Key points

Editor Commentary: In planning this issue of Clinics, I wanted to include all available options that would address the aging neck. Importantly, the aging of the skin envelope had to be addressed. I asked Dr Joseph to write this article. In so doing, he has summarized the available options and has informed us about the limitations of the various energy based skin tightening devices. I agree that we need to follow these technologies and see what we can expect as an average improvement realizing that patients show varying skin texture, collagen composition, elasticity and the effects of the environment on skin aging.

Introduction

At present, there are many different modalities that can be used outside of surgery to treat the aging neck. That being said, nothing works as well as surgery to address the primary issue of laxity in the neck. Although excess laxity is the major reason patients seek treatment in the region of the neck, surgery is unable to resolve issues such as texture, dynamic lines of expression, and pigment problems.

The alternative nonsurgical choices available today to improve the neck can be broken down into 3 groups: neuromodulators (NMs), fillers, and energy-based technologies (EBT). Because noninvasive or minimally invasive procedures have exploded in popularity over the last 10 years, refinement in EBT has occurred for the treatment of neck skin laxity. Due to a demand for minimally or noninvasive treatments, device companies have spent considerable amounts of time and money to advance new technologies. Currently, for select patient populations, these forms of energy-based treatments are now beginning to show noticeable improvement in treating the condition of excess skin laxity of the neck.

Introduction

At present, there are many different modalities that can be used outside of surgery to treat the aging neck. That being said, nothing works as well as surgery to address the primary issue of laxity in the neck. Although excess laxity is the major reason patients seek treatment in the region of the neck, surgery is unable to resolve issues such as texture, dynamic lines of expression, and pigment problems.

The alternative nonsurgical choices available today to improve the neck can be broken down into 3 groups: neuromodulators (NMs), fillers, and energy-based technologies (EBT). Because noninvasive or minimally invasive procedures have exploded in popularity over the last 10 years, refinement in EBT has occurred for the treatment of neck skin laxity. Due to a demand for minimally or noninvasive treatments, device companies have spent considerable amounts of time and money to advance new technologies. Currently, for select patient populations, these forms of energy-based treatments are now beginning to show noticeable improvement in treating the condition of excess skin laxity of the neck.

Neuromodulators

Neuromodulation of the neck can improve some components of the aging neck. In particular, the medial hyperdynamic platysmal bands, which project forward blunting the cervicomental angle, can often be dramatically improved from injection of a NM in select cases. It has been difficult to predict those patients who will benefit the most from this treatment. A trial injection is the only and best way to make this determination. The same can be done for the lateral bands. Some improvement in the jowl area can also be achieved by the judicious use of a NM on the platysma, which overlies this area. By reducing the downward pull of the platysma on the jowl, some mild elevation can improve the jawline. This technique has been described as a “Nefertiti” lift. Occasionally, the treatment of necklace lines can be accomplished with the broad application of a NM to treat the platsyma muscle overall. Care must be exercised with this form of therapy to avoid adverse events from the spread of the NM to adjacent and deeper musculature of the neck.