Neck & Jowl tightening

TREATMENT OF LAX SKIN OF THE NECK AND JAWLINE

Needle Radiofrequency also called Deep RF or Subcutaneous RF

Patient Concerns: “I have crepy, chicken skin on my neck and jawline which I don’t like but I don’t want a facelift just yet. I see big pores, loose skin, wrinkles. I know the neck bands would need a facelift but can you improve my neck skin?”.

Findings on Examination: Patient is aged 56 with Fitzpatrick type II. She has a remote history of acne vulgarism in teenage years and young adulthood but no attacks since the early 30’s. She has a type II neck with neck bands, lax skin, jowls, loss of definition of the jawline, minimal submittal fat, good chin projection and prominent platysmas bands which are currently camouflaged by the lax skin. Skin shows loss of collagen and elastin with evidence of solar elastosis, horizontal and vertical rhytids and central and lateral neck skin laxity and redundancy.

Options:

  • A properly performed cervico-facial rhytidectomy (facelift which means facelift and necklift in common parlance) would give her correction of most of these changes. We would improve the skin with a combination of skin lasers.
  • Fractionated CO2 laser will give her a moderate improvement but carries the risk of giving her a “mottled skin” appearance as the neck skin has relatively few sebaceous oil glands (compared to the face) and the laser has to be used very conservatively. If she decides to do this, she would need two or three treatments about six months apart.
  • High-frequency Ultrasound: will give her some improvement in her jowls and her jawline but will not show much improvement in the neck skin.
  • MicropulsedNd:Yag 1064 laser (micropulsed at 650 microseconds, which is the same as 0.65 nanoseconds) will give her a reasonable skin tightening but make only a moderate difference to the actual skin surface.
  • Transcutaneous delivery of radiofrequency (needle RF) has the advantage of allowing us to treat the skin at the epidermis, the dermis and the junctional levels by modifying the delivery of the energy between 0.5 mm and 3.5 mm deep into the skin with variable energy deliveries. This has the advantage of obtaining the benefits of skin needling (mild improvement in skin), together with the effects of RF energy deeper (skin tightening).

Patient decision and treatment: The patient would have loved to have a facelift but decided to proceed with the needle radiofrequency. Five treatments were administered with energy delivered at different depths of the neck and jawline skin and deeper tissues. Topical anesthetic and the Zimmer cooler were used for anesthesia. The level of discomfort was level 3 – 4 out of 10. Anything below 10 is considered reasonable in outpatient laser, high-intensity ultrasound and RF treatments.

Post-treatment care: Mild redness is present for about 24 hours.

  • No glycolic acid or lactic acid creams on the face for two days
  • Moisterize with regular skin moisturizer twice a day
  • Resume normal activities
  • Makeup can be used by day three

Results: An improvement is seen in the following:

  • Skin laxity
  • Pore size
  • Tightening of the jowl
  • Firmer jawline
  • Texture improvement
No improvement is expected in neck bands which are caused by the laxity of the platysma muscle. These can be improved partially with botox injections or more permanently with a neck and facelift.

Number of treatments: Ideally five treatments done monthly and maintenance with two treatments every year if they want to maintain the result.

Conditions that can be treated with the subcutaneous Radiofrequency treatments:

  • Acne scars
  • Skin laxity
  • Pores (often treated in combination with the carbon peel and Nd:Yag treatments
  • Fine lines
  • “Chicken skin”, usually on thence
  • Crow’s feet
  • Early jowls for a moderate improvement