What are the most effective procedures or treatments for sagging neck and jowls?

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What are the most effective procedures or treatments for sagging neck and jowls?


F, 55, Pennsylvania

With aging, the skin and soft tissues on the face and neck may begin to sag. A facelift can restore facial tissues to their natural position for a rejuvenated look. The facial muscles are surgically tightened, the skin is redraped, and excess skin is removed. Many patients choose to pair this with a neck lift, which can remove this extra skin and re-drape the remaining neck tissue in a natural manner.  This could be combined with fat grafting or the use of dermal fillers to help re-volumize key areas of the face if need be.  Alternatively, you can try to lift the tissues with dermal fillers alone.  I would seek out the consultation of a board certified facial plastic surgeon or plastic surgeon to discuss the goals of your treatment and establish a treatment plan based on realistic expectations.  Good luck moving forward!


Dr. Parker Velargo has 2 Brow lift, Lip augmentation, Necklift, Cheek lift before & afters:

Brow lift, Lip augmentation, Necklift, Cheek lift before image performed by Dr. Parker VelargoBrow lift, Lip augmentation, Necklift, Cheek lift after image performed by Dr. Parker VelargoForehead lift, Lip augmentation, Necklift, Cheek lift before image performed by Dr. Parker VelargoForehead lift, Lip augmentation, Necklift, Cheek lift after image performed by Dr. Parker Velargo

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Sagging skin around the neck and jawline can prematurely age a person. There is a wide range of non-invasive treatments and surgical options available to lift or tighten the skin in these areas and restore youthful, taut contours to the neck and jawline.

For the treatment of jowls, it is first essential to identify the cause of the jowls to then determine the most appropriate treatment. Jowls most often occur when lower cheek fat descends due to subcutaneous skin and tissue laxity. This causes loose skin and fat deposits around the jawline, and loss of volume in the cheeks. When the jowls are pronounced, a facelift procedure such as a high SMAS lift can pull the jowls back towards the cheeks, restoring volume to the middle of the face, and tighten the area around and under the jawline. It also softens nasolabial folds , gently elevates the corners of the mouth, and tightens the neck. The SMAS layer lies beneath the skin so results are more dramatic and last longer because they target the deep tissue plane.

However, jowls may also be caused by fat atrophy along the jawline or loss of soft tissue volume. For these individuals, fat grafting or dermal fillers can fill in the areas of fat atrophy, giving the appearance of a smoother, fuller jawline. This is often suitable for patients whose jowls are still not overly significant, or patients who have "pseudo jowls."

Non-invasive treatments for the neck are generally most effective for patients who are showing very early signs of aging, with no loose skin. Some of the more popular treatments include Ulthera, Botox injections, neck liposuction, and Thermage. Kybella can be used under the chin to melt chin fat and provide more neck/jawline definition.

However, these treatments often require more than one session, and cannot provide long-lasting results. A neck lift is the gold standard for correcting issues related to neck aging and can incorporate a range of techniques to improve the appearance of the neck. Neck lifts can correct turkey neck, remove fat deposits, smooth out the platysmal bands around the neck, contour beneath the chin, and excise loose neck skin.

Individuals who have good skin tone and aging mostly confined to the neck can benefit from a limited incision neck lift, via a small incision made under the chin. Those with poorer skin tone are better candidates for a traditional neck lift with incisions made in front of or behind the ear, which also serves to pull up the skin. An experienced plastic surgeon can discuss options with you and help you determine which procedure or procedures will best help you achieve your goals.

For most patients with loose neck skin, surgery is the best approach for dramatic facial rejuvenation. Sagging skin around the neck benefits from a neck lift, which lifts and tightens the neck skin to provide a toned, aesthetically beautiful result. This sagging skin is removed through incisions around the ears so the evidence of surgery is concealed.

Neck lifts also enhance contours around the neck and jawline, tighten the underlying muscles, diminish the appearance of muscular bands and minimize the appearance of fine lines and wrinkles. Very skilled surgeons can achieve beautiful natural results, without any distortion around the ears or surrounding skin.

While neck lifts can sometimes improve the appearance of jowls, they mostly focus on the neck skin. Sometimes additional separate procedures are necessary for contouring and smoothing of the skin around the jawline. Jowls occur as a result of fat in a deeper plane of skin tissue called the SMAS layer. Lower facelifts, mini-facelifts or high SMAS facelifts can address sagging, loose skin in the lower third of the face. For example, in a SMAS facelift, the jowl fat is pulled back over the jawline and advanced upwards toward the cheek to restore volume mid-face.

There are non-surgical options available for both sagging neck skin and jowls, however, they cannot give the dramatic improvement that surgery can. For the right candidates, such as those who are only just beginning to show the signs of aging on their lower face and neck, they can offer subtle improvements. Treatments such as Thermage, Botox, microneedling with PRP, dermal fillers, and even laser treatments can improve the appearance of the neck and jowls. Find a board-certified plastic surgeon who specializes in facial plastic surgery to determine which treatments are most suitable for you.

