What’s the Best Approach for Treating the Neck?

Problems with the neck have suddenly hit the mainstream. Whether this is due to our global “selfie” obsession or the fact that our means of communication now include visuals (Skype and Facetime versus the traditional phone), plastic surgery patients these days seem to be obsessed with their necks. And not without cause.

The neck tends to show the earliest signs of aging, particularly sun damage, due to the fact that there is less underlying fat in the neck than there is in the face. This can manifest in a crepe-y texture, brown spots, or simply an overall laxity to the skin. Board certified plastic surgeons Dr. Sean Doherty of Boston and Dr. Mike Lee of Dallas discuss the options, both surgical and non-surgical, available today for treating an aging neck.

Kybella is a Game Changer for the Neck

For moderator Dr. William P. Adams, Jr. of Dallas, not a day goes by when he isn’t asked by a patient, “What can I do about my neck?” Dr. Doherty is experiencing the same phenomenon. “Young, old, men, women are talking to me about the neck. Everyday.” It seems to be an issue that is universal, straddling all ethnic, gender, and age barriers. Everyone is concerned with the neck and he thinks it’s because we are seeing our necks on our phones and in photos so much more than in the past.

Traditionally, there were not a ton of options for treating the neck non-surgically. Thankfully,  that is no longer the case. Kybella, an injectable that was specifically designed to target fat under the chin, is turning out to be a game changer. The injection dissolves the fat in the treatment area with none of the downtime of liposuction. Doherty has found it to be an extremely effective treatment for many of his patients.

Non-Surgical vs. Surgical Approach to the Neck

How do you know whether or not a non-surgical or surgical approach is going to be best for your neck? “It depends,” shares Dr. Lee. “In the neck, we’ve got skin. We’ve got fat. And then we’ve got muscle beneath the fat.” The right procedure or technique is really going to depend on your individual issue. But when it comes to the neck, some patients have all three.

When this is the case, it is next to impossible to achieve any real improvement without a surgical neck lift. However, if the problem is simply excess fat and the patient is younger with good skin quality, then a non-surgical approach such as CoolSculpting (which freezes the fat in the treatment area) can be quite effective.“I also think that men do really well with non-invasive treatments, specifically Kybella” says Doherty. Removing the excess fat recreates a stronger jaw line which can take years of the face.

What About the “Turkey Gobbler”?

The “turkey gobbler,” that pouch of hanging, wrinkly skin at the juncture where the neck and chin meet, is a huge problem for so many men and women. It’s usually caused by an excess of extra skin. “As we age, we lose elasticity in our skin,” explains Lee. “Gravity rules the solar system, it can obviously control our necks.” When the skin is this loose, there is, in his opinion, no great skin tightening procedure that is non-surgical. The patient will need surgery.

A surgical neck lift will:

• Remove excess fat under the chin
• Tighten loose skin along the entire length of the neck
• Remove the excess fat and skin that causes “jowls”
• Tighten and smooth the muscles in the neck that may be forming “bands”

While Dr. Doherty also feels that a surgical neck lift is “the gold standard,” particularly for treating the turkey neck, he does think that some of these non-surgical techniques can “approach” a surgical outcome as long as the patient understands what to expect.

Managing a patient’s expectations is one of the primary jobs of the surgeon and the consultation. For a lot of people, a surgical neck lift is not an option. Perhaps the patient can’t afford it financially or can’t afford the downtime that surgery requires. For some patients, surgery isn’t medically appropriate. For them, the non-invasive treatments – even if the outcome is only a 30% improvement – are worth it.

For Dr. Lee, it comes down to patient education. It’s his job to let the patient know all of the options as well as the realistic outcome for each different technique so that the patient can make an informed decision. The obvious advantage of non-surgical treatments to the neck is no downtime. However, “if you fix the neck, which is usually associated with signs of aging, now all of sudden, you may be focused on the eyes or the jowl or the middle of the face.”

Bottom line, you need to have an honest conversation with yourself and your surgeon as to your goals, both immediate and long term, so that together you can come up with the best treatment plan for achieving your desired result.