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  • Restoration of a youthful neckline is arguably one of the most critical aspects of achieving overall aesthetic balance.

  • Multiple intrinsic and extrinsic factors including genetics, photodamage and gravity contribute to aging in the neck.

  • Combination treatments may ultimately yield better outcomes for many patients.

image Beginner Pearls

  • Loss of definition along the jaw—an invariable effect of changing anatomy over time—may be improved via the Nefertiti Lift.

  • Microbotox is another useful technique for improving the overall appearance of the neck.

image Expert Tips

  • For optimal restoration and multilevel cosmetic revitalization, dilute fillers are frequently combined with light- or energy-based modalities that stimulate tissue contraction and subsequent tightening.

  • Neck liposuction using tumescent anesthesia will dramatically improve the cervicomental angle and create a pleasing contour.

image Don’t Forget!

  • Combination treatments may offer the best solution for neck rejuvenation.

  • Plication sutures may be very useful to maximize and maintain lift.

image Pitfalls and Cautions

  • Laser resurfacing on the neck should be performed with caution due to the lack of pilosebaceous units and the attendant increased risk of scarring.

  • There have been reports of scarring even with a fractional CO2 laser.

image Patient Education Points

  • There is typically a tradeoff between the amount of downtime associated with a procedure and its efficacy.

  • Patients should understand that many treatments used for neck rejuvenation will need to be repeated on a regular basis.

  • Patients should ideally see neck rejuvenation as one component of a global approach to facial rejuvenation.


Treatment of the aging neck presents a special challenge to the aesthetic dermatologic surgeon. Thin, fragile skin, the small number of cutaneous adnexal and pilosebaceous units, variable accumulation of submental fat, and hypertrophied and separated platysmal bands require careful planning and a comprehensive approach.1 Restoration of the youthful neckline is arguably one of the most critical aspects of achieving overall aesthetic balance, particularly as the increasing popularity of procedures in facial aesthetics gives rise to greater disparity between the smooth contours of the treated face and a neck that appears skeletonized and distinctly aged.


While the overall anatomy of the neck is complex, the superficial anatomy most commonly addressed by cosmetic procedures includes the skin, subcutaneous fat, superficial cervical fascial system, and the platysma. Neck skin is very thin, only slightly thicker than upper eyelid skin. Subcutaneous fat distribution is variable, though it is thinly layered over the platysmal muscle, but tends to accumulate in the submentum. There is also a deeper submental fat pad.

The plastysma is a thin shield-like muscle. It originates on pectoralis fascia. Its anterior border is the risorius muscle at the oral commissure. Posteriorly, it inserts into the SMAS. The plastysma is innervated by the cervical branch of the facial nerve. Its ...

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