But less-invasive options are being developed to tackle that sagging skin around your throat.
Dr. Matthew White, a facial plastic surgeon at New York University Langone Medical Center, uses a new skin-tightening technique called Ulthera in New York, Dec. 16, 2010. These days, less-invasive options exist to improve the appearance of one's neck, provided it isn't a full-blown turkey wattle.
Necks don't lie. Sagging there betrays age like the rings on a tree, and now-common Botox and fillers in the face make neck imperfections stand out in stark relief. In her 2006 bestseller, "I Feel Bad About My Neck," Nora Ephron, then 65 and a resolved turtleneck wearer, raged against the injustice of having no remedy for her slackening throat skin, short of surgery.
But it turns out that isn't true. These days, less-invasive options exist to improve the appearance of one's neck, provided it isn't a full-blown turkey wattle.
Like a romance, a neck can go wrong in many ways. Weight gain or genetics might lead to a double chin. Loose skin can be compounded by underlying lax muscle. A neck-lift (on its own or with a face lift) remains the best bet for a striking, lasting fix.
But careful liposuctioning of excess fat can also help streamline the full-necked, especially those who still have relatively youthful elastic skin that can bounce back after the procedure. The trick is not to get suctioned to the point of looking skeletal -- and watch for underlying loose bands of muscle, which will become more obvious afterward.
If the issue is these isolated bands, injecting Botox into the neck muscle can make them less conspicuous in a patient with great skin tone, said Dr. Rod Rohrich, chairman of the plastic surgery department at the University of Texas Southwestern Medical Center in Dallas. But the fix lasts only three to four months.
Promoted on "The Rachael Ray Show," Ulthera is a new skin-lifting procedure that uses focused ultrasound to spur collagen growth deep under the epidermis. A single treatment might improve the contours of under-chin laxity in patients about 40 to 55 years old who feel they aren't ready for surgery or are not amenable to it, several doctors said, including Dr. Matthew White, a facial plastic surgeon at NYU Langone Medical Center in New York.
The Ulthera handpiece pressed to a patient's skin allows doctors to see underlying layers on a screen (as with gynecological ultrasounds) before they start the treatment, a first for noninvasive dermatological procedures.
"We deposit energy to a precise depth below the surface of the skin without affecting the intervening tissue," said Matthew Likens, chief executive of Ulthera, the Arizona company behind it.
Patients might feel pain during treatment. Prospective candidates should also be aware that peer-reviewed published studies have yet to quantify just how much tightening can be expected in the neck and lower face. "That's true," Likens confirmed, adding that such research is continuing.
That didn't stop Dr. Mehmet Oz, a cardiologist, from proclaiming on his TV show recently that Ulthera was a "revolutionary nonsurgical face lift" and promising to get rid of a viewer's sagging neck live onstage. In the segment, Dr. Haideh Hirmand, a plastic surgeon in New York, said it was the first time she was "really excited" about a noninvasive technology for tissue-lifting. She emphasized that Ulthera is no substitute for surgery if neck skin is too loose.
(In a later interview, she recommended a pain medication such as Percocet and an anti-anxiety drug such as Valium before treatment, which she said was worthwhile for minimal neck looseness.)
"The company will tell you it doesn't hurt -- it does," said Dr. Tina Alster, a dermatologist in Washington, D.C., who has made pain and anti-anxiety drugs mandatory for her Ulthera patients. That said, Alster, who will get a research stipend from Ulthera to study the device's effect on off-face areas, is seeing results in the eyebrow area, cheeks and necks of middle-aged patients.
The "Dr. Oz" segment left the impression that the Ulthera device has been cleared by the Food and Drug Administration to be used for the neck and lower face as well as for the eyebrow area.
Not so. "The company can only promote the device for eyebrow lift," although the treatment regimen included cheeks and neck, said Karen Riley, a spokeswoman for the agency. "But they can make no claims regarding these areas and cannot promote their device for treating specific conditions within these areas." (As with other procedures, however, doctors can treat other body parts at their discretion.)
Nina Meyerhof, who runs Children of the Earth, a peace organization, was willing to chance it when she met with White recently to have Ulthera firm up her neck and jaw line. "I wanted everything to look fresh and tight," she said.
At 68, Meyerhof, of South Burlington, Vt., is a decade or two older than White's typical candidate, someone who is just starting to notice under-chin skin laxity. But White, who has researched focused ultrasound, felt Meyerhof's skin was still so elastic that it would tighten. (How rapidly skin ages varies with factors such as sun exposure, genetics and smoking -- which may be why your older pal's neck skin is taut while yours gave way at 47.)
Ulthera's results take a few months to appear, since creating collagen takes time. But Meyerhof, who felt discomfort along her jaw during the procedure, said the slight hanging bit under her chin no longer sags, and her face is "tighter around the jaw line."
Likens, of Ulthera, said patients can expect results to last "a year or longer." But the peer-reviewed clinical trial of 35 patients submitted to the FDA tracked patients for only 90 days.
Meyerhof is thrilled with her results but said she would remain so only if they last. "I feel like I paid a whole lot of money for it," she said, declining to disclose how much. (Ulthera can cost $1,000 to $4,000 depending on areas treated.) But she put it this way: "If it only works for a year, I will not be happy. I took that gamble."