The late, great screenwriter and author Nora Ephron summed it up in her usual pithy way: “Our faces are lies and our necks are the truth,” she declared in her collection of essays I Feel Bad About My Neck: And Other Thoughts On Being A Woman. Whereas make-up, Botox and fillers hide a multitude of facial flaws, “short of surgery, there’s not a damned thing you can do about a neck”, she concluded, noting the number of her girlfriends defaulting to polonecks and scarves.
Yes, the neck is a dead giveaway. Thin skinned, sensitivity prone and with few oil glands to buffer it from moisture loss, its sheer nodding, craning, swivelling mobility predisposes it to wattles and creases. Indeed, these facts have lately inspired YSL’s team of skin experts to cite “tech neck” (an i-generation syndrome affecting those who typically check their smartphones, tablets and laptops up to 150 times a day) as one more reason why the over-stressed neck goes first. Chin down is never a good look, which is perhaps why, after years of upward-dog asanas, my yogic contemporaries have smoother necks than those with “joggers’ jowls” – yet another syndrome coined by dermatologists who warn that high-impact exercise and gravity are bedfellows from hell.
But whereas once a full-on face- and necklift was the only sure way to firm a flaccid jawline and tighten sagging skin, nine years since Nora Ephron shared her neck angst, surgery is taking a back seat to newer, non-invasive procedures – parasympathetic soft options that make clinical tweaks seem only a short hop on from regular skincare.
“Although surgery has more pronounced and long-lasting effects, concern over its permanence, the risks of a general anaesthetic and longer recovery times can make people think twice and opt instead for the ‘little and often’ approach,” reports Dr Toni Burke of CosMedocs, a Harley Street clinic that now treats 95 per cent of patients non-surgically.
“If there’s a way of delaying surgery, people will go for it again and again,” confirms Esther Fieldgrass, founder of EF Medispa, one of London’s oldest and most respected aesthetic clinics. “A natural effect is where it’s at now. The latest procedures are regarded as refreshing, rather than changing looks or even age reversing. And the least invasive they are, the better.”
As a knife-phobe myself, too chicken for a lift but nevertheless on the hunt for a turkey-to-swan alternative, this is encouraging news. “I’m just looking,” I lie to my husband when he frowns askance at the brochures. “There’s nothing wrong with your neck,” he huffs. A transparently gallant gesture, but then again, he probably wouldn’t notice if I did have something done. Which is precisely the result I’m after.
“People want subtle changes these days,” agrees Dr Sarah Tonks, who performs the Silhouette Soft face- and necklift, from £2,350 at Omniya, Knightsbridge. A maximum of four 0.12mm sutures made from soluble PDO (polydioxanone, used for surgical stitches) are threaded 5mm below the skin’s surface either side of the neck to create an instant V-shaped uplift. The threads dissolve over 12 to 18 months, stimulating collagen production and natural firming that can last for up to 24 months. “This isn’t surgery and won’t give you the same results as a lift,” Dr Tonks admits, “but it will improve skin quality and makes for a nice tidy up when things start to head south.” Soluble threads are a welcome evolution of the original permanent thread lifts, which are now distrusted by surgeons as unpredictable and difficult to resolve should there be any issues. Although Dr Tonks has performed Silhouette Soft on a 70-year-old, younger women with moderate sagging are ideal candidates. “I always tell my patients not to leave it until there’s too much tissue laxity,” she says.
“The younger and firmer the skin, the better the results,” says Fieldgrass, who is currently championing the Lace Lift for Face, Neck and Dec, from £1,800. Pioneered by Dr Gabriela Mercik in 2012, a supportive mesh of PDO threads is woven hammock-like beneath the skin’s surface to tighten and firm. At 64, Fieldgrass was sceptical until she tested the procedure herself. “I was very jowly, but I’m delighted with the results. Everything’s firmer, more lifted,” she says. While not appearing preternaturally taut, a year on from treatment her jawline is defined, and although her neck has contours, it’s nevertheless smooth and fresh-looking.
