The neck is definitely an area for better or worse, usually worse, that can really display the signs of aging and when undertreated can adversely affect the rejuvenation efforts invested in the face above. Not uncommonly, I see patients in consultation who have invested a great deal of their time and finances to improve their necks only to be offered sub-optimal treatments that leaves minimal to no change at all. Disappointment, frustration, and skepticism to future treatments is the end result, which is unfortunate when there are solid treatments that can make significant, long lasting differences. So I offer three questions to ask and consider before undergoing neck rejuvenation or neck lifting procedures.
1. How old am I?
This is important because treatments centered on the neck are highly dependent on the person’s age, and therein the quality and health of the skin. For example, if someone is in their twenties or thirties and is offered neck liposuction alone to rejuvenate their neck, this may be reasonable. But after years of experience, I would be hard pressed to remember anyone over the age of 45 requiring only liposuction to improve their neck. If you are in this age category and are offered only this as a solution, seek a second opinion. Additionally, for patients over 50, and some younger, if the recommendation is to rejuvenate by a non-surgical treatment only, then expect very modest results at best, and that's OK if you will be satisfied with very modest results and tightening.
2. What layers of my neck are specifically causing my neck laxity and sag?
Taking the time to understand the anatomy of your neck will empower you to consider only those treatments that will lead to real results. The “task” of taking the time to understand is actually quite simple if you consider the neck in basic terms. Simplistically speaking, the neck has three layers: skin, fat, and muscle. When someone reaches 50, typically at least two of the three structures are affected to some degree. So, if two or three structures are affected, then two or all three need to be addressed.
The treatment breakdown: Surgery, lasers, Thermage, Ulthera treatments affect the skin layer, liposuction only the fat layer, and the muscle is tightened with surgery (Botox can help but its effects on muscles are temporary). However, the skin tightening you get with lasers, Thermage, Ulthera and other non-surgical treatments are modest. Most people are thinking when they have these non-surgical treatments performed they will achieve significant tightening (or shrinking) of the skin, much like a wool sweater placed in a dryer, but in reality it's more like denim jeans, seems tighter at first but loosens to its normal state in just a little time and movement. So, the bottom line is this: if two or all three layers of your neck are affected and you choose a treatment option that affects only one layer (e.g., laser, Thermage, Ulthera) over a treatment option, such as a surgical neck lift, that can treat all three layers, you may be disappointed with the end results.
3. Are all neck lifts the same?
No, expertise in neck lifting takes years of experience and skill to master, and the patience and time on part of the surgeon to do it right. Liposuction is rarely used and the muscle tightening techniques can be very sophisticated, more simplistic and "quick" techniques do not last. Most surgeons who provide the best and safest results have undergone six years of formalized training (after 4 years of Medical School) within a recognized head and neck surgery training program at the university level, and are Board Certified by the American Board of Facial Plastic and Reconstructive Surgery and also hold Board Certification by the American Board of Otolaryngology and Head and Neck Surgery. There are only about 1100 surgeons in the United States who hold this distinction.
Timothy R. Miller, M.D.