Regardless of body weight, some people are vexed by a “double chin” or “turkey neck” that doesn’t match with their fit and more youthful body.
The loose neck or “double chin” is a very common concern among our patients. The cumulative effects of aging, sun damage, gravity and loss of elastin result in a neckline that loosens with time. While the neck is certainly not the focal point of our face, it is an area that contributes to the sense of how attractive we are and how old we appear. It’s also an area of our own face that we tend to focus upon when judging our own fitness and attractiveness.
Thankfully, we now have multiple options to lift and tighten the neckline. Let’s look at the options ranging from least invasive to most invasive. While, in general, minimally invasive options tend to be less effective, the neck is an area when non-surgical treatments can create dramatic improvements.
Botox is used to soften platysma bands or “cords” in the neck. By relaxing the platysma muscle that causes the band you can cause this tissue to relax, eliminating the band. The results last three to four months and can be repeated at your convenience. High doses of Botox or improper injection in this area can cause temporary swallowing difficulty but this is related to excessive treatment or injection in the wrong plane of tissue. I have never had a neck band Botox patient describe swallowing difficulty following treatment. Botox has absolutely no downtime but on occasion the injection can result in a small pinpoint bruise. This can be covered up with makeup immediately.
Injectable dermal fillers such as Juvederm, Voluma, Restylane or Perlane can also be used to improve the neck area by augmenting the cheeks and jawline and nasolabial folds. While the results can add to a beautiful neck, fillers alone will not directly lift or tighten the neck area. However, an injectable option that reduced the double chin fat pad, Kybella, has been shown to be highly effective at contouring the neckline.
Kybella is an FDA approved formulation of deoxycholic acid. The product has been used off label for fat removal for years but we did not have a safe, predictable formulation until Kybella was released in 2015. The product works by reducing the number of fat cells in the neck area beneath the chin. This results in swelling for about one week and then a slow slimming and tightening of the tissue beneath the jawline. Most patients will require 2-3 treatment sessions to achieve the results that they’re looking for. Treatment sessions require about 30 minutes of topical numbing (this can be done at home or on the way to your appointment) and about 5 minutes for the actual injection. The injection pain is minimal and most people describe some discomfort following the injection. This is usually described as 3/10 in severity. I’ve had two treatments with Kybella and found the discomfort and swelling to be totally manageable. There is no downtime, per se, with Kybella but a small bruise and swelling beneath the chin are common during the first week.
Ultherapy is an established technology that used microfocused Ultrasound energy to heat the neck and face tissues leading to contraction and collagen growth. The Ultrasound energy totally bypasses the skin resulting in no downtime following treatment. If you’ve ever had a sonogram you can recall that your skin looked totally normal after that study. The difference with Ultherapy is that the ultrasound energy is focused into small areas of tissue that have become lax with time. Multiple tissues layers can be treated to achieve optimal results. Most patients describe moderate discomfort with the treatment that resolves immediately after the treatment is complete. There is no downtime with this treatment. We recommend a small “touch up” treatment 1-2 years after the initial Ultherapy session to maintain results.
Liposuction is a minimally invasive surgical option to contour and tighten the neck. As the name implies, a small cannula is used to suction or sculpture the fat beneath the jaw and neckline. However, one of the more powerful benefits of liposuction is that the tunnels created beneath the skin result in collagen growth and tightening and contraction of the skin itself resulting in not only removal of a small amount of fat but a “shrink wrap” effect of the entire skin envelope beneath the jaw. The procedure is usually performed with intravenous sedation or general anesthesia at an accredited ambulatory surgery center. Downtime is limited to one week. This approach tends to work best for patients in their 20s, 30s and 40s who still maintain adequate elasticity in their skin to allow the skin to shrink and tighten after surgery.
The necklift procedure can create a huge improvement in patients with moderate to severe aging of the neck. The procedure begins with a small amount of liposuction which allows the skin to be elevated quickly and safely. The subplatysmal fat pad is often reduced as well. The platysma muscles, which are responsible for banding or cords in the neck, can also be tightened to eliminate those unattractive cords. The muscles and fascia of the lower face are also repositioned and secured to the very strong tissues behind the ear creating a “sling” the lifts and tightens the entire neck. Downtime is typically one week in duration.
The necklift, by itself, focuses on improvement of the neckline but can be combined with a lower facelift procedure if the jawline and lower face are also an area of concern.