If it hasn’t happened yet, trust me when I say that one day you will wake up and ask yourself the question “why is my neck sagging”. Nora Ephron wrote a book called I Feel Bad About My Neck and in it she gave us insight into the world of aging. I laughed all the way through it and now, a decade later, I appreciate it more than ever. Thankfully, she didn’t have to endure video chats on Zoom and Marco Polo where every flaw comes out depending on the position of the camera.

This post is dedicated to all of my girlfriends and clients who ask – why is my neck sagging and what can I do about it? It is a big deal, so let’s start by explaining why and then get into the what.

What’s the Cause of a Sagging Neck?

The skin on our necks is very thin and during aging, the natural breakdown of collagen is significantly more noticeable in this area than elsewhere. Additionally, weakened neck muscles and constant sun exposure further contribute to the problem. 

What Can Be Done About a Sagging Neck

A surgical neck lift is the most popular option for transforming a sagging neck. But did you know that there are several non-surgical options that offer impressive results? It’s a good idea to take these into consideration before deciding on surgery. 

A first step is to remember to include your neck and chest in your daily skin care routine. If you use retinoids, Vitamin C, alpha hydroxy acids, and hydrating serums, such as the Hi Serum on your face, be sure to apply them to your neck area as well. Collagen boosting products like the Hello Mask will increase cellular turnover, plump the skin and smooth unevenness.

Adding supplements into your diet can also delay the inevitable. I found collagen producing supplements after researching for a blog post on the topic and have been taking them daily ever since.

Non-surgical Options for the Neck

Ultherapy is known as a non-surgical facelift. The device used in this non-invasive treatment is called Ulthera. It uses high intensity focused ultrasound (HIFU) to “lift” skin and reduce lines and wrinkles. It does this by heating up a deep inner layer of the dermis which causes the skin to contract. The contraction makes the skin look firmer and tighter while stimulating collagen growth. After having the first treatment it will take about 3 months to see the subtle changes. 

Personally, I like Ultherapy because there’s no down-time, injections, anesthesia or surgery. You can think of it as a shrink wrap machine, but instead of heating the plastic on the outside you are heating it from the inside out. It’s not meant to replace a facelift, but it can help to stave off surgery or help your skin stay tight after a more invasive procedure. There are 2 schools of thought, some docs say the first year you can have one treatment per year while others say you can have two treatments 6 months a part. After that, it’s best to maintain the results by having the treatment annually. The average cost of an Ultherapy treatment is $2700.

In San Francisco, I recommend Christina Tucker, PA at 450 Derm.

Botox for Neck Sagginess

Botox can be a good option for people with low levels of neck fat and minimal skin sagging. Botox can tighten certain areas and relax the look of visible neck bands. It is recommended to repeat these injections every 3 to 4 months to maintain results. The treatment is minimally invasive and comes with an average cost of $600. 

PRP for the Neck

Platelet-rich plasma, otherwise known as PRP is another in-office treatment. For a full description of PRP you can refer to my previous post which goes into further detail. For treatment of the neck and décolletage area, there are usually two options that go well with PRP: microneedling and CO2 laser. Both create micro-pricks to the skin that initiate a wound response; it typically takes 7-10 days to recover from the redness, swelling, and flaking. Multiple appointments are necessary in the beginning and these would be done every 4-6 weeks until desired results. After that, you can repeat the treatment annually. The results are gradual and you will see an overall tightening and smoothing of the area. 

Surgical Options for an Aging Neck

The term “rhytidectomy” describes any facelift procedure. Surgeons use subsets of this to achieve better results. Neck contouring usually includes liposuction and a neck lift.

Liposuction on the Neck

Liposuction is a good solution for removing fat cells, e.g., if you have a double chin. However, this procedure is recommended sooner rather than later, ideally in the 30’s age range. The older we get, the elasticity in our skin is lost and the skin appears more “stretched out”. So, if we remove fat cells from this type of skin, it is not likely to snap back and appear firm. Rather, it will remain loose and sagging. 

What is a Neck Lift

A lower rhytidectomy, also known as a lower face lift is a surgical procedure that aims to reverse signs of aging in the neck and jaw region. The procedure pulls up the skin but doesn’t necessarily pull up the neck muscles. You may have seen people who have had facelifts where their skin looks “pulled” or like they’re stuck in a never-ending wind tunnel. This effect happens as a result of only tightening the skin and not focusing on the muscles. Nowadays, a good surgeon will lift up the platysma and tighten the underlying tissues and then gently pull the skin over that. 

Deep (Dual) plane Rhytidectomy aka Two Layer Facelift 

A deep plane rhytidectomy uses newer techniques to achieve better results. If you’re over 45 years old, the skin on your face has already begun to show significant signs of aging. Your surgeon will probably recommend a neck lift and a lower facelift. Having the two procedures together will ensure a more balanced look. However, if you’re 45 years old and living in a place like Beverly Hills you will probably be told to get a full facelift to get it over with. 

As you can imagine, these types of procedures are extremely personal, so arranging multiple consultations with various surgeons is essential. It’s worth the $150 (average) consultation fee to make sure you choose the best doctor for you.

Pricing For Neck Lifts 

Pricing runs the gamut and there are a lot of varying factors to consider when trying to compare apples to apples. For example, hospital fees in major cities, as compared to the Midwest are more expensive. Then, some doctors have their own in-office surgical suites and avoid hospital stays entirely, which can cut down on some of the costs. However, the price can go up again depending on overnight stay requirements or the expense of a private-duty nurse. Most of the time when you’re having a combination of a face and neck lift you will need an overnight stay and a nurse.

On average, in San Francisco or Los Angeles a neck lift could cost between $8500-$9500. Whereas, a lower face and neck lift combination would be $14,500-$15,500. Additional fees such as hospital, private nurse, and anesthesia fees can add up to $10,000 or more, especially if an overnight stay is required. Something to consider is the quoted fee “all-inclusive”, meaning, does it cover all surgical expenses or will you be billed separately for each item (surgeon’s fees, operating room expenses, anesthesia). 

Just remember to explore all of your options and especially the non-invasive ones first. Sunscreen will be your first defense, and preventing extra damage and maintaining existing collagen is key! 

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