Neck & Décolletage Rejuvenation

What is Neck & Décolletage Rejuvenation?

Neck and décolletage rejuvenation is an umbrella term for non-surgical treatments aimed at the changes that age and sun exposure cause on the neck and upper chest. It is not a single procedure; which treatment is considered depends on which change is most prominent in your case.

The neck is an area prone to ageing and often exposed to the sun; it ages in its own particular way. According to a joint assessment by doctors from different specialties, changes in the neck have no single cause: loosening of the thin neck muscle called the platysma, redistribution of fat tissue, remodelling of the bone structure and a decline in skin quality all play a part together. This picture varies from person to person, and also from one population to another.

On the décolletage, the change is more about the skin itself. Sun-damaged skin on the chest can show laxity, lines and wrinkles, skin darkening, redness, roughness you can feel with your hand, thinning of the skin and more visible thread veins. No single method addresses all of these changes.

This family of methods includes mesotherapy, collagen stimulators, hyaluronic acid treatments for skin quality, botulinum toxin for platysma bands and a thread lift for laxity; you can find the details of each on its own page. You can also read the guide article that explains step by step what changes in the neck and why.

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From findings to method: four separate issues

Changes in the neck and décolletage often look like a single concern, but they are actually made up of separate findings: loss of skin quality, horizontal neck lines, vertical platysma bands and tissue laxity. Each has a different cause and calls for a different method.

Botulinum toxin is considered for neck bands that appear when the muscle contracts in people with little skin laxity. For mild and moderate laxity and for marked sun damage, the options listed in the scientific literature are device-based methods. The fact that a method appears in the scientific literature does not mean that it is offered at this clinic.

Horizontal neck lines are a separate matter. Research shows that these lines appear not only in older age but also at a young age; in other words, having these lines is not, on its own, a sign of age. Studies of fillers and collagen stimulators (biostimulators) in the neck have also focused mainly on lines, wrinkles and skin laxity.

These findings can occur together in the same neck. For this reason, it is recommended that the area is assessed as a whole and that the plan is based on the person’s anatomy. Which finding is most prominent in your case is determined at a consultation.

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Mesotherapy for the neck and décolletage

Mesotherapy is the delivery of active ingredients into and under the skin through small injections. On the neck and décolletage, the aim is skin quality, not volume: hydration, skin texture and fine lines. The scientific evidence for this area is limited, and this directly determines what can be expected from the treatment.

Alongside fillers, mesotherapy is also used for injectable rejuvenation of the neck, chest and hands; however, there is little evidence specific to the neck. In an uncontrolled study (a study with no comparison group), a hyaluronic acid solution enriched with amino acids was applied to the neck using the mesotherapy technique, and 15 people were treated. On day 60, 33.3% of participants rated their appearance as very much improved and 46.6% as much improved, and no major adverse events were reported. Even so, an uncontrolled study of 15 people does not give a clear idea of the size of the effect.

For horizontal neck lines, a randomised trial (in which participants were randomly assigned to groups) compared non-cross-linked hyaluronic acid filler combined with mesotherapy against a single session of botulinum toxin. This trial compared two groups of 25 and 23 people; significantly greater improvement in the lines was reported in the combination group at every follow-up visit. However, this group had more pain; redness, swelling (oedema) and bruising were more frequent and lasted longer. No serious adverse events were seen, and the study was reported as level IV evidence.

The picture is similar for mesotherapy in general. According to a consensus guideline prepared by international experts, there is no internationally accepted, evidence-based standard for the clinical uses of the method, and high-quality research is still needed. Studies of mesotherapy complications also point to the lack of standards and stress that its safety needs to be assessed in larger studies. Which ingredients will be used and how many sessions are planned are discussed with you individually at your consultation.

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Collagen stimulators for the neck and décolletage

Collagen stimulator treatment means injecting substances such as calcium hydroxylapatite (CaHA) or poly-L-lactic acid (PLLA) into the tissue to stimulate the body’s own collagen production. On the neck and décolletage, these substances have been studied for skin laxity and wrinkles, not for volume. There is an important difference you should know about: the enzyme hyaluronidase breaks down hyaluronic acid, but CaHA and PLLA are not hyaluronic acid, so they cannot be reversed with this enzyme.

An analysis of 24 studies and 887 patients treated with fillers and collagen stimulators in the neck reported that hyaluronic acid, PLLA and CaHA all improved neck wrinkles and skin laxity. However, the studies used different measures, participant numbers were small and long-term evidence is limited. In an uncontrolled study of highly diluted (hyperdiluted) CaHA in 20 patients with skin laxity on the neck, significant improvement was seen at month 3 on photographs, using a newly developed scale, and no major adverse events were reported.

