We talk a lot about the face. But ask any expert where aging actually shows up first, and they’ll point south, right to the neck. “The neck is where you’re going to see the first signs of aging in terms of skin laxity,” says New York plastic surgeon Michael Kane, MD. “That skin is the thinnest and has the least sebaceous glands.”
Maybe that’s why the menu for neck rejuvenation is expanding well beyond wrinkle relaxers and surgery. “We’re seeing a surge in interest for neck treatments across all age groups,” says Pittsburgh plastic surgeon Leo McCafferty, MD. “Whether patients are concerned about skin texture, banding or loose skin, they are more aware that their neck can give away their age, and they want to do something about it.”
Skin-Deep Fixes
Neck creams are a great starting point, but for a more effective treatment plan, there are new options worth considering. “Neck creams can moisturize, but we haven’t found any that significantly tighten skin,” says Dr. McCafferty. “One of the most obvious and helpful things is using sunscreen, which will help prevent signs of aging from appearing or worsening.”
Now, a wave of high-tech, nonsurgical treatments is making it easier to address the neck early on. A high-tech facial like Hydrafacial can give an instant refresh. “It’s a great noninvasive option to address early signs of aging and skin laxity,” says San Diego dermatologist Tess Mauricio, MD. Ask for the new HydraFillic with Pep9 Booster add-on, which combines peptides, hyaluronic acid and vitamin B5 to help support firmness and hydration.
Another skin-boosting treatment gaining traction involves needles, but not in the way one might expect. SKINVIVE by Juvéderm, a microdroplet injectable originally approved for the cheeks, is now FDA-approved for the neck. “It’s more of a superficial injection that improves skin texture and hydration,” explains Montclair, NJ dermatologist Jeanine Downie, MD. “Neck aging is a major concern for my patients, from their late 20s into their 90s. When signs of crepiness or dryness set in, SKINVIVE is a great option.”
For a needle-free treatment, Enerjet uses a high-pressure jet to deliver hyaluronic acid, biostimulators and other actives deep into the skin without piercing it. “It helps thicken the dermis, smooth texture, plump and hydrate, without the discomfort or downtime of traditional methods,” says Beverly Hills, CA dermatologist Ava Shamban, MD.
Tox + Tightening
Named after the famously long-necked Egyptian queen, the Nefertiti lift has become a go-to technique for softening neck bands and subtly lifting the lower face. By injecting neurotoxin into the platysma, the thin sheet of muscle that runs from jaw to collarbone, doctors can reduce downward pull and enhance the contour of the jawline. (Botox Cosmetic is currently the only neurotoxin that is FDA-approved for use in the neck.) “It can create a more sculpted contour, smooth neck bands and help with early signs of laxity,” explains Dr. Mauricio.
A newer variation, sometimes called “gonial angle Botox,” zeroes in on the area where the lower jaw meets the neck. “It’s similar to the Nefertiti lift in technique, but the aim is for a more defined, slimmer and sculpted ‘snatched’ jawline rather than overall lifting,” she adds.
Results usually appear within two weeks and can last three to six months. “There are major blood vessels in the neck to avoid so precised placement and dosage is critical,” Dr. Mauricio notes. “And for those with more fullness or advanced laxity, injectables may need to be combined with other modalities to get the best result.”
Power Pairings
When it comes to restoring the appearance of an aging neck, one treatment rarely does it all. Biostimulatory fillers like Radiesse and Sculptra can give the skin a collagen-building boost, but subtlety is key. “There’s some decent data on these fillers’ ability to improve the neck, but the skin is thin, and it’s not as forgiving,” says Dr. Kane. “I tend to go very conservative there.”
Combination therapies are where many physicians see the most potential. A go-to pairing Dr. McCafferty utilizes is radio-frequency microneedling with platelet-rich plasma (PRP) across the neck and chest. “It’s one of the best nonsurgical approaches we’ve seen.”
New York plastic surgeon Andrew Peredo, MD likes to combine Sculptra injections with ultrasound-based treatments like Ultherapy or Sofwave. But for those seeking more lift, he recommends going a step further. “A scarless necklift, combined with MyEllevate suture suspension and FaceTite skin tightening, is a great in-between solution for tightening sagging on the lower face.”
“You almost always have to combine modalities to get a good result on the neck,” Dr. Kane adds. “Maybe a little filler, maybe energy, maybe neurotoxin—especially for platysmal bands. It’s rare that just one treatment can improve the whole neck.”
Scalpel Solutions
At a certain point, devices and injectables can only go so far. “If somebody is a candidate for surgery, the 50s is typically a good time to consider that option,” says Dr. McCafferty. “The skin tone has more integrity than it would if you waited until your 60s and beyond, and the results tend to last longer.”
But the modern necklift isn’t what it used to be. “A common mistake is thinking it’s all about fat removal,” says Chicago facial plastic surgeon Anil Shah, MD. “What really matters are the deeper structures within the neck. You have to ask your surgeon, ‘Can you lift the muscle? Can you elevate the hyoid bone?’ That’s the magic behind restoring a youthful neck.”
According to Dr. Shah, achieving a natural-looking outcome often depends on subtle, customized adjustments. “Everyone’s anatomy is different,” he explains. “As such, the best results often come from micro-touches, like lifting in the proper plane, adding fat where needed, and treating the neck as a continuation of the face.”
That’s also why patients who are hoping to “just do the neck” are sometimes surprised to hear their plastic surgeon recommend a facelift instead. “The skin doesn’t separate at the jawline,” Dr. McCafferty says. “The face and neck are part of the same sheet. To lift one, you often need to address the other.” Because after all the serums, sculpting and smoothing, sometimes the most elegant solution is also the most direct.
Before-and-After Photos
Houston dermatologist Scott Smith, MD used skin-tightening treatments and Botox Cosmetic to reduce this 68-year-old patient’s neck bands.
Portsmouth, NH plastic surgeon Anthony Wilson, MD performed a deep-plane facelift and necklift on this 62-year-old patient to address lower neck laxity.
Westborough, MA facial plastic surgeon Min Ahn, MD performed a deep-plane facelift and necklift, combined with Fraxel and Morpheus8 on this 51-year-old patient.
This 62-year-old patient had a lower facelift and necklift with Glen Burnie, MD plastic surgeon Adam Summers, MD for a younger profile and tighter neck.
