions and the total cost of all these treatments, which yield very modest results, actually costs nearly the same as a clinically proven face/neck lift which gives wonderful results that can last up to ten years. In summary, I am underwhelmed and view this as a very niche market and was a very poor decision on Allergan’s part.
Another non-surgical volume reduction technique is Cool Sculpting (Cryolipolysis), where fat cells are frozen with a contract device that leads to cell death. This also requires several sessions and not at an insignificant price point. There is no mechanism for skin retraction in conjunction with the fat reduction. Also, it is hard to isolate cells and any area that requires contouring often has areas of excess combined with some areas of under-contouring which cannot be addressed therefore the sculpting portion of the name is a bit misleading. I think this devise is best used on the torso and the neck should be avoided.
In my opinion the best non-surgical technique to correct unwanted fat excess in the neck (with overlying skin that has a reasonable chance of re-draping or retracting) is the SAFE liposuction technique. Three small stabs, one in the chin crease, one in the neck line, and one on each earlobe cheek junction can provide triangulation with the cannulas to first separate the fat from the surrounding fibrous tissue then selectively remove the excess fat and redistribute areas of excess fat to areas of under-contouring to truly sculpt the neck. Of course judgement is required because if too much fat is removed one can expose platysma bands in the neck giving an aged appearance. Unquestionably this technique leads to the best chance of re-draping of the skin to give a better contour compared to the above mentioned options. You will not see this option advertised in magazines or on television because industry can’t make any money on selling the liposuction equipment they need to hype injectables. What you pay for in liposuction is surgical experience and aesthetic judgement to give a great result.
Non-surgical skin tightening of the neck.
The technology of radiofrequency has been tried in many fields of medicine and surgery. It has found niches in vascular surgery for varicose veins and in some degree for skin/mucosal tightening for some vaginal rejuvenation and body as a whole. The main problem I have with this option is the technology is very expensive as with LASER machines and as such, the cost is passed down to the consumer. Results are modest at best. I have chosen to sit this one out but if you wish to explore this option I would chose a board certified plastic surgeon as opposed to a dermatologist or some other practitioner. The reason for this statement is under-qualified providers often hide behind new technologies that are marketed to get you in the door and if they can only offer one treatment option then everyone is a candidate for this treatment. Alternatively, a full service plastic surgeon who may have non-invasive equipment would not offer it to you if you were actually a surgical candidate so as not to waste your money and time.
For me the best non-surgical treatment for skin tightening is still liposuction. Even if there is little to no fat excess in the neck I would still employ SAFE liposuction techniques without aspirating any fat. The process of passing cannulas underneath the surface of the skin induces collagen production and skin tightening which is quite predictable in the right candidates.
Surgical correction of the aging neck
In general as a plastic surgeon who offers a wide ranges of options of facial rejuvenation both surgically and non- surgically, I can say with great authority and conviction that the best use of your money and time investment is with a clinically proven face/neck lift procedure. As I have mentioned before there are many varieties of surgical techniques employed by surgeons to provide an aesthetically pleasing rejuvenation. The most important factor above all else is the quality and judgment of the surgeon’s aesthetic eye. Unlike gallbladder extraction or knee replacement surgery, there is no one “best practice” technique. Because plastic surgeons live in a world of both science and artistry, and just like Van Goh and Matisse employed different techniques and subject matter, both created beauty. Since I am not a “cookie-cutter” surgeon, each patient I operate on gets a slightly different process based on anatomy and the state of aging of the individual. In general, I almost always open the anterior neck through a chin crease and sculpt the subcutaneous fat layer. Next I identify the platysma muscle and unify the two paired muscles together in the midline to the cervico-mental angle followed by division of the muscle superiorly away from the lower segment to get muscle retraction for a crisp neck line. Unlike some of my colleagues in South America and in Europe I tend not to perform much sub-platysma work such as defatting or removal of submandibular glands to de-bulk the neck. I personally find it can lead to the appearance of an overdone neck. My goal is to give a refreshed natural appearance not an over-operated stark look. In the lower face just as in liposculpturing there is the process of de-bulking areas of excess and the addition of lost volume in the central cheek area with fat grafting. Lifting the face without volume restitution leads to a much lesser result. In general the central face is volumized and the lateral face is lifted. Part of the lateral lifting is utilizing a deeper fascia layer under the skin to lift the lateral platysma muscle superiorly and laterally to yield a crisp mandibular border affect. These techniques combined with good aesthetic judgement can lead to excellent long lasting results that make the person feel proportionate to how young they feel on the inside.
If you would like a three dimensional global prospective for the aging face with both non-surgical and surgical options please visit my website at www.thelucascenter.com or call 865-218-6210.
Jay H. Lucas, MD
Board Certified Plastic Surgeon