Management of Neck and Chest Cosmetic Concerns?

​“I hate my neck” is a refrain commonly heard in my clinic. Patients often refer to the early and not-so-early changes that afflict the neck: jowls at the top, an irregular jawline, neck bands, double chin, brown spots, red spots, wrinkles (crepe-like skin), poor texture, loss of volume and more.

"Well, the last time I had a picture taken I could hardly see my eyes because of the weight of heavy eyelid. Then I paid attention to how I was actually using my eyes and I really noticed when I was looking at anything especially the computer I was straining my forehead to see better. Since I have had it done I no longer have to lift the forehead and tilt my head to see. It is amazing! I love..."  D. Rock  63 Yrs Old with Fat Droopy Eyes - Salt Lake City, UT

Why do my neck and chest look so much worse than my face?

Queen Nefertiti (1370-1330 BC), wife of Pharoah Akhenaten. Her name means “a beautiful woman has come” and is considered the final word in facial and neck beauty.

The face, neck and chest get exposed to almost the same amount of sun damage. However, most of us remember to apply sunscreen on the face, but rarely on the neck and chest. This damage begins when we are five and ten years old, only to accelerate as we age. Furthermore, neck and chest skin is thinner and has fewer sebaceous oil glands, which are necessary for the rapid and adequate repair of the skin when skin is injured (by ultraviolet light, trauma like lasers and peels, etc).

Finally, the thin skin with the superimposed ultraviolet light damage ages the neck and chest skin more and more rapidly than the face, resulting in areas of pigment loss if you have had sunburns, hyperpigmentation, fine wrinkles, “creppy” skin, and redness and blotchiness.

Sunscreens, repair creams, antioxidants, and vitamin-based products may be used to protect chest and neck skin, but need to be started early in life: especially so in sunny climes, and even more so in sunny lands which are dry! Sunburns and skin damage are all more common at altitude. ​

How can I make my neck and chest skin look less
damaged and more like my face?

Creams will only go so far in the neck and chest if the sun damage to skin is marked. If creams cannot help, you may need laser treatments. Remember, if you make the investment in laser treatments, be sure to use sunscreens, antioxidants, and laser treatments once a year to maintain that investment. We always make the skin of the face look as good as we can get it as there is often similar but less severe

ultraviolet damage to the face. Once the face skin is excellent, we try to get the neck and chest skin to match it as closely as possible using a combination of chemical peels and lasers. The aim is to improve the brown spots, the red spots, thicken the skin, blend in the loss of pigment from sunburns, and improve the texture.

Brown spots, red spots, pores and loss of skin turgidity results in a more aged appearance. Treatment with lasers yields very satisfying results.

What are all these brown spots on my neck and chest?

​Brown skin spots are essentially sun damaged areas but age also leads to us developing brown spots. You may have had them as freckles when you were younger, but they get larger and often darker as you get older. Although skin cancers are less common on the neck and chest, pigmented spots need to be examined to ensure there are no skin cancers present.

"I had a excellent eye lift done by Dr. Patel. He knows what he is doing and is very pleasant. Dr.Patel was easy to get an appointment and he works with you. The office staff was very pleasant and made you feel calm."  D. Gull Highly recommended for eye lift surgery - Salt Lake City, UT

Well, how do I manage all these brown spots and lines on my neck and chest?

1. First reduce further damage: make sure you use a sunscreen that protects you from Ultraviolet radiation. It is recommended that using sunscreens with at least 5-10% zinc or titanium or 3% mexoryl are best.
2. Over-the-counter “anti-pigment” creams will temporarily decrease the brown pigmentation in dark spots. Most of these over-the-counter creams will only contain 2% hydroquinone: although sometimes helpful, they are generally not very effective.
3. Prescription bleaching creams all contain 4% hydroquinone plus or minus other ingredients like hydroxy acids, sunscreens, or tretinoin. These are more effective but still temporary. For some patients who are allergic or don’t want to use a hydroquinone cream, there are plant-based bleaching creams. These ingredients are ones like arbutin, thymol, and kojic acid. However, they seem to be less effective than the prescription creams.
4. Microdermabrasion and light peels are also options for mild to moderate brown spots. These have to be repeated many times and the results are moderate and very gradual.
5. A medium peel, like a TCA peel, can also give good to excellent results but should be done by an experienced surgeon.
6. The most effective treatment option for brown spots (and the inevitable red areas) is a series of laser treatment. Look at the advanced photorejuvenation IPL section to see more results from these treatments. These lasers will reduce redness and the brown spots, stimulate mild collagen growth, and add to your skin’s glow. You will need maintenance treatments when brown spots reappear, usually once or twice a year.
7. The fractional lasers are newer and may be the best option if you also have wrinkles or acne scarring. Many clinics, including ours, are reporting excellent results. Fractionated erbium lasers heal more quickly but give more moderate results. Fracionated CO2 lasers like the Lumenis Active FX are the gold standard for this type of treatment and give very gratifying results. There is down time of a few days with these fractional CO2 laser treatments. The results continue to improve over four to six months. We generally perform two fractionated CO2 lasers separated by about six months.

Improvement in the skin feel and appearance when treated with multiple lasers

What about all these fine neck and chest lines and neck bands?

Some people get neck lines that are little lines or bands running horizontally across their necks. Because they can look almost like necklaces, they are called necklace lines. Some people get them relatively young, even in their 20s or 30s. You may even notice them on children. The fractional lasers can also help soften these neck lines, but they are not a home run. Also, be sure to use skin care products to protect your neck and chest.

Neck lines may be horizontal or vertical. The vertical bands respond well to surgical intervention or proper injections with botox as seen here.

Combination lasers including fraciontal CO2 laser and fotofacial lasers are used to improve the texture and appearance of neck and chest skin.

Neck Lines and wrinkles

​As we age, some of us notice that the skin on our neck acquires the texture of crepe paper. Others notice the skin can get a little loose and cause neck lines. What can you do about loose, crinkly, or crepey skin on the neck? Up until recently, there was no really good non-surgical option for neck lines and loose or crepey skin on the neck. But, a combination of advanced photorejuvenation lasers and fractionated CO2 lasers have yielded promising results.

Why do I have chords standing out on my neck? I never had these!

Some of us notice that we seem to be getting prominent vertical bands that stick out near the upper part of our necks (the platysmal bands). The two options to treat this are Botox, if these bands are minimal, or surgery. Also, vertical bands may standout on the neck which are bands of your platysma muscle. A non-surgical option is to have a small amount of Botox injected. These are exacting treatments which should be administered by someone well versed in the anatomy because, wrongly injected areas may could cause weakness of the neck muscles or difficulty swallowing.

Botox works best if the banding is early. With prominent or pronounced bands, the only option would be a surgical platysmoplasty.

Nefertiti lift of the jawline and neck with anatomically accurate injections with botox.

What causes wrinkles and lines on the chest?

Three things:

1. ultraviolet damage to the skin.
2. sleeping on the side, thereby causing a “crumpling of the skin” which to some degree everyone gets!,
3. Father time: tempus fugit.

The best way to treat chest wrinkles is with fractional lasers combined with advanced photorejuvenation and sometimes light peels. More recently, attempts have been made to inject sculptra into the chest. The results are still not entirely convincing.

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Dr. BCK Patel MD, FRCS
​1025E 3300S
Salt Lake City, Utah 84106, USA
(801) 413-3599 (phone/text)
E: [email protected]
bckpatel.info

Dr. BCK Patel MD, FRCS
585 E Riverside Dr Suite 201
​Saint George, UT 84790
(435) 215-0014
​E: [email protected]
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