Neck or Nothing

Mariel Chow explores treatment for sagging, turkey wattles, and everything else that ails the neck.

Dr. Thum Hok Yen - February 19, 06:15 PM

Despite recently turning 30 ONLY, wrinkles along my neck – especially horizontal lines – are apparent and becoming a source of frustration. While I look good for my age, the lines on my neck tell a different tale. Once ageing takes a toll, the skin becomes more laxed, delivering turkey wattles and chicken necks. If our diets spin out of control, double chins ensue. In short, if you want to find out a person’s true age, take a look at their neck. 
Although this may seem like nature’s cruel joke, there are multiple reasons why the neck ages rapidly. First, neck skin is thinner and weaker than the face. Moreover, the neck is given less attention with limited cleansing, exfoliating and moisturising as well as less sunblock application. Finally, laws of gravity apply, pulling down skin and contributing to turkey wattles. While most people believe the only pathway to rejuvenated necks are neck lifts, that’s not always true according to our experts. We speak to three aesthetic consultants and practitioners as they explain the many methods of neck rejuvenation including how treatments work to restore necks back to their former glory. 

Neck Lifts with Consultant Plastic and Reconstructive Surgeon, Dr. Kampee Karanapakorn
Dr. Kampee Karanapakorn says neck ageing is influenced by multiple factors. Like the hands, the neck ages rather quickly due to limited fat content. The platysmal muscles in the neck have fewer ligamentous fixation (retaining ligaments) compared to the midface, lower face and periocular and frontotemporal region. As gravity takes its toll, pulling forces cause dermal ptosis. Lastly, we tend to take better care of our faces, forgetting to apply anti-ageing products on the neck. If patients experience additional skin diseases like atopic eczema, then ageing becomes more rapid. 
In terms of the neck’s anatomy, the anterior digrastric muscle experiences hypertrophy and sagging. The lateral space in the submandibular gland also suffers hypertrophy and ptotic sagging, adding to the neck’s ageing. In cases where patients suffer turkey wattles, reasons for the problem are due to severely sagging anterior platysmal bands. 
When patients undergo rejuvenative neck treatments, trends are leaning towards less invasive procedures which affect in nominal downtime. These coveted pathways, according to Dr. Kampee, are only available through proper patient selection. The rule of thumb is always early intervention, when signs of early onset are present. The later you wait, the more advanced procedures become, necessitating invasive surgery like neck lifts. 
Early intervention is recommended to patients below 40-years old. Apart from cigarette cessation and alcohol reduction, applying sunblock on a regular basis and undergoing more physical activities like swimming can help. Where diet is concerned, eat healthy organic food and try consuming more vitamin C and collagen. Apply retinol cream at night as vitamin A derivatives are proven to boost collagen production and speed cell turnover. If patients experience early ptosis of the submandibular glands, neurotoxins (Botolinum toxin A) may be good options for reduced jowling. 
In Dr. Kampee’s experience, female patients may qualify for neck lifts after ages 50 and beyond. Males however, may benefit from surgery following their 70th birthday. In general, one of the first signs of surgical qualification is hanging turkey wattles under chins which are seen parallel along the vertical midline down the clavicle, during expression. Still, drooping of the submandibular gland and jowling is another prominent sign of possible surgery. 
When patients undergo rejuvenative neck treatments, trends are leaning towards less invasive procedures which affect in nominal downtime.
What is a Neck Lift?
A neck lift or lower rhytidectomy is a surgical procedure which improves ageing signs along the jawline and neck. It has the ability to address excess fat and dermal laxity in the lower face which causes jowling and loose, hanging skin. It also may remove excess fat under chins, tighten loose skin and treat muscle bands which create abnormal contours. 
In Dr. Kampee’s practice, neck lifts begin with a lateral pulling of the platysmal muscle in addition with some resection of redundant skin. In most cases, lower rhytidectomies are designed as Sub-SMAS dissections to tighten skin without pulling facial skin too aggressively. This is done in order to avoid unnatural dermal appearances, unsightly scars and ‘pixie ear’ deformities. In short, Sub-SMAS dissections allow surgeons to pull platysmal muscles while conducting tightening toward to the posterior periauriculomasseteric fascia or the posterior mastoid periosteum – away from the great auricular nerve – to avoid sensation loss along the ears. There are other minimally invasive neck lifts approaches including suture suspension and endotine ribbons. Despite benefits like minimal incisions and less downtime, they aren’t effective among individuals with severe turkey wattles. If sagging and loose skin is evident, then Sub-SMAS dissections approaches apply. Finally, should patients present heavy fat deposits under chins, submental liposuctions may be advocated as well.
Consultant Plastic and Reconstructive Surgeon, Dr. Kampee Karanapakorn

