The Surgeon Minute

The Best Surgical and Non-Surgical Neck Options

The Best Surgical and Non-Surgical Neck Options

Patients of all ages are hyper-focused on potential surgical and non-surgical neck options these days. Dr. Sean Doherty of Boston attributes our new neck obsession to a simple up-tick in awareness.

Thanks to the age of selfies and social media, everyone is seeing more and more of their neck in both photos and video, often taken at an angle which does no one any favors. And while a surgical neck lift is certainly the gold standard for lifting and tightening any loose skin and muscle on the neck, there are also quite a few non-surgical options that can improve its appearance. The key to a successful outcome is managing patient expectations.

Surgery is the Ultimate Treatment for the Neck

The strange thing about the neck is that it often seems to age almost overnight. One day you have a long, smooth neck, and then — BAM, the muscles and skin all seem to head south. Whil in reality this change occurs over time, the neck does show some of the earliest signs of aging. There are many reasons for the changes, such as:

  • the skin on the neck is thinner than the skin on the face
  • a loss of collagen causes thin skin to sag and wrinkle
  • muscles in the neck tend to be weaker
  • many patients don’t include the neck in their skin care regime
  • gravity pulls down on the skin, resulting in a turkey wattle

“For treating the neck, surgery is not always required, but it is certainly the ultimate treatment,” explains Doherty. Patients of all ages ask him everyday what they can do about their necks. He attributes this to two phenomenons.

Treating the neck.

One is simply aging. Older patients necks are just older. The second, however, is that younger and younger patients are simply more conscious of the neck. They are seeing hundreds of photos of their necks in selfies and/or on social media. Most of these patients are not using gravity to their benefit when snapping a photo. Honestly, no neck looks good at a 45 degree angle because the earth’s gravitational pull is going to yank the skin down, creating extra folds no matter what your age. Bottom line, patients are just more aware of what their neck skin, volume and contour looks like.

A neck lift is a surgical procedure that lifts the skin and muscles on the neck. It does involve anesthesia, either general or sedation, as well as 7-10 days of downtime for recovery. You will have some post-op swelling and mild discomfort. Many patients describe their muscles as feeling tight which is really the point of a successful neck lift. It will also leave a scar, typically hidden in the ear. Since there is not a lot of tension placed on the skin, a well done neck lift should heal very nicely. The best candidate is a healthy, non-smoker who is not taking blood thinners, and who’s skin still has nice elasticity.

Non-Surgical Options for the Neck

Younger patients – and also men – do really well with the new injectable Kybella to get rid of excess volume under the chin. For the best result, the skin needs to still have some “snap back”.  While liposuction is the gold standard for fat removal, it is also requires anesthesia and a longer recovery. However, the results are immediate. Kybella on the other hand is non-surgical and has minimal downtime, but there can be some bruising and swelling following your treatment. The downside with Kybella is that it can’t really improve the contour of the neck, and it will take 2-4 treatments, spaced two months apart, to see your final results. As Dr. Doherty tells his patients, “for non-invasive treatments, patients need to be very patient patients.”

Neck options - Kybella injections.

RF, or radio frequency, is another non-surgical option for the neck that uses heat to help tighten skin. Dr. Doherty is very clear with his patients that this is not a neck lift. It won’t deliver the same exemplary results. But for patients who do not want surgery, RF therapy, such as the Profound RF, combined with micro-needling, “is a very nice way to provide some tightening of the skin.” If the patient also has some excess fat in this area, RF can be then be combined with either Kybella or liposuction.

Neck options - radio-frequency.

Micro-needling is an old concept in dermatology. It’s really about stimulating the skin by injuring it with, in this case, small needles. It works because our skin responds to the trauma by increasing our collagen production, that ultimately benefit the skin. Although there is not a lot of downtime with a combination of Profound RF and micro-needling, the results are not instantaneous, and will take anywhere from 6-8 weeks.

The real trade-off for non-surgical versus surgical treatment of the neck is the effect. Surgery is always going to deliver more. So, while there are great non-surgical options, it’s all about managing patient expectations. For Dr. Doherty, this means always trying to evaluate what his patients really want. His patients have high satisfaction with their procedures because he spends a lot time talking about their options. “If I think that patients want to have a non-surgical procedure, but they’re really looking for a surgical result, it’s an awkward conversation to have, but a very important conversation to have at the beginning of the treatment,” he shares.

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