When a person's neck shows signs of aging, the face is generally not perceived as youthful either, no matter how limited the signs of facial aging are. Saggy neck skin, drooping jowls, and visible platysma muscle bands in the neck can add years to a patient's facial appearance.

For certain candidates who are very young or have very subtle signs of neck aging, fat grafting or dermal fillers can help to lift or modestly tighten the lower facial area. Younger patients with good skin tone can also benefit from submandibular or neck liposuction. Patients with good skin tone but poor neck definition can benefit from a suture suspension neck lift, a minimally invasive procedure with a quick recovery.

When the signs of aging are significant or if there is a large quantity of excess skin, surgery is the only truly effective option. Neck lift surgery is one of the most transformative procedures in cosmetic medicine. It dramatically restores a youthful appearance to the neck by removing loose neck skin, with no outward signs that surgery has been performed. Most importantly, the procedure can be adapted to consist of specific surgical techniques that suit the patient's needs, addressing issues such as slack platysma muscles, excess fat deposits, and loose skin.

For sagging jowls or a poorly defined jawline, a lower facelift will address the lower third of the face and the neck for more complete rejuvenation. Most patients with a sagging neck tend to also have prominent jowls, and, unfortunately, a neck lift alone will only properly rejuvenate the neck area. Consult with a board-certified plastic surgeon with extensive experience in performing neck and facelifts. Both the neck lift and lower facelift can be approached in a range of ways, prioritizing aspects such as skin, platysmal bands, SMAS layer or facial volume, depending on the aesthetic goals of the patient. He or she will be able to determine which procedure or procedures will provide you with the best results.

Dr. Frederic Corbin has 1 Necklift before & after:

Necklift before image performed by Dr. Frederic CorbinNecklift after image performed by Dr. Frederic Corbin

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There are a variety of non-invasive and surgical options that can improve the appearance of sagging neck skin, sometimes known as turkey neck, and droopy jowls. For younger patients who only need a mild lift in their neck or jowl area, non-surgical treatments can offer a short-term correction, temporarily tightening the neck and jawline, and helping to smooth out the skin.

Some of the more popular options to promote skin tightening include ultherapy which bypasses the epidermis and uses ultrasound to gently lift skin under the chin and on the neck at a deeper level, ThermiTight which delivers radiofrequency energy to the skin via a small electrode inserted under the skin laying down new collagen, dermal fillers such as Voluma which treat horizontal neck bands and reduce the appearance of early jowls, and neuromodulators such as Botox and Dysport injected into strategic areas along the jawline and platysmal bands of the neck to redefine the jaw and relax the neck muscles. This last procedure is referred to as the Nefertiti Lift, with the neuromodulators encouraging lengthening and upward movement of the skin. For younger patients in their 20s or 30s or those with minimal signs of aging around the neck and jowls, one or a combination of the above procedures could effectively correct early signs of aging around the neck and jowls.

However, if neck sagging is already significant, injectables and non-surgical treatments will be insufficient to bring about lasting change. The gold standard treatment is either a neck lift or a facelift. The surgical approach focuses on the natural lift vectors beneath the skin and elevates the underlying support tissue. The general rule is that if there is significant excess skin, surgery is the only option that will provide long-lasting, beautiful results.

Neck lifts correct neck skin laxity by removing loose skin, tightening the underlying muscles, and lifting the soft tissue back into place. The incisions used to perform neck lift surgery can be concealed behind the ear, beneath the chin, and within the hair.  A neck lift will offer some improvement to sagging jowls, but the improvement may be modest. To correct both sagging jowls and neck skin, a high SMAS facelift and neck lift can offer impressive facial rejuvenation. Fat grafting can also be performed to restore lost soft tissue volume.

Dear user 1307687:

Many options for enhancing the appearance of a “Double Chin” and / or “Turkey neck” under the jawline and neck are available. These include:

Surgical procedures:
     a.    “mini” lipo-contouring
     b.    Facial lipo-contouring (of the lower cheeks, jowl, jawline, double chin and neck) and neck suspension
     c.    Facial lipo-contouring and neck muscle lift (platysmaplasty) with or without neck suspension
     d.    Direct excision, ie. surgical incision with visual removal of the fat

      e.   Facelift elevation with SMASplasty in-continuity across the neck

Non-Surgical procedure:
     a.    Fat freezing using the CoolSculpting Cool-Mini applicator for under the chin and small fat bulges. “Cool-Mini” is the newest applicator in the line-up of CoolSculpting options specifically created for smaller areas such as the fat under the chin. It may also be used for non-surgical fat reduction in other small areas, such as the upper inner thigh, upper breast / armpit fat and equally smaller fat bulges

And, now, Minimally Invasive procedures

     a. ThermiTIGHT, a radio-frequency needle sized probe placed under the skin with local anesthetic to directly contract the skin using a very sophisticated controlled thermal unit for an immediate and 1-2 year progressive enhancement

     b. Sculptra, a injectible medication which stimulates skin fibroblasts to produce the structural molecules for skin firming, thickening and resistance to creasing.

     c. Silhouette InstaLift, a non-surgical dissolvable suture made of Sculptra to: lift, compress and stimulate tightening of the skin and fibro-fatty tissues of the neck, jowl, cheek, temple and brow.

