Dr. Barbour’s Answer: As with the face itself, there are both genetic and lifestyle choice components to how the neck ages and how rapidly it ages. There are three changes in the neck that seem to bother people the most. Let’s take them one-by-one:
1. The most common complaint about the neck is the quality of the skin. Usually, by the time people are upset about it, it has lost a lot of its elasticity and is looking crepey, especially at the base of the throat. Another common problem is the “necklace lines” that run horizontally. You may be relieved to know that contrary to what may seem apparent when we pull up on the neck skin in the bathroom mirror, the best way to treat this problem is not surgery, but to actually improve the quality of the skin. First of all, and forgive me for harping, sun damage (need we even mention smoking anymore?) is the most common cause of aging of the skin, so remember to protect your neck the way we know you so carefully protect your face. It’s never too late to start! P.S. Don’t forget those nasty UVA rays that come in through the car windows.
For the damage that’s already there, retinoids (some incarnation of Retin-A-type products) are invaluable, although they need to be used more sparingly on the neck than on the face. High quality topicals with antioxidants are also helpful. Again – never too late to start. A good aesthetician will have a variety of peels from which to choose and some of these can at least help the pigmentation and some of the texture. To tighten and shrink the skin and the underlying connective tissue, we use Pellevê, a radiofrequency-based treatment that my patients love. Variable success has been demonstrated with fractionated lasers. Both the radiofrequency and laser devices are technique-dependent, so those treatments require a good machine and a good practitioner.
2. The second most common problem is the bands or “turkey wattles” at the center of the neck. These are the edges of a muscle that runs vertically in the neck and up over the jawbone. As we age, those edges, rather than sinking nicely into the angle of the neck, tend to contract and lift away from the neck. Mostly we want our muscles to be nice and taut, but in this case we want the muscle relaxed so it can have the extra length to form more of an angle from under the chin down the length of the neck.
So while we don’t ever want to pull or stretch the skin, we want to stretch and relax that muscle beneath the skin. A good preventive and maintenance exercise for this is the “lion pose” if you practice yoga. Another excellent way to relax the muscle is to extend your head back and jut your jaw out as far as you can (F.Y.I. This is also a great way to clear your ears if you’re descending in an airplane.)
If the bands really are starting to show, we can relax the muscle by injecting it with some Dysport or BoTox. These muscle relaxers can also be used in many individuals to make the jaw look more defined. This all may sound a bit counterintuitive, but it does make sense anatomically! The nice thing is that Dysport and BoTox tend to last longer in the neck than they do in the face. Also, once the muscle edges are weakened over a period of time with repeated injections, the injections last longer as well.
Once those bands are prominent, I’m afraid we have to consider surgery to smooth out the neck.
3. Some people are bothered by a fat pad under the chin. Unfortunately, our skulls shrink as we age. (This isn’t about osteoporosis; it’s more about just having birthdays.) The little pad of fat may be minimally bothersome in youth, but as we age, we can accumulate additional fat there, and the loss of bone support in the lower face (the jawbone and chin) can make the fat look more prominent. Sometimes we can delay removing the fat surgically by using fillers to strengthen the jaw line or add dimension to the chin. This is literally sculpting the contour of the face from the inside out, and if done well, it can make an amazing difference.