Smooth, crisp contours of the neck and lower face are hallmarks of a youthful neck. As we age, the neck can start to sag with banding (evident in the platysma muscle), carry extra fat pockets, and have muscle bulging (produced by the prominence of the digastric muscles). Thus, a variety of different issues contribute to an aging neck, and each patient has unique features that can be addressed. Determining the specific anatomic reason for the change in appearance is the most important step in deciding the best treatment. Many treatments fail if they are not uniquely tailored to each specific patients anatomy.
- Skin: The outermost layer of the neck. While there can be excessive skin and laxity as we age, this is not the most important reason for an aged appearance. The skin is passive in the aging process—it simply follows the other more important issues that occur.
- Subcutaneous fat (thin layer of fat just underneath the skin layer): This fat is vital to maintaining a youthful appearance. This fat often gets blamed for a heavier appearing neck or the “double chin”, but actually it is the deeper subplatysmal fat that is the real culprit. As such, some treatments (Kybella, liposuction) which only address the subcutaneous fat do not produce results that are satisfactory.If too much subcutaneous fat is removed, this creates a very unnatural and gaunt appearance which in turn makes patients look older
- Platysma Muscle: this muscle is responsible for the “vertical banding” that is seen on the front of the neck. It is a large muscle that goes from the upper chest area to the lower part of the face, acting as a large hammock for the entire neck. As we age, this muscle loosens from its deeper attachments, thus creating less definition of the front of the neck (especially from the side or profile view). Patients often blame excess skin or skin laxity for this appearance, but the platysma muscle is actually at fault, with the skin passively following the muscle.
- Subplatysmal Fat: this is the deeper fat beneath the platysma muscle that can create a “double chin” in both thin patients and heavy patients. This fat is not accessible with non-invasive treatments (kybella, liposuction).
- Submandibular Glands: Remember as a child when your pediatrician would feel under your neck when you had a virus to see if these glands were swollen? As we age these glands can become more prominent and cause significant contour issues leading to a less than ideal neck contour.
- Anterior Digastric Muscles: These are paired muscles that border the subplatysmal fat and contribute to poor neck contour when they bulge excessively.