While the alternatives are expanding for results in neck enhancement (as with other procedures) you should expect a far smaller improvement with non-surgical and minimally invasive options as you would from surgical procedures.

When improvement of the muscle bands and loose skin become an issue, these minimally invasive and non-surgical options will not provide adequate tightening and lift. For these enhancements, a platysmaplasty, neck suspension and / or redraping and removal of excess skin are surgically necessary.


In all cases, please consult with a well experienced and talented Board Certified Plastic Surgeon for your best evaluation and recommendations. I hope this is helpful. Good luck with your journey!


Dean Kane, MD, FACS




Dr. Dean Kane has 3 Facelift, Necklift before & afters:

Facelift, Necklift before image performed by Dr. Dean KaneFacelift, Necklift after image performed by Dr. Dean KaneFacelift, Necklift before image performed by Dr. Dean KaneFacelift, Necklift after image performed by Dr. Dean KaneFacelift, Necklift before image performed by Dr. Dean KaneFacelift, Necklift after image performed by Dr. Dean Kane

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The gold standard to treating sagging neck and jowls is facelift surgery.  A good facelift surgeon can take years off of your appearance while maintaining a natural appearance and minimal visibility of incisions.

Dr. Mark M. Beaty has 1 Necklift before & after:

Necklift before image performed by Dr. Mark M. BeatyNecklift after image performed by Dr. Mark M. Beaty

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The most effective treatment is still a facelift. It's best to go for a personal consultation.

In general, while there are minimally and noninvasive approaches for neck enhancement (see one of my colleagues' answers listing several), most patients are best served with a lower face/neck lift (really the same thing and a matter of semantics - the incisions to lift a neck and take care of sagging skin there are the same as those used to lift the lower and mid face to large extent). This helps treat fat excess, muscle laxity, and extra skin. Skin tightening lasers/RF devices, suspension sutures/materials, etc. in my mind are far inferior to surgical lifting to get truly remarkable results that are worth the $ spent. I don't offer as many laser devices as some plastic surgeons because I believe many of them to be overhyped and marketed vs. the real results they achieve in most hands.


In almost every case where a patient is remotely a candidate for a procedure in the neck/jowl area for loose, sagging skin, a lower face/neck lift is far superior to any non- or minimally invasive technology, in my opinion.

-- Dr. Sayed

The best procedure for this area of concern would be a facelift.  Be sure that you see a board certified surgeon.

Dr. Arthur Shektman has 3 Facelift, Necklift before & afters:

Facelift, Necklift before image performed by Dr. Arthur ShektmanFacelift, Necklift after image performed by Dr. Arthur ShektmanFacelift, Necklift before image performed by Dr. Arthur ShektmanFacelift, Necklift after image performed by Dr. Arthur ShektmanFacelift, Necklift before image performed by Dr. Arthur ShektmanFacelift, Necklift after image performed by Dr. Arthur Shektman

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  1. Facelift with attention to the neck is still the most effective treatment for the neck.

Typically the gold standard for improving sagging neck and jowls is a face/neck lift. A consultation is very important so that a board certified plastic surgeon can access your goals and expectations and help determine the best options for your particular anatomy.

Open Lipectomy and platysmoplasy

Once there is sagging skin, most of the non-surgical procedures won't be effective. The surgical procedure that is specifically for this problem is a facelift which is a misnomer for it is really a neck and face lift. I do several variations of this including a mini facelift which I do totally under a local anesthetic with a smaller recovery time. 

I would recommend a standard facelift procedure to correct those areas. Although the name, facelift, implies a surgery that includes the forehead to the neck, it really address the lower portion of the face. No other procedure or treatment has been able to rejuvenate better than a facelift nor give the longevity of a facelift.

A facelift

Smartlipo Laser Liposuction under local anesthesia is a great option. The heat generated by the laser melts the fat which we suction away. The heat also causes the skin to retract over the next several weeks. The goal is to markedly reduce double chins and jowls while producing a stronger profile.

Some of the most popular procedures for sagging neck and jowls are surgical neck lift as well as minimally invasive procedures that are non-surgical such as Kybella, CoolSculpting and RF Skin Tightening. A plastic surgery office which offers these alternatives will help select the most appropriate for your needs. A consultation is recommended to find out what is best for you.

Facelift! Creams, lasers, and injections don't work. The drawbacks are the need for incisions but if planned well, these heal almost imperceptibly.

Lower face and neck lift.

Lower face and neck lifts, Lifestyle lifts, mini neck lifts, in office lifts and Look Natural Lifts are perfect for sagging neck and jowls.

Mild sagging can be improved or camouflaged using injectable fillers and/or directional sutures (threadlifts). The duration depends on the products used but think in terms of about two years. In general, jowls and sagging neck skin are best treated with a face lift.

I have a great video on this subject. Please view https://www.youtube.com/watch?v=tv9y_pmcpYE Dr. C