The new secret to fixing a sagging neck with closed-door beauty

Feeling bad about your neck? You’re not alone. There was a time when many of us began to consider the feasibility of wearing a complementary scarf in every ensemble – and it’s happening sooner than ever. “The lower face and neck have become a real focal point,” says Dendy Engelman, M.D., a Manhattan-based dermatologist. “I don’t know if it’s because we’re all used to doing upper and midface and now our necks don’t match, or if it’s because of the scaling effect of being overwhelmed by our reflexes all day, or tech necks spending hours on the phone, but I’m seeing much younger neck treatment patients than ever before.”

For those who aren’t ready for a surgical neck lift, the good news is that there are now many non-invasive procedures that can bring about significant improvements. “Non-surgical neck tightening relies on forms of energy that can penetrate deep into the skin, primarily radiofrequency and ultrasound,” says Robert Anolik, a dermatologist practicing at the Laser and Skin Surgery Center in New York. “What may work for one patient may barely work for another, so it’s great that we have several different modalities. Sometimes we need to try more than one thing, but we can find something that works for everyone.”

The first step, Engelmann says, is to identify the major issues affecting the appearance of the neck. “We see a lot of things going on. You can get vertical bands from the broad neck muscles that protrude and blunt the angle under the chin. You may get horizontal lines from sleeping or bending over your phone. And your skin may develop wrinkles or texture changes. Some people may have all of the above. But we first need to isolate the main problem and work from there.” The most effective treatments to address the trifecta are here.

Radiofrequency microneedling
Engelman likes to use Genius MicroNeedling in combination with RF to both improve skin texture and stimulate collagen to tighten the skin over time. The device uses a gold-plated needle that penetrates the skin and emits RF at its tip. “The beauty of it is that you can focus the energy directly and deeply into the dermis without affecting the epidermis,” Engelman says. Because it bypasses melanocytes, the risk of post-inflammatory hyperpigmentation is minimal, making it an excellent choice for people with darker skin tones. The treatment is also simple: numbness is required, but the procedure is painless and causes only a slight redness that lasts a day or two. Results will begin to show after a month and continue to improve for up to six months.

Laser Peels
Ablative lasers such as Fraxel or CO2 technology can be a powerful tool to eliminate wrinkles and restore smooth, soft texture to the neck. However, Anolik warns that there can be long downtime after these procedures, and when they are used on the neck, where skin is ultra-thin, there is a greater risk of prolonged redness or discoloration compared to the face. For gentler methods, he says, “we can still get results with non-invasive or non-ablative laser surface resurfacing. It won’t lift, but it will help alleviate wrinkles, and you’ll only turn pink for a few days.”

Botox.
One of the most common off-label applications used by dermatologists for Botox is to address the broad neck muscles in the neck. As we age, these muscles become more prominent, forming vertical bands under the chin and making the neck look thicker. As the neurotoxin takes effect approximately one week after treatment, these muscles soften and restore a smooth contour. Anolik also supports combining Botox injections with energy-based treatments to maximize results. “I strongly believe that if someone is going to choose a non-surgical method to tighten the skin, such as radiofrequency or ultrasound, Botox should work on the neck for a few months after treatment,” he says. “We’re trying to stimulate lifting, and I don’t want any reverse pull that would slow down the lifting process.” He recommends synchronizing treatments, injecting Botox a week or two before the radiofrequency or ultrasound procedure, then following up three or four months later when the neurotoxin begins to wear off.

Ultrasound
FDA-approved to lift the neck, chin and eyebrows, Ultherapy is touted as a cosmetic alternative. While the results aren’t actually that dramatic, the procedure can lead to impressive collagen remodeling and overall tightening. The device focuses ultrasound energy into the skin, creating a heating effect that promotes collagen formation – and because it bypasses the skin’s surface, it can be used on all skin types and has zero downtime. It has a reputation for being painful, but newer iterations have greatly reduced the bite and tolerance. For a more comfortable experience, there’s now Sofwave, a new player in the ultrasound space. “Unlike the focused ultrasound used in ultrasonic knives, the sound waves are delivered in parallel, almost like a layer of energy under the surface of the skin,” says Anolik. That means the energy doesn’t penetrate as deeply, but it’s more diffuse – meaning it’s less painful, and many patients report seeing results faster within 10 days after the first treatment (most take 2 days), rather than 2 to 3 months with Ulthera. In both cases, major improvements in texture and sagging are expected over time.