The neck is an area where signs of aging appear as quickly as on the face, yet it tends to be relatively neglected in skincare and procedures. In fact, neck wrinkles are broadly divided into three types — horizontal neck wrinkles (necklace lines), platysmal bands, and skin laxity — and each type has a different mechanism of occurrence, requiring a tailored treatment approach. This article systematically guides you through the anatomical causes of neck wrinkles, indications for each procedure, and treatment strategies, all based on medical evidence.
1. Anatomical Understanding of Neck Wrinkles — Why Does the Neck Age So Quickly?
The neck's structure features thinner skin than the face, with a lower density of collagen and elastin in the dermis. Additionally, the neck is constantly exposed to the outside, leading to continuous accumulation of photoaging caused by UV radiation. The main anatomical structures involved in neck wrinkle formation are as follows:
- Platysma muscle: A thin, sheet-like muscle that runs from the mandible towards the sternum. As aging progresses, the medial borders of the muscle separate, causing vertical band-like structures to become prominent on both sides of the neck's midline. These are called 'platysmal bands,' appearing as noticeable vertical lines on the neck. They are particularly evident during facial expressions or vocalization.
- Horizontal neck lines / necklace lines: The neck is an area prone to frequent flexion movements. Repeated flexion over a long period, combined with decreased skin elasticity, leads to the formation of horizontal lines around the neck. Particularly, as the 'tech neck' posture, where one bows their head due to smartphone use, becomes commonplace, the incidence of neck wrinkles is increasing even among younger age groups. Horizontal neck wrinkles are initially shallow and fine, but they deepen and become static lines over time.
- Skin laxity: This refers to the sagging of the neck skin itself due to weakened dermal support structures caused by accumulated UV exposure, collagen degradation, and subcutaneous fat loss. In such cases, simple fillers or Botox are insufficient, and energy-based procedures that contract and regenerate skin tissue are effective. In severe cases, surgical intervention may be necessary, going beyond the limits of dermatological non-surgical treatments.
2. Treatment Strategies by Type — Accurate Diagnosis First
The most crucial principle in neck wrinkle treatment is 'accurately diagnosing the type and then selecting the appropriate procedure.' Even if they appear to be the same 'neck wrinkles,' the treatment method will be completely different if the underlying causes are different.
① Platysmal Bands — Botox (Nefertiti Lift)
Platysmal bands can be effectively treated with botulinum toxin (Botox) injections. This method is called the 'Nefertiti lift,' named after the sharp jawline of the Egyptian Queen Nefertiti. It selectively inhibits excessive contraction of the platysma muscle, thereby alleviating vertical bands and simultaneously lifting the jawline, offering a combined effect.
A clinical study published in the Journal of Cosmetic Dermatology in 2010 reported that the Nefertiti lift showed improvement in platysmal bands and jawline lifting effects in over 75% of subjects on average. Botox is typically injected in small, dispersed amounts along the medial and lateral borders of the platysma muscle, with effects lasting approximately 3-5 months.
Caution: The platysma muscle is adjacent to swallowing and vocalization muscles, so excessive injection can lead to dysphagia or voice changes. Accurate knowledge of anatomical boundaries and injection depth is essential, and execution by experienced medical professionals is particularly crucial in this area.
② Horizontal Neck Wrinkles — Fillers or Skin Boosters
Horizontal neck wrinkles are approached in two ways, depending on their depth and characteristics.
- Shallow horizontal neck wrinkles: Primarily caused by reduced skin hydration and elasticity, the effective method is to micro-inject skin boosters (hyaluronic acid micro-injections) into the dermis to increase the skin's own moisture content and elasticity. Cumulative effects can also be expected through repeated treatments.
- Deep horizontal neck wrinkles: Caused by a lack of volume between the dermis and subcutaneous tissue, low-viscosity hyaluronic acid fillers are thinly placed in shallow layers using a linear threading technique to fill the wrinkles themselves. Since the neck's vascular distribution and skin thickness differ from the face, excessive injection can easily lead to foreign body reactions or swelling, so small, dispersed injections are the principle. Furthermore, there is a risk of the Tyndall effect (blue discoloration due to light scattering) with neck fillers, making it important to ensure sufficient injection depth.
