But it turns out that isn’t true. These days, less-invasive options exist to improve the appearance of one’s neck, provided it isn’t a full-blown turkey wattle. Like a romance, a neck can go wrong in many ways. Weight gain or genetics may lead to a double chin. Loose skin can be compounded by underlying lax muscle. A neck-lift (on its own or with a face lift) remains the best bet for a striking, lasting fix.
But careful liposuctioning of excess fat can also help streamline the full necked, especially those who still have relatively youthful elastic skin that can bounce back after the procedure. The trick is not to be suctioned to the point of looking skeletal (one should watch for underlying loose bands of muscle, which become more obvious after).
If the issue is these isolated bands, injecting Botox into the neck muscle can make them less conspicuous in a patient with great skin tone, said Dr. Rod J. Rohrich, chairman of the plastic surgery department at the University of Texas Southwestern Medical Center in Dallas. But the fix lasts only three to four months.
Promoted during the last year on “The Rachael Ray Show,” Ulthera is a new skin-lifting procedure using focused ultrasound to spur collagen growth deep under the epidermis. A single treatment may improve the contours of under-chin laxity in patients roughly 40 to 55 years old who feel they aren’t ready for surgery or amenable to it, several doctors said, including Dr. Matthew White, a facial plastic surgeon at NYU Langone Medical Center. The Ulthera handpiece pressed to skin allows doctors to see underlying layers on a screen (as with gynecological ultrasounds) before they start treatment, a first for noninvasive dermatological procedures. “We deposit energy to a precise depth below the surface of the skin without affecting the intervening tissue,” said Matthew Likens, chief executive of Ulthera, the Mesa, Ariz., company behind it.
Patients may feel pain during treatment. Prospective candidates should also be aware that peer-reviewed published studies have yet to quantify just how much tightening can be expected in the neck and lower face. “That’s true,” Mr. Likens confirmed. (Such research is continuing, he said.)
That didn’t stop Dr. Mehmet Oz, a cardiologist, from proclaiming on his television show last month that Ulthera was a “revolutionary nonsurgical face-lift” and promising to get rid of a viewer’s sagging neck live onstage. In the segment, Dr. Haideh Hirmand, a plastic surgeon in Manhattan, said it was the first time she was “really excited” about a noninvasive technology for tissue-lifting. She emphasized that Ulthera is no substitute for surgery, if neck skin is too loose. (In a later interview, she recommended a pain medication like Percocet and an antianxiety drug like Valium before treatment, which she said was worthwhile for minimal neck looseness.)
“The company will tell you it doesn’t hurt — it does,” said Dr. Tina Alster, a dermatologist in Washington, who has made a pain and an antianxiety drug mandatory for her Ulthera patients. That said, Dr. Alster, who will get a research stipend from Ulthera to study the device’s effect on off-face areas, is seeing results in the eyebrow area, cheeks and necks of middle-aged patients.
The “Dr. Oz” segment left the impression that the Ulthera device has been cleared by the Food and Drug Administration to be used for the neck and lower face as well as for the eyebrow area.
Not so. “The company can only promote the device for eyebrow-lift,” although the treatment regimen included cheeks and neck, too, Karen Riley, a spokeswoman for the agency, wrote in an e-mail. “But they can make no claims regarding these areas and cannot promote their device for treating specific conditions within these areas.” (As with other procedures, however, doctors can treat other body parts at their discretion.)
Nina Meyerhof, who runs Children of the Earth, a peace organization, was willing to chance it when she met with Dr. White this month for Ulthera to firm up her neck and jawline. “I wanted everything to look fresh and tight,” she said.
At 68, Ms. Meyerhof, of South Burlington, Vt., is a decade or two older than Dr. White’s typical candidate, someone who is just starting to notice under-chin skin laxity. But Dr. White, who has researched focused ultrasound, felt her skin was still so elastic that it would tighten. (How rapidly skin ages varies with factors like sun exposure, genetics and smoking — which may be why your older pal’s neck skin is taut while yours gave way at 47.)
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