A Systematic Approach to Neck Rejuvenation
Dermatologic Mohs Surgeon Gabriela Casabona, MD shares her seven-step approach to treat skin laxity and restore volume to the neck.
Neck rejuvenation is a common request from patients seeking to improve their appearance. It has been well documented how impactful aesthetic procedures can be on a patient’s lifestyle and self-esteem. Among the patients seeking non-surgical procedures in our clinic over the last 5 years, 30% were requesting neck rejuvenation, specifically. Many patients seeking neck rejuvenation believe that the problem is at the skin level; however, the neck is impacted by ageing across the neck and other regions, such as the mandible, mid-face, and temples. Therefore, planning treatments to rejuvenate the neck becomes difficult. The solution lies in using combinational procedures not only to address the problem in the neck region but in the other regions as well.
Understanding the ageing process across each layer, such as the superficial musculoaponeurotic system (SMAS), skin, and fat, is vital to correctly evaluate and determine a treatment plan when considering the use of energy-based devices, threads, biostimulation or fillers.
In 2019, a study performed on 200 patients evaluated the ageing of the SMAS as well as the superficial and deep fat layers in different age groups, gender, and body mass index (BMI). While in 2022, another group looked into the same age groups, gender and BMI but included the skin thickness. Both studies concluded that with age, the SMAS became more superficial in certain areas, such as the preauricular, submandibular, and neck due to the loss of the superficial fat layer. In addition, there was evident thinning of the skin, especially in the neck, related to the patient’s age. Therefore, with a patient who is over 45 and seeking neck rejuvenation, it is likely I will have to address skin thickening as well as add support to the skin below the dermis by adding or restoring the fat layer. I may choose to combine PRP and microneedling7 or radiofrequency to treat the skin surface plus HA or biostimulators to restore the subdermal layer.
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