Sabika Says

Dr Sabika Karim considers the importance of the neck to overall aesthetics

The neck is often overlooked in skincare and aesthetic treatments, yet it is one of the most revealing indicators of ageing. Moreover, facial aesthetic treatments are often undermined if the neck is not addressed concurrently. The presence of an aged or sagging neck can create a visual disparity between the treated face and untreated cervical region. In historical contexts, Cleopatra’s beauty was attributed to her meticulous skincare, which likely included treatments for the neck. Similarly, during the 18th century, high collars and chokers were used to conceal neck ageing, demonstrating a longstanding awareness of its impact on perceived youthfulness.

THE IMPORTANCE OF NECK CARE IN PROACTIVE AGEING

The ageing process of the neck involves complex physiological changes that affect the skin, subcutaneous tissues, and musculature. Despite its critical role in facial aesthetics, the neck often forgotten. Its thinner dermal structure reduced sebaceous gland activity, and continuous exposure to environmental stressors make it particularly susceptible to premature ageing. Throughout history, figures such as Cleopatra have been reputed for their skincare regimens, which likely included treatments to maintain the integrity of the skin on the neck. In contemporary aesthetic medicine, a targeted, evidence-based approach is essential for effective neck rejuvenation.

THE PATHOPHYSIOLOGY OF NECK AGEING

Neck ageing is a multifaceted process influenced by intrinsic (genetic and hormonal) and extrinsic (photoageing, pollution, lifestyle) factors. The structural changes in the skin, connective tissue, fat, and musculature contribute to the characteristic signs of an ageing neck, including skin laxity, crepiness, rhytids, and volume redistribution.

KEY CHANGES IN THE AGEING NECK:

1. Dermal and epidermal changes: The epidermis of the neck becomes thinner with age, leading to decreased barrier function. The dermis experiences a reduction in fibroblast activity, resulting in decreased collagen (types I and III) and elastin synthesis. UV-induced degradation of extracellular matrix components further exacerbates skin laxity and wrinkling.

2. Subcutaneous tissue alterations: Adipose tissue redistribution leads to the formation of submental fat deposits (‘double chin’) or volume loss, contributing to hollowing and loss of structural support.

3. Muscular and ligamentous changes: The platysma muscle, a superficial cervical muscle responsible for neck contouring, becomes hypertrophic and forms visible platysmal bands due to repetitive contractions and loss of overlying soft tissue support. Weakening of the supporting cervical ligaments further contributes to sagging.

PROACTIVE AGEING: MEDICAL APPROACHES BY DECADE

A systematic, decade-based treatment approach allows for preventative, corrective, and restorative strategies. These can be modified to suit the skin age of the patient rather than the chronological age.

IN YOUR 20S: PREVENTION AND BARRIER PROTECTION

• Topical sunscreen (SPF 50+): Photoprotection is paramount in preventing collagen breakdown and actinic damage. I recommend SmartSkincare Neova SPF 50, which combines physical and chemical filters with antioxidants and DNA repair enxymes

• Topical antioxidants (vitamin C, E, ferulic acid): Neutralises free radicals and enhances photoprotection such as CE Ferulic by SkinCeuticals

• Growth factors: For reducing inflammation and promoting regeneration, I recommend Anteage Serum with concentrated recombinant growth factors and antioxidants

• Ergonomic modifications: Reducing ‘tech neck’ postural habits to prevent premature horizontal rhytids.

IN YOUR 30S: CELLULAR STIMULATION AND EARLY INTERVENTION

As per 20s plus:

• Topical retinoids: Promote epidermal turnover and dermal collagen synthesis

• Exosomes: For reducing inflammation, promoting regeneration and neocollagenesis I recommend: Anteage Bisiomes, biomimetic human placental and mesenchymal stem cell derived exosomes

• Superficial chemical peels (glycolic, lactic acid): Improves textural irregularities and pigmentary changes

• Preventative neuromodulators (botulinum toxin A): Modulate early platysmal hyperactivity to prevent deep-set bands.

