The [Deep] Neck Guide: Erasing Lines, Sagging, and "Turkey Neck"

The neck is one of the first places to show the "tell-tale" signs of aging, yet it's consistently overlooked in daily skincare routines — even though its skin is thinner, more mobile, and more sun-exposed than the face.

In This Guide

01Changes in the Neck with Aging
02Why Neck Skin Ages Faster
03Underlying Structural Changes
04Topical Treatments
05Medical & Surgical Procedures

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THE BASICS

Changes in the Neck with Aging

The neck is often one of the first areas to show visible signs of aging. These changes can affect the skin's texture, the definition of your jawline, and the underlying muscle structure.

Skin Texture

The development of fine lines, horizontal wrinkles, and "crepey" (thin, crinkled) skin that results from the breakdown of collagen and elastin over time.

Structural Changes

Sagging skin and "jowling" along the jawline, which can lead to a less defined profile or a "turkey neck" appearance as underlying fat pads shift and skin loses its support.

Muscle & Fat

Prominent vertical bands (platysmal bands) caused by muscle changes, and fat accumulation under the chin in the "submental" region — the classic "turkey gobbler" look.

Discoloration

The appearance of dark spots or uneven skin tone, often accelerated by years of inadequate sun protection on the neck relative to the face.

DID YOU KNOW

The Impact of "Tech Neck": Beyond natural aging, modern habits play a role. Constant downward glancing at devices can cause "tech neck" — premature horizontal creases formed by repetitive postural strain (Bernardo et al. 2013, Xie et al. 2018).

These changes in neck appearance are driven by aging-related changes in skin, fat, muscle, and bone, as well as repetitive movement. They can be addressed with topical products as well as medical procedures with lasers, ultrasound, fillers, thread lifting, and surgical options such as neck lifts. A combinatory approach involving both topicals and other interventions leads to the best and most dramatic results.

THE SCIENCE

Why Neck Skin Ages Faster

The skin of the neck is more vulnerable to aging and shows the signs — wrinkles, laxity, dark spots — before the skin on the face. There are several reasons for this.

A Thinner Dermal Layer

The dermal layer of the neck skin — which contains collagen and elastin — is thinner on the neck than on the face. Think of collagen like tent poles holding up the tent of your skin, and elastin like rubber bands giving it bounce and elasticity. With less of both to begin with, aging-related declines show up sooner. This is quantifiable at the histological level (Naveen et al. 2014), leading to measurable decreases in skin firmness and greater skin displacement with muscle activity (Engerer et al. 2022).

Greater Range of Motion

The neck is highly motile — subject to constant movement with a larger range of motion than the face. It is more extensible and elastic as a result. In the case of "tech neck," much of this movement is repetitive and regular. The combination of a thinner dermal layer and mobile, repetitive movement makes the neck more prone to horizontal lines and thin, crepey skin (Kim et al. 2013).

Neglected Sun Protection

People are far less likely to protect the neck skin from UV photoaging than the face. UV rays create free radicals that destroy collagen and elastin. Sunscreens and antioxidant serums like Vitamin C serums can protect against UV photoaging, but many people simply do not apply these products to their neck (Seo 2023). This hastens aging and can lead to additional hyperpigmentation and dark spots.

GOING DEEPER

Underlying Structural Changes in Aging

Coupled with these changes in neck skin are underlying changes in bone, fat, and muscle. The bones in the face recede and remodel with age resulting in the repositioning of fat pads and muscles as they realign over the shifting bone foundation. Though these changes in bone structure are small (i.e. millimeters), the effects on overlying structures can be dramatic (Swift et al. 2021).

Fat Redistribution

Generally, subcutaneous fat (the fat right underneath the dermis) declines in the face and neck, leading to a hollowed-out appearance. At the same time, fat in the jowls becomes more prominent with age. Fat deposits also start to accumulate in the region underneath the middle of the chin — called the submental region.

This accumulation of submental fat can lead to a "turkey gobbler" appearance. Looser skin and weakening of the mandibular septum that holds fat compartments in place also causes fat in the jowls to sag and contribute to a "turkey neck" appearance (Hatef et al. 2009, Swift et al. 2021).

Platysmal Bands

The muscles in the neck also lead to widespread changes. Changes in the platysmal muscles lead to something called "platysmal bands" — vertical linear bands that increase in prominence with aging. These bands start appearing in mid-life and increase exponentially as we age.

The platysma muscles can also pull downwards, contributing to jowls and the loss of definition of the jawline. The muscle is a thin sheet contiguous with the muscles in the face. While overall muscle strength declines with age, the medial borders of the platysma muscle on either side of the neck start to part from one another, and the anterior portion becomes more hyperactive with age (Swift et al. 2021, Perez and Hohman 2023).

KEY INSIGHT

The hyperactivity of the platysma muscles is what causes their prominent appearance. Patients with paralysis on half of their face who were followed for up to 10 years only developed visible platysmal bands on the non-paralyzed side — confirming that muscle activity drives their formation. Aesthetic intervention for platysmal bands is one of the most common requests from patients wishing to improve their neck appearance (Trevidic and Criollo-Lamilla 2016).

TREATMENT

Topical Treatments

Treatment for signs of neck aging includes topical serums and creams, non-surgical medical interventions, and surgical options. A combinatory approach is found to yield the best results.

