"There is a new injectable for the neck now. Does that mean I can skip surgery?"
That question has come up in nearly every neck consultation since the FDA approved
SKINVIVE by Juvederm for neck appearance in June. It is a good question, and the honest
answer depends entirely on what is happening in your neck. Below are the questions patients
ask most.
What was actually approved?
SKINVIVE is a hyaluronic acid microdroplet injectable. It was previously approved for smoothing
fine lines in the cheeks, and the new indication extends that to the appearance of neck wrinkles.
It is the first and only hyaluronic acid product carrying a neck indication.
What it does is improve skin hydration and smoothness at the surface. It is not a volumizing
filler, and it is not placed to lift anything.
Will it help my neck?
If your concern is fine horizontal creases, dry crepey texture, and skin that has lost its glow, then
yes, this is a reasonable option and the results can be genuinely pleasing.
If your concern is a heavy or full neck, a jawline that has lost its edge, or vertical cords that
appear when you speak, then no. A hydrating injectable placed in the skin cannot change what
is happening beneath the skin, and no amount of it will.
What causes the vertical bands, and can BOTOX fix them?
Those are the edges of the platysma, a broad thin muscle that runs from the collarbone up over
the jaw. In youth it lies flat. Over time the muscle separates down the midline and its front
borders become visible as two vertical cords, most obviously when you tense or speak.
This is a muscle problem, not a skin problem. That single fact resolves most of the confusion in
this area.
As for botulinum toxin (BOTOX): sometimes, partially, and temporarily. Botulinum toxin placed into the
platysmal bands relaxes the muscle and can soften their appearance for a few months. It works
best when the bands are early and mild and there is little loose skin.
Once there is meaningful skin laxity or a well-defined fat pad under the chin, relaxing the muscle
does not accomplish much. You end up chasing an appointment every three or four months for
a result that is diminishing each time. Many patients reach that realization on their own, and it is
often what prompts the consultation.
When does a neck lift become the honest answer?
When the underlying anatomy has changed rather than the surface. Look for a jawline that no
longer has a clear border, fullness under the chin that persists regardless of weight, skin that
stays creased when you lift your chin, and cords that are visible at rest and not only in motion.
A neck lift addresses these directly. The platysma is tightened and the separated edges are
brought back together, fat is addressed where it sits, and skin is redraped rather than pulled.
When it is combined with a deep plane facelift, the neck and jawline are treated as one
continuous unit, which is usually how patients experience the area anyway.
Can I do both?
Frequently, yes, and this is where the newer injectables are genuinely useful. Surgery restores
the contour. It does not change the quality of the skin covering that contour, and sun damage
across the neck and chest is common in patients from Carlsbad, Del Mar, and Rancho Santa
Fe.
Treating skin quality after surgical healing is complete is a sensible sequence. The structure is
corrected first, then the finish. Read more about neck lift surgery at moradimd.com.
How do I know which one I need?
An in-person assessment answers this in a few minutes. A surgeon looks at your neck at rest
and in motion, checks skin elasticity, feels where fat sits relative to the muscle, and assesses
your chin projection, which quietly influences how a neck looks more than most people expect.
Be cautious of any recommendation made from a photograph or made before anyone has
examined how your platysma behaves. The most common error in this area is treating a muscle
and laxity problem with a product designed for skin, then concluding that nothing works.
A reasonable next step
If you have been watching your neck change and you are not sure whether an injectable, a
non-surgical treatment, or surgery makes sense for you, a consultation is the fastest way to find
out. Dr. Moradi will tell you plainly if a less involved option would serve you better. His Vista
office is open to patients throughout North County San Diego at (760) 726-6451.