In a small preliminary study (pilot study) of 20 people with skin laxity on the neck and décolletage, the tissue sample (biopsy) was taken from a separate injection of the same substance around the ear. This tissue showed an increase in collagen, elastin and blood vessel formation, and the findings were consistent with improvements in skin elasticity measurements. However, the tissue change was shown in a sample taken from around the ear, not from the neck.

There are also randomised trials on the décolletage. In a randomised trial in which diluted CaHA was given at two different treatment intervals, at least a one-grade improvement in décolletage wrinkles at rest was reported in 73.5% of participants 16 weeks after the last treatment. In a randomised trial of 30 people in which PLLA was prepared with two different reconstitution volumes (reconstitution means mixing the powder with a sterile liquid before injection), most participants in both groups showed improvement at month 9.

In a PLLA study of 25 women with sun-damaged décolletage, the assessors found improvement in 90% of participants at month 6, while 57% of participants reported improvement themselves. In other words, the improvement seen on a scale may not match the person’s own perception. None of these décolletage studies had an untreated comparison group.

At the clinic, treatment of the décolletage is assessed individually, with the aim of improving skin quality, fine wrinkles and tissue support rather than adding volume; as well as hyaluronic acid, collagen stimulators such as CaHA or PLLA may also be assessed separately. The front of the neck needs particular care: it has been reported that PLLA injection in this area is off-label (outside the uses covered by the product’s licence or approval) and may cause nodules (small lumps under the skin) more often. You can find details on choosing the substance, how it is prepared and sessions on the Collagen Stimulator Treatments page.

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Hyaluronic acid for skin quality and horizontal neck lines

Hyaluronic acid is used in this area for two separate purposes. The first is in treatments where it is injected finely and evenly into the skin to target hydration and the quality of the skin’s appearance; these are commonly known as skin boosters, or in Turkish as ‘gençlik aşısı’ (Turkish for ‘youth vaccine’). Here the word ‘aşı’ (vaccine) does not refer to a vaccine; it describes an injection into the skin. The second is to support horizontal neck lines. In both uses, the aim is the appearance of the skin, not lifting the tissue.

An analysis of the effect of hyaluronic acid injections on skin ageing reviewed 12 studies, and the data from 6 of them could be combined. After injection, there was a significant improvement in skin hydration and radiance; however, no significant difference was found in skin elasticity or pigment measurement (melanin index) compared with the comparison groups. This analysis is not specific to the neck or décolletage; it shows that the measurable effect is on skin hydration and radiance, and that no effect was shown on laxity or pigmentation.

For horizontal neck lines there is more evidence, but it is still limited. An analysis covering 11 studies and 379 people reported that hyaluronic acid (HA) fillers produced a significant improvement in wrinkle severity and overall aesthetic appearance. In this analysis, the retreatment rate within 12 months was 50% and the complication rate was 14%; the reported side effects were mild and temporary. The analysis is level IV evidence.

In a randomised trial of 188 people comparing two different non-cross-linked hyaluronic acid solutions, three sessions were given 4 weeks apart. At 4 weeks after the last treatment, the great majority of participants in both groups showed a response in their neck lines, and no serious adverse events related to the product or procedure were reported. In another randomised trial of 26 people with horizontal neck lines that are visible even at rest (static lines), some participants were given saline for comparison; this trial allowed optional additional treatment and reported significant improvement from baseline at day 360. The numbers of sessions in these studies were set by the research protocol; they do not show what your own plan will be.

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Neck bands and botulinum toxin

The vertical bands that appear on the front of the neck when the muscle contracts come from the thin platysma muscle just under the skin. The method considered in this case is botulinum toxin, often called Botox®, which reduces the movement of the muscle. That name actually comes from a product’s brand name and is used in everyday language as if it were the general name of the substance.

An analysis pooling three randomised controlled trials and 912 people that compared botulinum toxin with placebo (a dummy treatment) for platysma bands found significantly greater improvement and higher satisfaction in the treatment group, in both doctor and participant assessments. The frequency of treatment-related adverse events is similar to that in the placebo group; most of these events are mild and temporary. The method is considered mainly for people with little skin laxity whose bands become more visible when the muscle contracts.

The anatomy of this area needs care. The platysma muscle covers the whole neck and the lower part of the face. Lack of knowledge of the muscle’s anatomy and the toxin’s properties can lead to side effects such as difficulty swallowing (dysphagia), voice changes and weakness of the neck muscles; for this reason, anatomically safe injection points are recommended.

This method targets the muscle; it does not target skin quality, excess skin or fat under the chin. You can find more details about neck bands on the Botulinum Toxin for the Neck page.

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Neck laxity and thread lifts

If tissue in the neck has moved downwards, the issue is no longer only skin quality but the position of the tissue. One of the non-surgical methods considered in this case is a thread lift: supporting the tissue upwards with threads that are placed under the skin and grip the tissue.

The clinic uses dissolvable threads (PLLA/PDO). ‘Thread lift’ is the general name for lifting treatments carried out with threads; the French Thread Lift is one of the techniques within these methods.

