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What Can I Do About Sagging Neck Skin?

By: Christopher Knotts, MD


The neck is anatomically complex and patients first need to understand the various layers so they can understand where their ‘problem area’ lies, and in turn, understand what procedure is necessary to fix it.

The surgical layers of the neck are (from superficial to deep), the skin, the superficial fat, the platysma muscle and the deep fat. Depending on which area is the most problematic, a patient may choose a minimally invasive option or a surgical option.

The skin: If there is excess or drooping skin, the best fix is surgical. The skin can be lifted and re-oriented so it is tighter and smoother. The deeper areas can also be addressed at the same time.

The superficial fat: This fat is immediately under the skin and can be approached with liposuction or with a non-invasive injectable like Kybella. The differences between these 2 are an entire conversation, but the short answer for which is better is that nothing removes fat as good as liposuction.

The platysma muscle: If there are muscle bands or a loose neck with poor contour (especially in profile view), then the platysma needs to be surgically tightened. This is typically done via a small incision under the chin. The deeper fat can also be addressed at the same time.

The deep fat: This fat cannot be approached with a non-invasive option like Kybella® or even with liposuction. A small incision beneath the chin is required to surgically remove the fat. This is where there is potential to give the sharpest profile view possible and the most powerful neck transformation.

Often patients fall in a continuum of several areas they desire improved. An injectable may be a few days of soreness and a week of swelling, whereas a neck lift may be bruising and sutures for a week, followed by several more weeks of residual swelling. Each patient’s neck is approached individually based on desires, recovery, cost and timing. During a consultation, your doctor will tell you which layers are required to get the look you desire.

- Christopher D. Knotts, MD


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