Minimally invasive and Non-invasive Neck Rejuvenation with Consultant Aesthetic Dermatologist, Dr. Christeen Youssef
Before we understand why the neck rapidly ages, we must first comprehend differences in dermal anatomy. As specified by Dr. Christeen, differences in qualities are divided into skin thickness, amount and type of hair, number of glands and oiliness. 
Skin thickness: The skin has different thicknesses because it has opposing demands, depending on location. For example, skin thickness on the eyelid is 0.5mm while the sole of your foot goes up to 5mm in some places. The facial epidermis however, is about 0.12mm while the body’s skin is thicker, coming in at 0.60mm.  
Amount and type of hair: Density of hair follicles on facial skin is quite high, although fine and hard to see. In fact, densities of hair follicles on the face are much higher than on the back. 
Number of other glands: The skin under the arms, groin and ear canals have special glands that produce sweat. While these apocrine glands produce sweat, which doesn’t smell bad, sweat can become smelly when in contact with bacteria. 
Oiliness: The facial skin has more sebaceous glands (oil glands) compared to other parts of the body. The oil or sebum has different proposed functions, like hydrating the skin. It also contains antioxidants and antimicrobial substances.
Consultant Aesthetic Dermatologist, Dr. Christeen Youssef

Why the Neck Ages
Besides natural ageing processes like gravity and collagen loss, personal neglect like ‘tech neck’ or constantly tilting the neck forward to look at your phone contributes to rapid neck ageing. Another reason is sun exposure or photo damage, as well as under-treating the neck when applying sunscreen. Correspondingly, photodamage develops in the form of fine lines, wrinkles, sunspots and even spider veins. Genetics and hormonal fluctuations also influence collagen and elastin production all over the body, including the neck.
Compared to the face, the neck contains fewer elastin fibres, which keep skin stretchy. This means your neck enjoys less support. When this lack of support is combined with personal neglect and constant tilting, necks ultimately experience accelerated development of wrinkles and saggy skin. 
Finally, and as previously explained, the skin on our neck is thinner, making collagen and elastin loss even more noticeable. Likewise, it doesn’t have the same emollient-producing oil glands which keep skin plump and hydrated. 
Why Neck Rejuvenation Treatments?
Due to the abovementioned factors, patients normally experience many signs of neck ageing. These indications may include: 
•     Excess fat and skin redundancies in the lower face, creating jowls
•     Double chins
•     Loose neck skin
•     Muscle banding in the neck
•     Turkey necks
•     Wrinkles and creases
•     Vertical neck bands
•     Poor dermal texture and photodamage
In order to battle these physical distresses, Dr. Christeen recommends many minimally invasive and non-invasive solutions. Such pathways may include:
•     Chromophore-based laser and light-based systems – IPL (Intense Pulsed Light)
•     Radiofrequency (RF) resurfacing – Fractional RF resurfacing 
•     High Frequency Focused Ultrasound (HIFU) – Ultherapy
•     Laser-assisted lipolysis
•     Thread and suture suspension
•     Neurotoxins 
•     Fillers
These recommended treatments work in varied ways, targeting different layers of the skin. Chromophore-based lasers and light-based systems have wavelengths of light specifically attracted to intra-epidermal, epidermal and superficial dermal melanin through a process called selective photothermolysis. This is essential in promoting cell rejuvenation while affecting in zero downtime and no damage to non-targeted areas. 
Treatments that use transcutaneous external contact like RF tends to apply lower energies and require multiple passes to heat large volumes of tissue. Consequently, patients experience new collagen and elastin formation. Micro focused ultrasound mechanisms however, bypass the epidermis to work on deeper tissues. Microneedles and microinvasive technology elicit fractionated RF, allowing doctors to vary energies and depths to promote new collagen and elastin as well.
Laser lipolysis are minimally invasive procedures that use heat from fibre-optic lasers at different wavelengths to melt body fat. It’s a different process than liposuction as the former melts fat while the latter removes fats using a vacuum suction. The added benefit of laser lipolysis is that aside from reducing double chins, it spurs collagen production, making skin tauter. 
Thread and suture suspensions are called threadlifts. They’re a convenient, less invasive alternative to traditional neck lifts, designed for those with early signs of sagging and jowling. Apart from a physical lift, some threads even stimulate collagen production. Lastly, neurotoxins and fillers have abilities of relaxing muscles which contribute to wrinkles and plumping skin riddled with deep lines. 
Treatment Side Effects
Most recommended treatments aren’t typically painful, Dr. Christeen says. However, at the behest of patients, topical and local anaesthesia may apply. Once treatments are over, patients can return to normal routines as long as specific recommendations related to pain management and sun exposure limitations are heeded.
When treatments are provided by skilled and experienced doctors, complications aren’t common. Still, patients should be made aware of potential risks and side effects. These may include:
Chromophore-based laser systems:
•     Ablative light devices: slightly painful, long downtime, pigmentations and infection.
•     Non-ablative light devices: temporary lightening or darkening of the skin, scarring, swelling, redness and infection.
•     Infrared devices: transient oedema, striations, transient post-inflammatory pigmentation, subcutaneous nodules and temporary nerve affection.
RF resurfacing: transient erythema and oedema.
Ultrasound devices: erythema, oedema and striations.
Thread and suture suspensions: some ecchymosis, erythema, small haemorrhage and mild transitory aesthesia.
Treatment Longevities
Results usually appear almost immediately or after second or third sessions, depending on treatment type.
IPL treatment requires four to ten treatments at four to six-week intervals. Results last an average of three years. RF resurfacing necessitates six to ten treatments at four to seven-week intervals, lasting an average of two years. HIFU patients may benefit from one treatment, depending on severity. If more treatments are needed, sessions should be spaced between three to six-week intervals. Results last an average of two years. Laser-assisted lipolysis involves four to six treatments at one to two-week intervals with results lasting three to six months. Threadlifts are singular procedures enduring three to five years. Neurotoxins and fillers continue working for at least four to six months and two years respectively. 
Choosing Between Minimally invasive and 
Non-invasive Treatment
Neck rejuvenation is considered minimally invasive when procedures penetrate the epidermis, whether with a scalpel or a needle. While non-invasive treatments do not penetrate skin, their ablative and non-ablative natures do fight tissue laxity. This is precisely why non-invasive treatments are sometimes referred as ‘scarless neck lifts’. 
Normally, non-surgical skin tightening best suits individuals bothered by mild to moderate dermal laxity. If patients present greater severities, minimally invasive or invasive procedures may be recommended. This is why consultations are vital. Besides assessing patient’s acceptance and tolerance of risk and reward, consultations may determine a patient’s suitability for the treatment based on his/her anatomy. Discussion of salient features of prospective recovery periods is also essential.

