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Aesthetics Practice Today

"I Hate My Neck"

Published September 9, 2014 3:38 PM by Mina Grasso

Looking in the mirror at submental (under the chin) fat, loose, crepey, puckered skin and tight platysmal bands going down the neck can have a psychological impact. Loss of the definition of the jawline and neck can be from a genetic predisposition, weight gain or aging. It is generally considered aesthetically unappealing.

Most seem to be aware of the surgical (facelift) option with or without liposuction of the submental fat or a platysmaplasty. Surgical procedures are very effective, but some patients may not be candidates due to various medical, social or economic conditions. The rapidly advancing world of light and laser technology in aesthetics during the last 2 decades has introduced patients to a variety of exciting non-surgical options. Pigmentation, texture, broken capillaries, sun damage, fine lines and wrinkles have been treated with various light, laser, radiofrequency and ultrasound devices externally. Most procedures require multiple treatments. Some of these procedures resulted in minimal satisfaction for patients while others depending on severity of condition and patient expectations result in great satisfaction.

Injections for localized fat reduction is performed in some clinics including ours years ago. Often a combination of phosphatidylcholine and deoxycholate is compounded in the formulation. The solution disrupts adipocyte membranes, which leads to adipocytolysis.  This creates an inflammatory response, reduces the fat but causes swelling in the area treated for several days. Other potential side effects include localized pain, bruising and erythema. It is common for patients to report transient numbness and induration post procedure. Multiple treatments are required. These localized fat injections have gone in and out of popularity probably due to lack of well-controlled clinical studies and standardization of formula. There is a proprietary formulation of synthetically derived deoxycholic acid that is currently being studied. In our experience, our patients felt that it was too much downtime per procedure and multiple treatments were required.

Injectable RF (radiofrequency energy) using ThermiTight is a new minimally invasive procedure. Local anesthetic is applied to the neck and jowl. A thin radio frequency probe is inserted under the skin and used to heat the submental fat and surrounding skin while the resulting temperature rise is closely monitored with a special heat-sensing camera. Fat reduction and skin tightening is the end result. Patients are noted to see improvement around 2-3 months but may continue to improve for up to 15 months.

Neurotoxins, such as Botox, have become one of the favorite treatments for the neck. It minimizes necklace lines, softens platysmal bands and helps define the jaw and neckline. Patient satisfaction is extremely high with one or more of the above treatments.

In addressing patient's concern of wanting to improve the appearance of their neck, realistic expectations with results must be carefully discussed. Practitioners have to be sensitive to social downtime and accurately describe the post-procedure time frame and possible complications. Satisfaction is highest using a combination of modalities while keeping in mind the patient's budget.


I have neck bands that need to be addressed, also wrinkles upper lip and parentheses around mouth, etc.  A week ago I had restylane under my eyes and they look horrible with puffy bands.  I am leaving for Vegas Saturday and be back the following Friday.  How much is a consultation.

dianne shore, RN retired November 25, 2015 8:27 PM
Riverside CA

At Schrier Family Chiropractic, we help our patients to achieve their optimal health. Many of our clients struggle with pain management so our company focuses on teaching our patients to be proactive, and how to reach their goals using an inside out approach. We understand how you feel. To find out more about us, visit us at

Ocele September 16, 2014 7:00 PM
Miami NY

Excellent article Mina Grasso - thank you.  Wise practitioners create realistic expectations for baby boomers by emphasizing improvement rather than perfection. Photographs of results similar to what can be reasonably expected are valuable for the patient prior to treatment and may be valuable for the practitioner after treatment, in the event the relationship sours.

Susan Keane Baker, Managing Patient Expectations - Author September 13, 2014 2:27 PM
New Canaan CT

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About this Blog

    Occupation: Physician Assistant/Nurse Practitioner
    Setting: Miami & Upland, Calif.
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