The skin plays an important role in a person’s appearance. As such, the skin-care market is packed with various products that aim to protect the skin, preventing the development of wrinkles and fine lines. However, the general public often focuses only on skincare for the face, forgetting about the areas further down the neckline.

The neck and decolletage are equally important to the face as indicators of aging. As such, moisturizers, serums, cosmetic fillers like Belotero, and SPF protection should be applied on these areas, as exposure to the environment may accelerate the aging process on these delicate areas. Unfortunately, these areas are commonly neglected by many patients, leaving them running to the clinic for intensive treatment once the damage has already been done.

While prevention is key in treating these areas, cutting-edge anti-aging treatments can be performed to restore their natural youth.

The aging neck

Following the periorbital area of the face, the neck has the most delicate skin surface on the body. This area contains low amounts of elastin fibers and fatty structures, thus reducing support for the collagen matrix in the skin. The platysma is the main muscle of the neck, running vertically from the chest to the base of the head. Throughout the aging process, this muscle shows through the weakened neck skin, causing the formation of platysmal bands, sagging jowls, the loss of the cervicomental angle and jawline, and decreased submental fullness.

What’s more, today’s modern lifestyle further accelerates the aging process, as individuals constantly tilt their heads downwards to look at their smartphones. This can cause a new phenomenon known as “tech neck,” in which deep creases are formed under the jaw from this downward motion.

Treatment options

Luckily, these signs of aging can be reversed through cosmetic treatment. A variety of nonsurgical options exist for treating these issues, including dermal fillers, botulinum toxin injections, and thread lifts, among others.

Cosmetic injectables

When it comes to eliminating wrinkles, hyaluronic acid-based dermal fillers are a popular non-invasive treatment. They are used to improve the elasticity and volume of the neck and decolletage area via intradermal injection. Generally, fillers will offer 6–9 months of relief from concerns in these areas, making these treatments totally reversible if needed. To maintain results, follow-up treatments will be required.

Botulinum toxin

Known as a “Nefertiti lift,” the use of botulinum toxin injections can relax the neck muscles, reducing mild jowling and platysmal bands.

For the initial assessment, request the patient to bite down on their back teeth. This helps to visualize the contraction of the platysmal bands, making it easier to perform this intramuscular injection. Administer the injections vertically along the bands down the neck. These injections are strictly intradermal, so practitioners should avoid other delicate structures within the neck, such as blood vessels and nerves. Otherwise, difficulty swallowing and speaking may occur.

Thread lifts

Thread lifts are used to resolve sagging skin of the neck. In these treatments, surgical threads are placed within the dermis, providing lifting power. Doctors may use either free-floating barbed threads or suspension threads anchored to the face or the scalp, depending on the clinical indication. Generally, these threads are made from polydioxanone (PDO), an absorbable substance that promotes collagen formation.5 This improves the skin’s natural structure.

This being said, this method can result in serious side effects if done improperly. These include swelling along the thread insertion site, hematoma, the formation of seroma, infection, migration of the sutures, and dislodging of the thread’s position. As such, a trained medical professional must perform these procedures.

Other treatments

If the patient is not comfortable with intradermal treatments, they can invest in devices that demonstrate positive results in treating the aging neck and decolletage. These technologies may include radiofrequency, ultrasound, and laser resurfacing with fractional CO2 laser. As each device has its own benefits, it is highly recommended for both patients and doctors to research which device is most suitable for each clinical indication.

The most common factor among all these devices, however, is the utilization of thermal energy. These devices funnel localized heat into the dermis, stimulating fibroblasts to produce more collagen in the subcutaneous tissues. Additionally, the increased temperature causes collagen fibers to contract, smoothing out fine lines and wrinkles on the skin.6 Overall, this produces more youthful-looking skin texture.

Other treatments that are applicable for the neck and decolletage include mesotherapy, microneedling, platelet rich plasma (PRP) therapy, and skin peels. Some of these alternative treatments, or “add-ons,” can be included in the patient’s skincare and treatment regimen to enhance the rejuvenation process, and do not require frequent office visits.


Clearly, the neck and decolletage are equally as important as the facial skin in the realm of anti-aging treatments. To avoid sagging skin and wrinkles, patients should always apply high-quality skin-care products and SPF for sun protection to these areas. In addition, they should adopt a lifestyle that involves a healthy diet and exercise, as this can help improve skin health. If the patient has the habit of smoking or drinking alcohol, it is important to encourage smoking cessation and the reduction of alcohol intake, as these factors also contribute to the aging process.

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