when we think of esthetic treatments, we always tend to limit our thoughts to the face , however its the difference between the youthful face and the aging neck that truly gives away the true age.
holistic approach treating the neck and decollate areas alongside the face is the proper way when we talk about esthetic treatment and rejuvenation
THE AGING NECK
the skin of the neck is the most delicate after the per orbital area because it contains way less elastin fibers compared to the face resulting in weaker supporting structure to the collagen matrix
the coined effect of saggy jowls , sub mental fullness ,inelastic skin all contributes to the aging neck appearance
The platysma is a vertical muscle that runs throughout the whole neck. It lacks support from surrounding connective tissue, which leaves it practically free-floating. As we age, the muscle fibres of the platysma shorten and contract which creates the classical platysmal bands, which are the most obvious and feared sign of ageing neck, commonly referred to as ‘turkey neck’.
We are now living in the world of the ‘selfie’, which increased pressure to look picture perfect 100% of the time. We capture our lives using smartphones but constant overuse of technical devices means we spend more time looking down at our phones than looking at each other. The constant head tilt leads to excessive pressure and creasing of the delicate skin in the neck area, which can result in accelerated formulation of lines and wrinkles.
As with any aesthetic consultation, the first step is to establish the patients concerns. Having an open discussion with the patient and exploring how much the problem affects their life on a day-to-day basis is a good starting point.
Also discussing previous treatments and how long the problem has been bothering them gives a good insight into the extent of the issue. In addition to covering the routine medical assessment, it is also useful to discuss lifestyle factors, in particular, smoking, diet, exercise and skincare regime, including SPF use.
Classically, the main patient concerns related to the neck and décolletage include:
- Skin laxity
- Fine lines
- Crepey skin
- Double chin
- Treatment choices
Fortunately, there is a wealth of minimally-invasive treatment options available for treating the ageing neck and décolletage.
This is where the value of a thorough initial assessment comes in to guide the best treatment choices for the individual needs of each patient.
Botulinum toxin-‘Nefertiti lift’
Named after the famous youthful jawline of the Egyptian queen, the Nefertiti neck lift involves injections of botulinum toxin into the lower jaw and neckline. The amount of injections is variable depending on the patient in terms of muscle bulk and definition.
This treatment is best suited to patients with early signs of the ageing neck, in particular mild jowling and platysmal bands. Assessment includes visualising contraction of the platysmal bands, which is best achieved by asking patients to bite down on their back teeth. The bands are injected vertically along the neck. It is essential that the depth of injection is intradermal to avoid diffusion of toxin into deeper structures of the neck, which can affect speech and swallowing.
Hyaluronic acid (HA)-based dermal fillers aim to replenish lost moisture and improve volume and elasticity, making them a suitable option for treating the delicate skin of the décolletage. Once treated, the skin appears plumper and the lines and wrinkles are effectively smoothed.
Compared to traditional HA dermal filler injection, the treatment involves superficial microinjections of filler to create small blebs along the valley of wrinkle.
The results generally last between six to nine months and how long they last depends on the condition of the skin initially, especially the degree of elasticity and depth of wrinkles.
The threadlift offers an alternative to the traditional facelift in patients with concerns about sagging skin of the neck and jowl formation in the lower jaw. Threads are usually made from polydioxanone (PDO), which are inserted into the dermis to create a mechanical lift, which is maintained by collagen formation.
There are many different techniques that can be used. The number of points needed to create elevation is best decided on a case-by-case basis. Patient selection and management of patient expectations are essential.
Threadlifting, however, has more potential side effects and downtime than injectables. The most common ones being: swelling, haematoma, , infection, migration of the sutures, and dislodging of the thread position which may result in asymmetry. If dislodging happens, then this will need review and possible correction.
There are many different devices on the market that have demonstrated results in the treatment of the ageing neck and décolletage. The specifics of each device are worthy of an individual write up to fully explain the complete mode of action.
In summary, however, all devices share the same fundamental action: using thermal energy to create local heating of the dermis of the skin to stimulate fibroblast activity and increase collagen production in the subcutaneous tissues. The increased temperature results in contraction of collagen fibres, which causes contraction on the overlying tissues creating traction on the surface of the skin. The overall effect is to tighten and smooth the overlying skin, lifting out fine lines and wrinkles and improving the overall texture of the skin.
The different technologies include:
- Laser resurfacing
- ingectable RF
Many of the treatments discussed work best synergistically, so it is useful to explore the option of combination treatment depending on the practitioner’s experience and the patient choice.
The neck and décolletage are all too frequently forgotten when it comes to preventative treatment. As a result, aesthetic treatment in these areas will likely remain commonly sought-after.
Although the neck and décolletage were traditionally challenging to treat, the emergence of high-tech devices, advanced techniques such as threalifting, combined with the mainstay of injectables and optimim skincare, mean than the a experience and patient choice.
Other treatments such as platelet rich plasma (PRP) therapy, mesotherapy, microneedling and skins peels can provide great alternative treatments or ‘add-ons’ to the patient treatment regime to support the rejuvenation process.