IN YOUR 40S: COLLAGEN REMODELLING AND STRUCTURAL SUPPORT

As per the 30s plus:

• RFMN: Stimulates fibroblast activity and collagen remodelling for improved skin tightness, I recommend Secret RF

• High-intensity focused ultrasound (HIFU): Targets the SMAS layer for non-surgical skin lifting, I recommend Sofwave

• Platelet-rich plasma (PRP): Enhances cellular regeneration and improves dermal elasticity, I recommend Regenlab

• Injectable skin boosters such as hyaluronic acide and polynucleotides: Improve hydration, elasticity, and dermal thickness. I recommend Prohilo, Juvederm Volite and Croma Philart.

IN YOUR 50S: VOLUME RESTORATION AND LIFTING STRATEGIES

A section of treatments from the 40s plus:

• Collage stimulators: PLLA will give deep collagen stimulation, and it is hypothesised that they can have a positive effect on muscle stimulation due to the sustained release of lactic acid. If you are an expert injector, I recommend Lanluma or Julaine

• Fractional laser resurfacing: Enhances skin texture, addresses dyschromia, and improves collagen synthesis. I recommend Untraclear cold ablative fibre laser

• Deoxycholic acid injections: Facilitates adipocyte apoptosis in submental fat deposits.

IN YOUR 60S AND BEYOND: MULTI-MODAL APPROACH FOR ADVANCED AGEING

A selection of treatments from 50s plus:

• Thread lifting: Provides temporary mechanical support and collagen stimulation for mild-to-moderate skin laxity. I recommend Silhouette Soft™

TREATMENT STACKING

When treating the neck, it is important to remember three essential points:

1. Lifting and repositioning tissues of the face will improve the neck. Face and neck treatments should always occur in conjunction with each other.

2. Treatment stacking with topicals, injectables and EBD treatments such as RFMN are the only way to ant-age the neck.

3. Prevention is better than cure.

ESSENTIAL PROTECTIVE MEASURES FOR THE NECK

Maintaining a structured, evidence-based skincare regimen for the neck is crucial:

• Daily photoprotection: SPF50+ with broad-spectrum UVA/UVB coverage

• Barrier repair: Ceramidesand barrier repair exosomes

• Collagen induction: Topical peptides and growth factors

• Lifestyle modifications: Avoiding harsh perfumes, prolonged flexion posture, and ensuring optimal hydration.

CONCLUSION

The neck is an essential aesthetic unit requiring a targeted and scientifically-backed approach. By implementing a proactive ageing strategy that incorporates preventative, corrective, and restorative interventions, we can ensure long-term neck rejuvenation. Addressing the ageing process at multiple anatomical levels – from the epidermis to the platysma – allows for a comprehensive, non-surgical approach to maintaining youthful contours and skin integrity. With advancing medical technologies, non-invasive and minimally invasive treatments continue to redefine neck aesthetics, offering patients safe and effective alternatives to surgical intervention.

DR SABIKA KARIM

Dr Sabika Karim, founder of Skin Medical, is a multi-award-winning international educator who combines her NHS GP background with 19 years of aesthetic medical practice to deliver gold standard treatments to her patients at the clinic whilst raising industry standards by teaching and training her peers.

Conflict of Interest Statement – The views expressed are solely my own and have not been influenced or sponsored by any external parties. For full transparency, I am a key opinion leader (KOL) for Sinclair Pharma, Cellese, Evolus, Dermalux, and Erchonia.

REFERENCES

*Krutmann, J., Bouloc, A., Sore, G., Bernard, B. A., & Passeron, T. (2017). The skin aging exposome. Journal of Dermatological Science, 85(3), 152-161. *Fabi, S. G., & Sevi, J. (2019). A Review of the Literature on Aesthetic Rejuvenation of the Aging Neck. Dermatologic Surgery, 45(2), 259-275. *Carruthers, J., Carruthers, A., & Humphrey, S. (2019). Botulinum toxin treatment of platysmal bands: A review. Journal of Cutaneous and Aesthetic Surgery, 12(1), 1-7. *Alam, M., Dover, J. S., & Arndt, K. A. (2008). Energy-based devices for skin rejuvenation: Review and clinical considerations. Plastic and Reconstructive Surgery, 121(5), 114e-125e. *Gold, M. H. (2021). Microneedling for the neck: Advances in technique and technology. Journal of Cosmetic Dermatology, 20(7), 2142-2150.