ProductsYou may feel that your face still looks like you, but your neck doesn't. I'm Dr. Debra Jaliman, and in my New York City dermatology practice, I start by finding out what is happening under the skin. That's because non-surgical neck tightening works best when the treatment matches the problem. Loose, crepey skin over a defined jawline usually responds to radiofrequency treatments. Vertical bands can be softened with Botox. Fullness under the chin may be treated with CoolSculpting. When skin hangs below the jaw, a surgical neck lift may be a better option. Understanding the difference is important as it helps in choosing the right treatment.
Why the neck responds differently from the face
Three things make the neck different: thinner skin, constant muscle movement, and sun damage.
Neck skin is thinner than facial skin and has fewer oil glands, so it is more prone to dryness and irritation. That's part of why neck skin turns crepey.
Under the skin sits the platysma, a broad, thin sheet of muscle running from the upper chest over the collarbone to the jaw. It tightens with expressions such as surprise or disgust, so the skin over it is stretched all day. The platysma shortens and may thin as we age creating visible vertical bands.
Sun damage is the third factor. Thin skin makes sun damage more noticeable, so sunscreen shouldn't stop at the jawline.
Because neck skin gets irritated more easily, skincare products may need a lower strength. Surface treatments have limitations when the problem is the muscle, not the skin.
Which neck concern do you actually have?
Loose or crepey skin, vertical bands, and fullness under the chin are different problems, and each is treated differently. Many necks have more than one of these problems, and I address them all.
A mirror and good light are enough for a first look, though that doesn't replace an exam. At your consultation, I evaluate which problems you have and the best order in which to treat them.
Loose or crepey skin
The skin looks finely wrinkled or slightly loose, but your jawline and the angle under your chin are still defined. When the skin looks like this, texture and mild looseness are probably the main issue. Radiofrequency and certain lasers can stimulate collagen and improve the texture of the skin.
Vertical neck bands
Vertical bands come from the platysma pulling, so they appear or become more prominent when you tense it. To check, look straight ahead with your face relaxed, then pull the corners of your mouth down hard. Bands form where the muscle edges drift apart with age. Botox can soften these bands by relaxing the muscle.
Fullness under the chin
Submental fullness means extra fat under the chin. The skin may be in good condition, and the problem is the shape from chin to neck. CoolSculpting targets this fat.
A new lump under the chin that feels hard, keeps growing, or lasts more than a few weeks should be examined first, because it can be a swollen lymph node.
How to tighten neck skin without surgery: the realistic options
Radiofrequency and lasers can improve neck skin without surgery, Botox can soften bands, and fat under the chin needs its own treatment.
Before any injection, I review your medical history, medications, and allergies.
- Radiofrequency skin tightening heats the dermis, the deeper layer of the skin, tightening tissue and prompting new collagen to form. It suits mild to moderate looseness and crepey texture. Our options include Thermage CPT and TempSure Envi. They both can treat the neck down to the collarbone. There is no downtime. I determine which treatment is best for you, and my medical assistant, who has 13 years of experience, performs it.
- Fractional laser resurfacing treats surface texture on the neck. Fraxel delivers heat through thousands of tiny columns, and the skin repairs them with new collagen. Expect redness, mild swelling, and rough texture for 3 to 5 days. My medical assistant performs this treatment too.
- Botox can soften the bands. It temporarily blocks the nerve signal to a muscle. The FDA has approved Botox Cosmetic for moderate to severe platysma bands, the medical term for these neck bands. I determine the dose and placement after evaluating your anatomy, muscle strength, expressions, and goals, and I do every injection myself. Botox softens banding without tightening the skin, and most patients repeat treatment every 3 to 4 months.
- Fat under the chin needs a treatment aimed at fat, because radiofrequency and Botox usually don't reduce it. In our office, that treatment is CoolSculpting, which freezes fat cells. A double chin takes two sessions a month apart in most cases, with full results by about 3 months. In rare cases, fat in the treated area grows instead of shrinking, and that usually needs surgery to correct. CoolSculpting targets fat, not loose skin, so if your skin is already loose, that looseness can become more visible.
Botox isn't right for everyone, so please read who should not get Botox. The Botox label warns that swallowing, speaking, or breathing problems can appear hours to weeks after injection. This is a very rare reaction. If you notice any of these, get medical help right away, then tell the office.
What non-surgical neck tightening usually can't do
Saggy neck and turkey neck: when the skin hangs
When excess skin hangs below the jaw as you lift your chin, the look often called turkey neck, skin tightening devices usually produce a small improvement. The same often applies when prominent bands come with loose skin.
For these necks, a neck lift performed by a board-certified plastic or facial plastic surgeon is commonly the most effective option. Surgery can address slack muscle and extra skin, which heat and injections usually can't match.
What the first year of treatment usually looks like
Treatment starts with sorting out which problem you have. If bands are part of it, I start with a low dose of Botox and review it at a complimentary two-week follow-up. If you need more Botox at that visit, there's no charge. Botox for neck bands usually lasts 3 to 4 months, so most patients repeat it.
Skin tightening takes longer. Results are usually visible at 3 to 6 months and typically last 12 to 18 months, depending on the device and your natural rate of collagen loss. Thinner neck skin often holds results for less time, and I recommend annual maintenance for Thermage CPT.
When more than one problem is present, I usually space treatments over months and reassess before each step.
A retinoid, a vitamin A cream, can support the texture of neck skin, and because the neck is more prone to irritation, a lower strength is the place to start. Avoid retinoids during pregnancy.
Sunscreen belongs on all skin clothing doesn't cover, which means continuing past the jawline to the collarbone every day. Daily sunscreen matters even on cloudy days.
Your cost depends on which treatments are best for your neck. Botox is priced by treatment area, and we'll go over exact pricing at your consultation. The consultation fee is credited toward same-day treatment or a future appointment.
FAQ
Does non-surgical neck tightening actually work?
It depends on which problem you have. For mild to moderate crepey or loose skin over a defined jawline, radiofrequency often produces a modest improvement over several months. Botox commonly softens bands for a few months. When skin hangs below the jaw, improvement from devices is usually small.
How many sessions before a difference shows in the neck?
Thermage CPT is one session, and TempSure Envi is four sessions one month apart. With either, results commonly show at 3 to 6 months as collagen builds. Each Botox treatment for bands is a single visit, with a check at two weeks.
When is a neck lift the better option?
A neck lift is often better when skin hangs below your jaw as you lift your chin, or when prominent bands come with loose skin. A board-certified plastic or facial plastic surgeon can remove excess skin and tighten the muscle in one procedure.
What the first visit involves
Your consultation covers your whole face and neck. I'll evaluate your neck at rest and in motion, explain which of the three problems you have, and recommend only what fits, including telling you when non-surgical treatment isn't the best choice. You can read about what a consultation covers.
Finding out what your neck needs
Choosing among non-surgical neck tightening options depends on whether your problem is texture, muscle, or fat, so the first step is finding out which. That's what I evaluate at your consultation. I've injected Botox in New York City since 1992, and every Botox injection in my Upper East Side office at 931 5th Ave is one I place myself.
Request an appointment with Dr. Jaliman to have your neck checked, or call >.
