NECKS don’t lie. Sagging there betrays age like the rings on a tree, and now-common Botox and fillers in the face make neck imperfections stand out in stark relief. In her 2006 best-seller, “I Feel Bad About My Neck,” Nora Ephron, by then 65 and a resolved turtleneck wearer, raged against the injustice of having no remedy for her slackening throat skin, short of surgery.
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.)
Ulthera’s results take a few months to appear, since creating collagen takes time. But Ms. Meyerhof, who felt discomfort along her jaw during the procedure, said the slight hanging bit under her chin no longer sags, and her face is “tighter around the jawline.” (Heating collagen to a certain temperature can cause immediate contraction, Dr. White explained.)
Mr. Likens, of Ulthera, said patients can expect results to last “a year or longer.” But the peer-reviewed clinical trial of 35 patients submitted to the F.D.A. tracked patients for only 90 days.
Ms. Meyerhof is thrilled with her results but said she would remain so only if they last. “I feel like I paid a whole lot of money for it,” she said, declining to say how much. (Ulthera can cost $1,000 to $4,000 depending on areas treated.) But she put it this way: “If it only works for a year, I will not be happy. I took that gamble.”
Many doctors won’t offer Ulthera until more research is done. Dr. Rohrich, the editor of the journal Plastic and Reconstructive Surgery, said he can’t always differentiate between the photographs of the neck taken before and after the Ulthera. The tightening is “very minimal,” he said, adding that long-term multicenter studies are needed. “Hope springs eternal, and hope springs incredible revenue based on hype,” he said.
Many people who “hate” their necks conclude that tightening the neck requires tightening the face, since, as Ms. Ephron put it, “it’s all one big ball of wax.”
Not necessarily. Granted, “all necks are difficult,” and it’s the hardest part of a face-lift, said Dr. James Stuzin, a plastic surgeon in Miami.
But he and some other surgeons have long offered a so-called “isolated neck-lift.” Some surgeons don’t do neck-lifts, since patients might return complaining that they cannot live with their imperfect jowls once their neck is tight.
PERHAPS surprisingly, men get more isolated neck-lifts than women, plastic surgeons say. “Usually with women, they are getting a face- and neck-lift,” said Dr. Felmont Eaves, the president of the American Society for Aesthetic Plastic Surgery, who practices in Charlotte, N.C. “In men, we don’t have exact statistics, but it’s pretty common to see them come in just for the neck.”
After a 50th reunion for business school made him “very neck-conscious,” Douglas Weil, 74, signed up for an isolated neck-lift in November with Dr. William Y. Hoffman, the chief of the plastic surgery division at the University of California, San Francisco. “It was one of the last things I ever thought I’d do,” Mr. Weil said, adding he hasn’t thought twice about his baldness. But now he’s thrilled with his sleek neckline, he said, and even told his rabbi about the surgery.
The rabbi’s retort? “What men do to please their women!”
A man’s face may age gracefully, but “there’s no way a man’s neck, with all that tissue hanging down, can be graceful,” said Dr. Phil Haeck, the president of the American Society of Plastic Surgeons, who has done two neck-only-lifts for every three face-lifts in his practice in Seattle this year.
“That was the only part that made me look old,” said Walter Dowgiallo, 73, the chief executive of a label-printing company, referring to what he used to call a “rooster thing” under his chin. That was five years ago, before he was operated on by Dr. Joel Feldman, a plastic surgeon in Cambridge, Mass., who wrote a 2006 book, “Neck Lift.”
“You’re out a week, but, boy, I tell you, I’ve got 20 years of looking great,” Mr. Dowgiallo said. Two decades may be an exaggeration, and two-week recovery is more common. But, Dr. Feldman said, “The way I put the muscle together lasts years and years, and usually patients have a better-looking neck for the rest of their life.”