According to a 2019 meta-analysis in the Aesthetic Surgery Journal, the application of hyaluronic acid fillers for neck wrinkles has been reported to show high satisfaction when appropriate technique and product selection are made.
③ Skin Laxity — RF Lifting (Shurink Universe / Thermage FLX)
For overall loss of elasticity and sagging of the neck skin, energy-based procedures are primarily recommended.
- Shurink Universe (HIFU, High-Intensity Focused Ultrasound): This device focuses ultrasound energy at 2mm (dermis), 3mm (deep dermis), and 4.5mm (SMAS layer) from the skin surface to induce thermal coagulation. Shurink Universe, which reaches the SMAS (Superficial Musculoaponeurotic System), can achieve noticeable lifting effects through fascial unit contraction of the neck skin. A 2021 study in Lasers in Surgery and Medicine confirmed improved neck skin elasticity and enhanced lower facial contour for an average of 12 months after 1-2 treatments of the neck area using HIFU.
- Thermage FLX (Monopolar Radiofrequency): This delivers uniform radiofrequency thermal energy to all layers of the skin, inducing collagen remodeling. In the neck area, Thermage FLX provides a more uniform elasticity improvement over a relatively wider area compared to HIFU, with the advantages of less pain and no downtime. When both devices are used in combination, a complex treatment targeting both deep layers (SMAS) and all skin layers simultaneously is possible, and synergistic effects are expected.
④ Complex Neck Wrinkles — Thread Lift (PDO/PCL Threads)
In cases where platysmal bands and skin laxity appear in combination, especially when the lower facial skin sags towards the neck, thread lifting becomes an effective complementary option. Absorbable threads made of PDO (polydioxanone) or PCL (polycaprolactone) are inserted under the skin to provide both physical support and stimulate collagen production. The lifting strength, duration, and collagen stimulation ability vary depending on the type of thread. For the neck area, mono threads or screw threads are generally placed from the submandibular area towards the neck.
3. Treatment Selection Guide — Recommended Procedures by Type
When deciding on neck wrinkle treatment, it is advisable to approach it based on the following criteria:
- Predominant issue is platysmal bands → Botox (Nefertiti Lift) first
- Predominant issue is horizontal neck wrinkles (shallow) → Skin boosters or small amounts of hyaluronic acid filler
- Predominant issue is horizontal neck wrinkles (deep) → Hyaluronic acid filler + RF combination
- Predominant issue is skin laxity → Shurink Universe, Thermage FLX, or thread lift
- Complex type (platysmal bands + laxity + wrinkles) → Botox + RF + thread lift combination treatment
A 2020 study in Aesthetic Plastic Surgery showed that the group treated with a combination of Botox and energy-based lifting had statistically significantly higher satisfaction in neck wrinkle improvement compared to the group treated with Botox alone. This indicates that each procedure targets different pathophysiologies, leading to synergistic effects.
4. Neck Wrinkle Prevention — Daily Care Tips
Daily prevention is as important as procedures for neck wrinkles.
- UV Protection: The neck is chronically exposed to UVA, leading to accumulated photoaging. Applying sunscreen with SPF 30 or higher daily, thoroughly covering the neck, is fundamental.
- Posture Correction: The 'tech neck' posture, where the neck is tilted forward when using smartphones or computers, accelerates the formation of horizontal neck wrinkles. Adjusting screen height to eye level is recommended.
- Moisture Management: The neck skin is prone to dryness. Regularly using neck creams containing hyaluronic acid, retinol, and peptide ingredients helps maintain moisture and support collagen synthesis.
- Early Treatment: Neck wrinkles are often more difficult to correct than facial wrinkles. Proactive management with skin boosters or lifting procedures in the mild early stages is effective in the long term.
Neck wrinkles are an area where various anatomical and physiological factors, rather than a single cause, interact complexly. Therefore, a customized strategy based on accurate diagnosis is absolutely necessary rather than a uniform treatment. At BA Clinic, we meticulously evaluate the type and severity of neck wrinkles and propose the optimal treatment plan from various options, including Botox, fillers, Shurink Universe, Thermage FLX, and thread lifting.
If you have concerns about neck wrinkles, please feel free to contact BA Clinic Daejeon Dunsan branch for a consultation.