Aesthetic Physician, Dr. Thum Hok Yen
The question that everyone wants answered: should we really use neck creams, or are they just gimmicks? Well, according to dermatological experts, neck skin has different densities compared to the body, making body butters inappropriate for thinner neck skin. Also, the skin turns drier over time from dipping hormones and sun exposure. If patients would like skincare which best serves one of the most delicate parts of the body, then reach for a neck cream like Nectifirm which encourages and maintains healthier, more youthful necks. 
Dr. Thum reminds that a good homecare system is vital when maintaining youthful, supple skin. Aside from sufficient protections against UV damage, patients also need a good moisturiser to lock in water and stimulate collagen growth. Although most patients apply copious amounts of creams and potions on faces, the neck is often disregarded. Moreover, because the neck’s dermis is much thinner and prone to wrinkling and lines, it is beneficial to have a cream unique to the neck’s anatomy for improved hydration, tightening and smoothing. Nectifirm is a specific targeted cream tailored to the neck and mid-chest. It has abilities of stimulating collagen and elastin growth, encouraging firming and lifting effects. 
What is Nectifirm? 
Nectifirm is formulated with peptides and several potent extracts which help skin appear firmer and smoother. These active ingredients comprise:
•     Palmitoyl Tripeptide-5 – which reduces the appearance of fine lines and wrinkles.
•     Saccharomyces cerevisiae, Palmitoyl Hexapeptide-12 & Palmitoyl Tetrapeptide-7               – to firm and lift skin.
•     Algae Extracts – for the retention of dermal moisture and tone.
•     Ceramide 2 – to enhances water retention and reduce skin dryness.
•     Bamboo, English Pea Extract & Glucosamine HCl – to smoothen skin and                           decrease appearances of fine lines and wrinkles.
•     Dihydromyricetin (from Wax Myrtle Shrub) – which reduces signs of rough, crepey skin.
•     Vitamins C & E – to brighten and balance skin tones.
Why Nectifirm?
Unlike other skincare systems which target older individuals, Nectifirm is advantageous across all age groups. Among young patients, it prevents neck lines. Middle aged or mature patients may enjoy smoother, firmer, more lifted skin with fewer indications of lines and wrinkles. A fast-acting product, patients have been noted to enjoy visible outcomes following two to three months of continuous use. In Dr. Thum’s opinion, Nectifirm is a firm contender in the skincare game because of its efficacy and rapid results. Should patients desire better rejuvenative outcomes, Dr. Thum recommends combining good skincare regimes with treatments like skin boosters, laser rejuvenation and ultrasound to enhance and prolong Nectifirm’s awesome results. 

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