Thank you for your question.
You submitted your question with a photo of the lower part of your face.
And you express a concern about the appearance of the lower part of your face or actually
the neck area as not matching the way the face appears.
And you are concerned about some fine lines and some loose skin.
Well, I can certainly share with you the type of discussion I have with my patients when
we talk about this area which is of significant concern to pretty much everyone who has any
history of sun exposure or is dealing with the natural progression of facial aging.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Helping people rejuvenate their necks is a very big part of what I do every day in my
practice.
So I explain to my patients the way to prioritize or to actually understand what is the approach
to helping the neck as opposed to improving the face.
There are a few things that we also want to emphasize.
A lot of times, people will see a disconnect between the facial appearance and the neck
appearance.
And what is often referred to as a giveaway, what a person’s neck or hands look like
versus the appearance of their face.
So what you want is a harmonious balance and improvement.
When it comes to the neck, there are several things that are much more challenging.
One is the difference in the skin texture and quality compared to the face.
The neck doesn't have as many oil and sweat glands compared to the face and the skin of
the neck is extremely thin, that combined with laxity or looseness of the skin and the
activity and behavior of a muscle called platysma muscle.
So when it comes to rejuvenation of the neck, we first want to decide is there enough sagging
that there needs to be lifting.
Now there’s a distinction here.
When people look at their necks, a lot of women look at their necks particularly, they’ll
pull back and say “Look, it looks so much better.”
And even though that may be true, it’s not because there’s a lot of loose skin but
rather because the skin quality has diminished.
So anything that is getting thinner and more rippled, when you pull, it will actually look
better.
But if you were to surgically try to correct that, the tissue is so thin and so weak that
there’s going to be a significant amount of regression and that would be a challenge
in justifying the procedure.
So when it comes to helping people with their neck, if there is enough laxity, then we do
something called a neck lift or it is often combined as part of a facelift.
So a face and neck lift.
Now that’s one surgical option.
The non-surgical options which are also done in conjunction, it’s not one or the other
but non-surgical options more about texture and quality of the skin and everything for
doing a procedure such as the use of platelet-rich plasma (PRP), whether it’s injections under
the skin or what we refer to as intradermal injection which is within the skin to help
the quality of the skin.
Platelet-rich plasma is derived from your own blood and it’s a concentration of the
wound healing growth factors that stimulate collagen and restore blood supply.
It’s something that does improve neck skin quality and texture.
Further, we also employ different types of lasers.
And what we have been doing a lot of is the use of something called the Q-switch laser
to treat the neck skin in a way that is referred to as laser toning.
And this is using a certain wavelength, time and energy into the skin to stimulate what’s
a remodeling of the skin quality so that the lines and fine textural issues are improved.
Topical treatments can include anything from glycolic acid and something like Hydrafacial
to the use of topical retinols that can be used at home.
Basically, there are more than a few options but I would say that if you have more of a
textural issue as opposed to a sagging issue, then discuss with your doctor the strategy
because frankly, a lot of times, people will be disappointed that they’ll be doing one
thing at one time.
Usually, for skin texture improvement, we describe it as being comparable to exercise
or gaining muscle.
You stimulate, you wait for the body to respond and then you stimulate further.
So very often, there’s a strategy of different treatments done at different timeframes towards
a particular endpoint.
And of course, there are different lasers that can be employed.
You don't have just one laser.
You can do two different types of lasers applied for different reasons to help improve the
skin quality and texture.
I believe in a synergistic approach.
I think that the concept of regenerative medicine using platelet-rich plasma is very valuable
to maximize your body’s response to any treatment done with a laser.
And there’s also microneedling and different ways to deliver hyaluronic acid and PRP through
a mirconeedling type of device.
So as you can imagine, there are many options for you and you have to figure out with your
doctor what makes the most sense and of course I believe very strongly in photo documentation.
Texture is very difficult to really show with photos but it is worthwhile to understand
what kind of outcome you can expect so you will be able to appreciate the change over
the course of your treatments.
So I hope that was helpful, I wish you the best of luck and thank you for your question.