We always strive to provide you with the most up-to-date treatments and procedures for facial anti-ageing, as well as information about products backed by medical science to maintain healthy, radiant skin. One area that tends to be neglected (and actually shows ageing the most), is the neck. Dr Riekie Smit unpacks why our necks betray our age and offers some interesting solutions.

You may have heard people say that you can tell a woman’s true age by looking at her neck or hands. Often, this is really the case due to a combination of factors:

• The skin on the neck is thinner than the skin on the face, with a thinner dermis and less sebaceous glands (oil glands).
• The neck is frequently neglected with sun protection and is exposed to UV damage on a daily basis, especially in South Africa.
• We also often forget our neck and chest with skincare and skin treatments.
• The strong muscular bands in the neck (platysma) causes tension and movement over years and especially in those who exercise regularly.
• The neck has started showing earlier signs of ageing due to our addictions to phones. This is called ‘tech neck’ or ‘text neck’.
• Fat pockets in the neck show the changes in weight in our body, as the fat pockets below our chin easily expand with weight gain and deflate with weight loss.

A few or all of these factors contribute to the various concerns that we develop in the neck region.

That leads us to some questions:

• Are there preventative measures that can be adopted in order to avoid premature ageing in the neck?
• If this area is causing concern already, are there treatments that target this region?

The answer to both questions is positive, but everyone is different, so to be able to choose the most effective treatment, we need to look at the specific concern that has developed. If there are a variety of concerns, then multiple types of treatments may be required.

NECK CONCERN

Wrinkles: how they are formed

Necklines start developing due to a combination of the factors mentioned earlier, and may also be genetic when seen at an early age. Hours of phone use worsens these lines. If you have started noticing these ‘tech neck’ lines or want to prevent them from forming, it is important to change the way you use your phone: rather bring your phone higher up towards your face instead of moving your neck down to look at your phone.

Also, avoid pinching your phone between your head and shoulder to free your arms. This is detrimental to the skin on your neck as well as for your neck muscles and joints. Bad posture and incorrect use of your neck is a common cause of headaches and neck pain.

Neck wrinkles

 What to do

Treatments for necklines are focused on boosting the collagen content in the dermis to reduce wrinkles. Injections that promote skin boosting are made of very small particles of hyaluronic acid fillers. These are injected into the necklines. Free or non-crosslinked hyaluronic acid is a natural form of the acid that is hydrating and is often injected to enhance skin hydration and boost collagen. Wrinkles can also be treated with non-ablative laser treatments that boost collagen production.

Loose Skin

Ageing, smoking, unhealthy lifestyle, sun exposure, excess movement and weight fluctuations all cause a loss of collagen, which in turn triggers the dreaded ‘turkey neck’ appearance.

Loose skin

Tightening the loose ends

The goal of treatment is skin tightening. This can be done by physically pulling the skin away from the midline with surgery or with non-surgical treatments. The non-surgical options include thread lifting, intense collagen boosting (with fractional ablative lasers or skin revitalizing injections/ mesotherapy) or tightening devices such as radiofrequency, HIFU, infrared laser tightening such as Thermage®, Ulthera®, Exilis®, Titan® or similar devices. Ablative fractional lasers give more intensive tightening than non-ablative lasers but are riskier in those with darker skin. There could also be a risk of scarring.

Neck Bands

The strong platysma muscle is a broad muscle starting from the chest, covering the neck and attaching to the lower face. Although it’s an important muscle, its overactivity causes the unsightly bands in the neck and contributes to sagging of the lower face.

Neck bands

The noose around your neck

It has become very popular to treat or relax the platysma with botulinum toxin injections. This reduces the bands in the neck, but also gives you a better defined, improved jawline by preventing sagging of the lower face. A misconception is that one should exercise the neck muscles – rather strengthen your core and stretch your neck muscles.

Double Chin

This is formed due to fat accumulation in the area below the chin and jawline, mostly because of weight gain, but genetics also play a role.

Double chin

Keep your chin up

Obviously, weight loss would help significantly, but these fat pockets can be reduced in size with either fat dissolving injections or device treatments such as fat freezing devices and certain radiofrequency devices.

The fat dissolving injections should only be performed by a well-trained doctor who understands the danger zones of the anatomy of the neck. It is a very effective and affordable treatment if the procedure is done correctly and safely.

Sun Spots/Sun Damage

Chronic sun exposure in the thin-skinned neck and chest area can show significant sun damage and brown spots.

Sun Spots/Sun Damage

Prevention is better than cure

Avoid the sun!

The most important step is to apply a high SPF daily to this delicate region. Repeated superficial peels may improve this area, but usually, a more intensive treatment may be required for significant sun damage. Fractional ablative lasers (Fraxel®, PicoFX ® or similar) or medium depth peels (in fairer skin) are effective.

PDT-ALA is a medical treatment that treats pre-cancerous and superficial cancerous sunspots. This is often combined with a course of prescription cream to remove cancerous cells. The chest area is very delicate and surgical removal of skin cancer may be required, which may lead to unsightly scarring. Rather avoid the damage, cover up and use good sunscreen.

Redness or Poikiloderma

Sun ageing causes a red or red-brown discolouration of the neck area called Poikiloderma of Civatte.

Redness or Poikiloderma

A Red Flag

Besides religious sun protection, the only effective way to treat this is with vascular lasers. Vascular lasers emit a specific wavelength that is selectively absorbed by the red pigment (called haemoglobin) in blood vessels.

This means that a vascular laser can remove vascular lesions, areas or red pigmented areas without damaging other tissues or surrounding skin.

These types of lasers could include KTP, NdYag, Pulse-dye lasers, and to an extent, IPL treatments. This type of laser treatment should be performed under the medical supervision of a registered doctor.

Saving your Neck

To sum it up, make sure you understand your specific neck concern and have a discussion with your doctor to choose the most suitable treatment.

Use your SPF daily on the neck and chest area, lather on that expensive night or throat cream and start some clinical treatments on your neck as well as on your face. Do neck stretches rather than neck exercises, and limit the stress to your neck when using your phone.

Preventative measures will go a long way to avoid this particular area being a pain in the neck.

Written by Dr Riekie Smit

Dr Riekie Smit

MBChB, MSc Sports Med, Adv Dip Aesth Med

• Dr Smit has a private practice in Pretoria, South Africa. The focus of her practice is aesthetic medical procedures for face, body and skin treatments www.drriekie.co.za
• Honorary secretary of AAMSSA (Aesthetic & Anti-Ageing Medicine Society of South Africa).
• A faculty member of the American Academy of Aesthetic Medicine.
• Chairperson of the Aesthetic Medicine Congress South Africa (AMCSA).
• President member of the International Union of Aesthetic Union.

A2 Disclaimer: This article is published for information purposes only, nor should it be regarded as a replacement for sound medical advice. 

This article was written by Dr Riekie Smit and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine Summer 2020 Edition (Issue 35 – Dec 2020 to Mar 2021). 

A2 Magazine prints only four magazines each year – reporting seasonally on everything you need and want to know about aesthetics, anti-ageing, integrative medicine, quality and medical skincare, cosmetic dentistry and cosmetic surgery in South Africa – where to go, who to see, what to expect, something new and so much more! Never miss an edition – click here for more info about where you can buy the print and/or digital copy of A2 Magazine (including back copies).

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