Q&A: 6 Fixes for Neck Lines and Wrinkles

Dr Irwin – Skin Tour.com

QUESTION: What is the best procedure for lessening the vertical tree line marks on the neck? I’ve had these vertical/tree line circles around my neck since I was 15 so I know they aren’t from aging but I would like to lessen them still.

ANSWER: We sometimes joke with our patients that the neck is the “holy grail” of non surgical skin improvement. Very few men/women over 40 would say they are completely happy with their necks. If you haven’t read the very funny book by Nora Ephron called: “I Feel Bad About My Neck, and Other Thoughts on Being a Woman,” it will make you laugh! Below are some helpful tips for neck lines and wrinkles.


Skincare Products that Help the Neck

We use the Neora Firm Body Contour Cream (morning or twice a day), the SkinCeuticals Neck, Chest & Hand (night) and, of course, high zinc sunscreen the most with our patients. We like the Elta MD UV Clear SPF 46 best for the neck.

“Necklace” Lines or “Tree” Lines

These are the lines that run around the neck like a necklace up on the neck or the rings that run around a tree. These are most often hereditary so look at your mom or dad.

  • Botox/Dysport injected in tiny drops into these or “threaded” along the lines will relax them.

  • Very light HA fillers can be used here (like Volbella or Restylane Refyne) but will stay red for awhile and often bruise so be prepared.

Vertical Bands or Lines (Platysmal Bands)

Lines that start generally up under the chin and reach down toward the collarbone. These bands can be thicker or thinner.

  • Botox/Dysport is worth trying at least twice to see if these will “relax” back into place up under the chin

  • The problem is not that they are too loose, but that they are often too tight, which is typical of our “head forward” culture and bad posture.

  • You can try to stretch these (I highly recommend) by sitting very upright on a chair or your bed, place both hands on your chest and pull down. Then gently stretch these bands. It helps to push your jaw forward a little also until you feel more stretch.

  • Sometimes they are too loose in which case a good plastic surgeon may be able to tighten them.

A Fat Pad or Thickened Area Under the Chin (Submental)

  • Usually hereditary and not age dependent. People in their 20-30s sometimes have it.

  • If you have enough fat here to fit in the Coolsculpting Adapter head, then this is the best option.

  • Kybella is a second option and great for fine turning, or those who have a small amount of fat under the chin

Sun Damage and Blotchiness on the Neck

Usually red, tiny red blood vessels (poikiloderma), brown spots or all of these.

  • Best is an Intense Pulsed Light series done by an office with experience and one of the more powerful IPLs (using a recognized medical device). Generally good results in 2-5 treatments depending on how much sun damage.

  • Be sure to do everything also under skincare products above.

Wrinkles and Sagging Skin on the Neck

Caused by a combination of sun damage, intrinsic aging and genes.

  • The sagging is difficult to treat non-surgically if it’s moderate to severe.

  • If you want to go nonsurgical, a combination of CO2 laser, IPL, Sublative Radiofrequency, peels, and the skincare products above are the most effective. Experts only and please ask your dermatologist!

Hope this helps,

Dr Brandith Irwin


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