SKN: What contributes to the aging neck?

Doctor: The face is by no means the only area of our body that reflects the ravages of the passage of time. The neck, too, is vulnerable to assault from long-term ultraviolet exposure, the dictates of our genetics, gravitational effects and changes in muscle mass and elasticity with chronological aging. The interplay of these factors gives rise to several cosmetically troublesome hallmarks of the aging neck.

SKN: Why is it so important to focus on the neck?

Doctor: Striving for balance and symmetry between the face and the neck can be as critical for attaining overall cosmetic improvement (i.e. the appearance of “total” rejuvenation) as it is for achieving these goals when concentrating only on the face. If you restore fallen cheeks, for example, but ignore prominent tear troughs under the eyes or heavily drooping brows, you will no doubt look better. But an apparent age discrepancy and esthetic asymmetry-between the cheek region and the eye unit can sometimes result. In the same way, neglecting to treat the aging neck and focusing exclusively on the face may give rise to a similar incongruity in appearance.

Put another way, if your face looks refreshed and youthful, but the neck looks weather-beaten, the results may appear odd and jarring, similar to spotting someone with severely wrinkled skin who has dyed his hair and left no hint of gray. It also becomes a dead giveaway that cosmetic work was done on the face - a fact that you may not wish to share with friends or even family.

SKN: What are some traditional options that work on the neck?

Doctor: A variety of surgical options exist for dealing with neck problems. These include full lifts, mini-lifts, minimal incision lifts, and S-Lifts. All are predicated on removing excess skin, shoring up the underlying tissue and reinforcing the long, thin, sheet-like muscle layer, known as the platysma. This muscle extends from our jaws down to the upper chest and is responsible for much of the structural support and elasticity of the neck. For this reason, a surgical neck lift procedure is referred to as platysmaplasty.

But all these methods of repair are true surgery: they’re expensive, painful and require a long recovery. away from work and social activities. Happily, a number of completely non-surgical approaches, several of which I have either improved upon or developed myself, may be used to get rid of unsightly necklace lines and turkey necks.

The somewhat playful names,“turkey gobbler neck,” “turkey wattle” and “chicken neck” describe the effects of both sagging skin under the chin and the presence of long, vertically-aligned and parallel, ropey-looking cords that stretch north to south along the front of the neck. An equally fanciful term, “necklace lines,” refers to parallel bands of wrinkles that encircle the neck like a series of thin chains.

SKN: Please talk about these innovative, new non-surgical procedures.

Doctor: Since the platysma is after all a muscle, once again the unique muscle-relaxing properties of Botox Cosmetic can be marshaled to play an important role. Microdroplets of Botox can be implanted along (and sometimes above and below) the necklace lines at approximately half-inch intervals. The immediate appearance of the treated areas looks like a series of tiny mosquito bites strung like beads around the neck. These little bumps are quickly and completely absorbed usually in the next 24 hours to two weeks afterward. Benefits tend to last up to six months after which touch-ups for maintenance may be given as needed.

SKN: Okay, let’s get technical. How do volumizers work?

Doctor: Combining Botox Cosmetic and volumizers is best for dealing with the vertical neck cords. In order to accentuate the ropey-like appearance of the neck, you will first be asked to grit your teeth tightly together. Next, tiny amounts of Botox are injected down the entire stretch of each cord to slightly weaken the underlying muscle sheet. This allows the platysma to re-drape itself over the length of the neck, diminishing the appearance of the cords. To supplement the effect, small amounts of Botox can also be injected along the underside of the jawline. This serves to dampen the downward pull of the uppermost portion of the neck muscles. It gives the facial musculature immediately above the jawline just enough of a competitive edge to act like a sling and pull the neck upward on both sides of the lower face.

To enhance and prolong the improvement, Radiesse — a calcium hydroxylapatite-containing volumizer — can be instilled along the jawline, into the depression immediately under the chin, as well as horizontally and vertically as needed along the angle between the neckline and chin line (about a half-inch above the Adam’s apple). The pull exerted in all directions by volumizing these regions further reinforces the sling effect Botox creates.

Radiesse not only imparts immediate volume to the treatment areas, but stimulates native collagen production several months later on. This lengthens the duration of the overall improvement to somewhere between nine and 18 months in my experience. Juvederm-UltraPlus and Perlane, two heavy-duty hyaluronic acid fillers, have also been used successfully for this purpose, with results lasting between eight and 12 months.

SKN: How do you choose which liquid treatments to use?

Doctor: The choice of which agent to use will depend upon a number of factors. If budgetary considerations come into play, or if you’re unsure of how you will like the effect, or if you have a big business or social event very shortly afterward, you would do well to choose the hyaluronic acid products. They’re less expensive, less likely to cause significant bruising or swelling immediately afterward and offer a relatively shorter period of time in which to “try out’ the new look. If you’re completely satisfied, Radiesse may be used instead the next time for longer-term improvement.

SKN: If fillers and volumizers like Restylane, Juvederm and Radiesse require patients to keep coming back, why not use permanent fillers?

Doctor: In the U.S., Artefill and silicone (siloxane) are the sole permanent filling agents available. Composed of microscopic polymethacrylate beads, Artefill is the only FDA-approved filler for cosmetic use. Methacrylate is the main ingredient in super glues, and silicone is related to glass.

The problem with permanent filling materials is precisely that they are permanent. If they’re placed too superficially or if too much is administered at one time, unsightly lumps and bumps may become visible in the skin that are hard or impossible to treat.

In addition, the long-term effects of these foreign materials in the skin remain largely unknown. Recently, there have been a few reports linking Artefill with the subsequent development of granulomas (inflammatory lumps) months to several years after injection. And for many years there have been reports of silicone causing various kinds of lumps and shifting from its injection site over time.

Finally, even if these agents were found to be completely safe with no long-term adverse reactions, there would still be the issue of how good the cosmetic result will look five, 10 or 20 years down the road. The concern is that shifts in fatty tissue and changes in bone muscle and cartilage with aging have the potential of altering an excellent cosmetic result today into an entirely unacceptable one tomorrow. So, be wary of the allure of permanent.

Got a question for Dr. Novick? Send him an email at info@skincare-news.com. Your question might be featured in an upcoming article.

Skincare-News.com extends a big thanks to Dr. Novick for his insight on non-surgical neck lifts. Check out the other interviews in our seven-part series. Plus check back with us for the last two interviews on non-surgical procedures.

The Non-Surgical Rejuvenation Series:

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Facelifts (Part 1)

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Nose Jobs (Part 2)

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Eye and Brow Lifts (Part 3)

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Lip Enhancement (Part 4)

On Non Surgical Chest Enhancement & Breast Lifting (Part 6)

Chatting About Non Surgical Hand Rejuvenation (Part 7)

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In addition to Dr. Novick’s role as bestselling author, clinical professor of dermatology at The Mount Sinai School of Medicine in New York City and attending physician, he is also a fellow of the American Academy of Cosmetic Surgery (FAACS) and maintains a private practice in Cosmetic Dermatology and Cosmetic Dermasurgery on Manhattan’s Upper East Side. He has been featured on many popular television and radio shows and lends his expertise to scores of major publications.