Neck Neglect

Does anyone else remember when Richard Fish played by Greg Germann on Ally McBeal infamously referred to sagging neck skin as the “waddle”? Horrifying! I remember watching that episode with my mother whose hand immediately shot up to her own waddle the instant the word left Richard Fish’s mouth. The first time I became aware of my turkey neck was in 2014 when Tyra Banks taught her America’s Next Top Model hopefuls “the turtle” a simple motion of jutting out your chin when being photographed to alleviate the dreaded double chin, which actually has nothing at all to do with your chin, it’s just…scrunched up neck skin. Then there are the rules for the Insta-models that are all over social media. Never look straight into the camera. Tilt the chin down. Raise the camera above your sightline. I’m sure there are more, but I'm too old to know them. And anyway, I think I’ve made my point. People care about their necks in photos, so why not, instead of becoming a photographic contortionist, just fix your neck? You can’t walk around looking like a turtle all of the time!

Sometime shortly after that disturbing Ally McBeal episode, my mother booked an appointment for a neck lift consult with a local surgeon. Had it happened just a few years later, she would have had so many non-surgical options! Between Radio Frequency for tightening and fat reduction, BBL or Photofacial for redness and brown spots, resurfacing for texture and tone, and even injectables for a multitude of fixes, surgery might not be necessary.

Tightening skin on the neck can be accomplished in several ways, but in my experience, the most efficient and effective, with the least downtime, discomfort, and cost is microneedling with radio frequency. There are lots of these devices on the market right now and after researching and doing demos on our favorites, my colleagues and I decided that they are all good, but one stands out as superior. Scarlet SRF uses the basic principle of adding radio frequency to microneedling to stimulate collagen, and then cranks it up a notch by using specially milled needles that drive the energy to the deeper tissues of the skin while insulating and protecting the surface. At the bottom of each needle stamp the RF energy is released into the reticular dermis where elastin fibers live. The energy is converted to heat that causes contraction and tightening in the deeper architecture of the area being worked on. Between the collagen stimulation and elastin fiber contraction, a significant lift occurs that has the constitution and support to last for years to come. This technology is, by far, my newest favorite tool for treating skin laxity of the neck (BONUS: it can be used everywhere else on the body too).

What if it’s not just skin hanging down and ruining your selfie? What if there is a fat deposit living there too? Some people carry fat in the submental area under the chin. In years past, liposuction was the best way to address this pleasantly plump pocket of adipose tissue, but not anymore! While liposuction is still a viable option for some, those who want a non-surgical avenue are in luck. Kybella is an injectable product that destroys fat. It can be somewhat effective when properly injected but comes with some pretty significant bruising, swelling (it’s referred to as the bullfrog effect to give you an idea), and takes 4-6 weeks to see results that I would describe as only okay. A better alternative is another amazing radio frequency device called AGNES RF. This device is so effective that it has replaced the need for Kybella in our office. It works by delivering energy into the targeted area and creating lipolysis. When subcutaneous fat is heated to 70⁰C it melts and the body excretes it. Depending on the amount of fat being treated you can expect a little bit of swelling and in some cases bruising, but nothing that will keep you from living life.

So, now you have a beautifully taught neck, but it’s covered in sun damage. Most people know that brown spots are caused by sun damage, but did you know that diffuse redness in skin is also a result of too much unprotected sun exposure? Reds and browns in the skin can easily be treated with pulsed light therapies such as Intense Pulsed Light (IPL) and BroadBand Light (BBL™). Both target chromophores in the skin but the difference is that IPL targets a group of wavelengths or multiple target chromophores at once, while BBL is one specific wavelength at a time making it more precise. BBL is one of the best corrective treatments available in medical aesthetics. Not only does it produce dramatic change in appearance as brown spots disappear and vascular redness fades away, but it also changes the gene expression in the skin to turn back the clock.

A 2012 study out of Stanford University shows that Sciton BBL (BBL™) treatment changes the expression of genes linked with aging to resemble the gene expression of young skin. Pulsed light therapies whether IPL or BBL come with only what I call “social downtime” meaning that you won’t have to stay home, but you might want to schedule your treatment well before any social engagements because superficial pigment will respond to treatment by turning dark brown (resembling coffee grounds) and then sloughing off over a period of 1-2 weeks depending on the area treated. For the neck, plan on it taking closer to 2 weeks. If you have a treatment but don’t get coffee grounds, which are actually called micro crusting, that just means that your pigment is deeper in the skin. It will still darken, but instead of sloughing off, it will be absorbed by the body.

Redness in the skin is always a result of vascular dilation. The red color comes from blood that flows through vessels that have stretched out like the elastic in an old pair of undies. Pulsed light will coagulate the blood in those vessels signaling the body to absorb the vessel and reroute the blood flow thereby reducing redness in the skin. When treated, the reds get redder until the body gobbles up the offending vessels which can take a week to ten days. Erasing years of sun damage and aging within two weeks is a rather good deal if you ask me!

These treatments are all well and good, but when you have rough textured skin, or if you’ve developed keratoses you may need to pull out the big guns and opt for resurfacing. Resurfacing can be scary if you’ve never had any exposure to the process, but it’s actually not too bad (I’ve had it done…a few times). Treating the neck is a little tricky because we can’t be as aggressive as we would be on the face due to thinner more delicate skin, but with the right parameters, resurfacing can transform your neck. There are several options for resurfacing. Erbium energy is used to ablate the skin whittling down the top layers for full field regeneration. That means that 100% of the treated skin will have been ablated and need to heal. Erbium can also be used fractionally, meaning that there are only columns of ablated skin (think aerating a lawn). We use fractional ablation for highly textured skin. It regenerates in a shorter timespan than full field ablation because each column is surrounded by healthy cells that aid in the healing process. There is also the option of plasma regeneration which can have the same dramatic transformation without the added downtime. Plasma is a newer technology that allows us to resurface deeper tissue while the superficial skin acts as a dressing shielding the healing process from external irritants. This means less downtime! Check out my post “Plasma for Skin” to learn more about this awesome device and it's benefits.

Options for non-surgical neck rejuvenation abound, but none of it will matter if you don’t follow up with proper at-home care. Your skincare regimen should always be carried down to the neck and chest with the exception of strong exfoliants and corrective acne treatment products. My earlier blog post “Distance Learning: Products 101” will give you solid guidance on what to use, and when to use it. If you are using products on your neck but aren’t seeing a whole lot of change, maybe it’s time to upgrade to medical grade products I explain the difference in the post “Why Are You Still Using That?” While we touched on devices and products for the neck, there is a whole world of injectable possibilities too. Don’t worry, I called in an expert to tell you all about it! Stay tuned for part two in the neck series “Thank You, Necks” written by Kendra St. John, BSN,RN

To schedule a complimentary consultation with me, Erin Cooper, LME,CLT, call The Skin and Laser Center at Stephen P. Beals, MD 480.947.6788. Begin your neck transformation today by taking advantage of our June Specials that are all about the neck!

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