First, prevention is the best medicine — and this is especially true for neck skin. Apply sunscreen to your neck daily, and add a Vitamin C antioxidant serum. Together, these help prevent photo-aging that leaves skin wrinkled, crepey, and mottled.

Second, use the same topical ingredients you would on your face that increase both collagen and elastin content — applied to your neck. These include retinoids and wrinkle-fighting peptides.

Retinoids (Retinol & Retinal)

Classic anti-aging ingredients that up-regulate collagen and elastin production. Highly effective, though they come with some downsides: potential irritation for sensitive skin, and lack of safety during pregnancy and lactation (Mukherjee et al. 2006).

Wrinkle-Fighting Peptides (Matrixyl 3000, Copper Tripeptide)

A newer class of ingredients well-tolerated in sensitive skin and safe during pregnancy and lactation. Studies show topical peptide creams applied to the neck can improve overall sagging, wrinkles, skin hydration, and tone (Makino et al. 2021). Copper tripeptide-1 (Cu-GHK) and signal peptides in Matrixyl 3000 have been specifically shown to boost collagen and elastin with corresponding reductions in lines and wrinkles (Badenhorst et al. 2016, Sederma Matrixyl 3000).

Muscle-Targeting Actives (Argireline, Acmella Oleracea)

Many topicals contain muscle-targeting actives that can reduce vertical banding and repetitive-movement-related lines. Argireline (colloquially called "botox-like") has shown efficacy in limiting expression lines (Lipotec Argireline) and can extend the benefits of botox injections (Lungu et al. 2013). Acmella Oleracea (Paracress) extract contains Spilanthol, a fast-acting subcutaneous muscle relaxant with lifting and anti-wrinkle benefits. Clinical studies show it can lead to noticeable improvements in movement-related lines in as little as two weeks (Savic et al. 2021, Ye et al. 2021), with additional collagen benefits (Tamane et al. 2016).

Hyperpigmentation-Fighting Actives

If you have dark spots on the neck, apply the same brightening actives used for facial skin. Vitamin C and Niacinamide both help even out skin tone. Additional hyperpigmentation-specific actives include tyrosinase inhibitors such as licorice root extract, alpha arbutin, and kojic acid.

PRO TIP

For those curious about facial massage: gua-sha and jade rollers have been shown to increase blood and lymphatic flow (Miyaji et al. 2018, Nielson et al. 2007), and blood flow to skin decreases with age. However, these alternative treatments have not been rigorously researched and their benefits remain largely unstudied (Hamp et al. 2022) — so consider them a complement, not a replacement, for evidence-backed actives.

You can use the same products you use on your face on your neck for many of the same benefits. However, neck creams like Forever Firm are specifically targeted for neck needs and include actives more targeted to muscle hyperactivity and elasticity.

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Formulated with Acmella Oleracea extract, copper tripeptide-1, Matrixyl 3000, and Argireline — a full stack of collagen-boosting and muscle-targeting actives for the neck.

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ADVANCED OPTIONS

Medical Non-Surgical and Surgical Procedures

Just as in the face, there are many non-surgical and surgical procedures available for the neck. A combinatory approach tends to yield the best results, and topicals are recommended for maintenance treatment.

Fillers & Thread Lifting

Hyaluronic acid filler injections and absorbable thread lifting can improve neck lines and wrinkles. One study found this combination improved the appearance of horizontal neck lines significantly at six-month follow-up (Liao et al. 2022). Fillers have also been combined with lasers for neck line improvement (Ribe et al. 2011).

Ultrasound & Radiofrequency

Mild to moderately lax skin can be addressed with micro-focused ultrasound and radiofrequency with microneedling. Intense focused ultrasound (IFUS, e.g. Ulthera) is used to tighten neck skin, with some patients seeing minor improvement (Friedman et al. 2020).

Lasers

Since neck skin is thinner than facial skin, aggressive resurfacing is less appropriate — but laser resurfacing with conservative settings can still work. Fractional ablative lasers can address sun damage (Sturm et al. 2022). For submental fat, the 1440nm pulsed laser uses infrared to dissolve fat while promoting skin rejuvenation (Bernardo et al. 2013).

Injectables for Submental Fat & Platysmal Bands

Deoxycholic acid injections into the submental region dissolve fat non-surgically. Botulinum toxin (Botox) injections inhibit the platysmal muscle and can achieve good results for mild-to-moderate platysmal bands and horizontal neck lines (Carruthers et al. 2021). Cryotherapy is another option to freeze submental fat.

Surgical Options

More extensive laxity may require surgical options such as a neck lift (Perez 2023). Liposuction — often combined with laser assistance (e.g. Smartlipo) — addresses submental fat. Platysmotomy surgery sutures the parted medial borders of the platysma back together and is often combined with neck lift or facelift (Daher et al. 2011, Perez 2023).

THE BOTTOM LINE

Surgical interventions are often combined — for example, neck lift with liposuction for submental fat. For any approach, topicals are recommended for ongoing maintenance. A combinatory strategy involving topicals, non-surgical treatments, and when appropriate, surgical options, delivers the most dramatic and lasting results.

That's it! Thanks for reading. We hope you learned something useful.

This newsletter is written for readers with some formal education in biology or medicine. If you'd prefer a version for everyone, here it is:[link].

Written by our senior scientist Sunbin Song, PhD, and edited for clarity by Bradley Yim, our Head of Formulation. You can read more about them on our Team Page.

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