In an analysis of the safety of thread lifts on the face and neck, covering 59 publications and 14,222 patients, the most common side effects were asymmetry, swelling and bruising. Serious side effects were reported rarely; they included altered sensation, hair loss, and injuries to blood vessels and glands. Contour (surface) irregularities, injuries to blood vessels or glands, infections and inflammatory reactions were listed among the effects that do not go away on their own. Whether the method gives long-lasting, satisfactory results is not yet clear; new studies are needed to answer this.

Another analysis of thread lift complications on the face found that dissolvable threads were associated with a significantly lower risk of altered sensation and thread extrusion (a thread working its way out through the skin) than permanent (non-absorbable) threads. In this study, long-term satisfaction was lower than satisfaction immediately after the procedure; the researchers recommend discussing before the procedure that the lifting effect may not last in the long term. You can find neck-specific planning on the Neck Thread Lift page.

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Sun protection is part of the plan

A large part of the change in the neck and décolletage is related to sun damage; so whichever treatment is chosen, regular sun protection is part of the plan. An injection does not remove the factor that started the change; skin that continues to be exposed to the sun keeps changing after treatment too.

There is evidence on this from a randomised trial. In this trial of 903 adults under the age of 55 in Australia, the group who used broad-spectrum sunscreen every day showed no detectable increase in skin ageing after 4.5 years. Over the course of the study, skin ageing in this group was 24% less than in the group who used sunscreen at their own discretion. The same study found no overall effect of beta-carotene supplements on skin ageing.

The study also has limitations: some outcome data are missing, and its power to detect moderate-sized effects is limited. In addition, the study is not specific to the neck or décolletage; it is based on assessing the fine creases on the skin surface (microtopography). It is also worth remembering that the neck is an area often exposed to the sun. The form of sun protection that suits you is discussed at your consultation.

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Limits of these treatments

Neck and décolletage rejuvenation treatments do not remove excess skin and are not a substitute for surgery. According to reviews of this subject, surgical lifting and operations on the platysma muscle are effective; however, they carry a higher risk, a longer recovery time and a higher cost. Non-surgical methods are one option within this picture, not a replacement for surgery.

The second limit relates to which concerns the treatments address. Besides injections, there are many other methods for décolletage skin, such as chemical peels, light and laser treatments; these are not among the treatments described on this page. Skin darkening and visible thread veins are not concerns that injections are designed to treat; the analysis of hyaluronic acid injections also found no significant change in pigment measurement (melanin index).

The third limit is the scientific evidence itself. In studies of fillers and collagen stimulators in the neck, different measures, small participant numbers and limited long-term evidence prevent a firm conclusion. There are also few publications on the safety and effectiveness of combining methods on the décolletage. High-quality research is also still needed for mesotherapy.

For this reason, no promise is made about how long results last or about success rates for any method. The figures in studies describe that study’s methods and participants; they do not show what will happen to your neck or décolletage.

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Known risks

Treatments on the neck and décolletage are medical procedures that involve injections or placing threads, and they carry risks. The type of risk depends on the method. It is also important to remember that a rare risk can have significant consequences if it does happen.

An analysis of the side effects of hyaluronic acid fillers in the face reported injection-site effects such as swelling, pain, redness, bruising, lumps and firmness; although rare, serious complications that may be irreversible cannot be ignored. These data relate to the face. In the neck, a case has been reported of a delayed inflammatory reaction that appeared as redness three weeks after hyaluronic acid was injected into neck lines and went away on its own two weeks later. Hyaluronic acid can be dissolved with the enzyme hyaluronidase. Hyaluronidase is kept at the clinic.

Side effects of varying severity have been reported with mesotherapy; this information is based on case series and single-patient case reports. An analysis of non-tuberculous mycobacterial (NTM) infections (a type of bacterial infection) linked to mesotherapy, covering 423 patients in 30 publications, reported that the infections came from injections contaminated with germs from the environment. Most of these infections cleared with antibiotics, but treatment could take weeks and scarring could remain. Most cases occurred on the abdomen, buttocks and thighs.

With collagen stimulators, the most important issue is nodules: in an analysis of the safety of CaHA, 96% of reported adverse events were nodules; most of these were not visible and went away without any intervention. It has been reported that PLLA injected into the front of the neck may be linked to nodules forming more often. With botulinum toxin injections into the platysma, difficulty swallowing (dysphagia), voice changes and weakness of the neck muscles have been reported. With thread lifts, the most common effects are asymmetry, swelling and bruising.

Before the procedure, you will be asked about blood thinners, antiplatelet medicines (which stop blood platelets clumping together) and supplements that can affect bleeding. Do not stop any prescribed medicine on your own. If needed, the procedure is planned or postponed after consulting the relevant doctor. How much these risks matter for you is discussed at your consultation.

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