Soluble thread lifts like these are invariably combined with Botox, which softens the platysmal bands (those bulging vertical “turkey neck” muscles), and hyaluronic acid fillers, which plump out lateral creases (those intractable rings that look as though you’ve slept in a choker). At EF Medispa, PRP (platelet-rich plasma) therapy, from £1,850, increases collagen production even further. Human growth factors harvested from the client’s own blood are injected into the skin in a procedure similar to that used by the Ministry of Defence to boost wound-healing. A course of three treatments every five or six weeks is recommended for skin rejuvenation.
Minimal downtime is a further advantage of thread lifts. Procedures take about an hour and need a local anaesthetic. “You feel little twitching sensations from the threads for the first couple of weeks, then nothing – no scars, no pigmentation,” Fieldgrass reassures. However, swelling and bruising are to be expected. “Don’t book a thread lift unless it’s at least a week before an event,” warns Dr Tonks.
Since I bruise easily as well as being a coward (even hair-fine needles draw blood), I venture into the calm white interiors of Harley Street’s PHI Clinic in search of something more superficial. Laser technician Spirithoula Koukoufikis introduces me to Ultherapy (from £1,500) in which ultrasound penetrates the paper-thin dermis, without disturbing it, to stimulate collagen production beneath. Once again, skin continues to produce collagen for up to 18 months, although peak production is at three to six months. “Most people come for a jawline tone-up, while getting rid of rough, sun-damaged skin texture,” Koukoufikis tells me. Sounds like my kind of procedure but, alas, this is not to be. Ultherapy hurts, like touching a hot radiator. Moreover, my thin skin has crepey lines reaching right up behind my ears where it’s likely to be most sensitive, she informs me, exposing hidden signs of ageing I never knew I had. My best bet is Infini (from £750 per session), in which bursts of radiofrequency are administered by tiny needles, creating micro-injuries that stimulate collagen’s healing response. I would need three of these treatments to tighten my sagging neck and smooth those lines, then a review after three months, possibly two more sessions and yearly top-ups thereafter. “It’s not the worst neck I’ve seen, but your skin needs constant stimulus,” is Koukoufikis’ diagnosis. (Clinics are clearly not places to expect compliments.) But there is no guarantee that my incipient double chin will shrink significantly.
Still, there’s hope. News of a “fat jab” that specifically targets submental fullness – a double chin – caused excitement when it broke this spring. ATX-101 (deoxycholic acid) has been under development for more than eight years and has been trialled on over 1,600 patients in Europe and the US, with fat loss maintained in the majority of cases. “We’re using a cleaned-up form of bile salts that the body uses to emulsify fat before it is metabolised,” explains Dr Ash Mosahebi of London’s Plastic Surgery Centre, who participated in the trial. Fifteen to 20 injections are typically needed and the precise dosage has still to be assessed, but Mosahebi speculates that should the FDA and EU regulators eventually license the drug for aesthetic use, “it will be a simple, minimally invasive treatment as easy to administer as Botox”. Meanwhile, unless genetic, double chins are invariably caused by weight gain, he warns, so the effects may not be permanent if more weight is put on.
Back at PHI, liposuction expert Hassan Shaaban has for the past three years used his own Precision TX technique (from £3,000) on intransigent fat pads. A laser probe is inserted through nicks in the chin creases, “melting” fat before it is siphoned out; the heat also promotes collagen production. Precision lipo is minimally invasive surgery and needs only a local anaesthetic, yet it may in some circumstances prove the precursor to further non-surgical work for maintenance purposes.
“The fat goes instantly, but skin tightening can take longer,” says Shaaban. “Patients must judge their results themselves at three months.”
Additional Ultherapy improves tightening, but “all treatments have limitations,” he says. “We’ll see how far we can go with lasers, but if there is still loose skin, we’ll recommend a mini necklift whereby we can hide the scars behind the ears and in the hairline.”
So it seems the knife is the only guaranteed route back to Nefertitidom. Ever hopeful, I scan the tubs of neck cream littering my desk and resolve to be pragmatic; however “technologically advanced” no cosmetic potion can compete with laser or knife. Yet I wonder how much worse my neck would look now, had it not enjoyed a lifetime of creams and serums. After all, dermatologists agree that, surgery or not, a dedicated skincare routine both protects and improves texture and traction.
According to New York-based plastic surgeon Dr Gregory Bays Brown, with fewer sweat and sebaceous glands than the rest of the body, what the fragile, fractious neck needs most is moisture, but not heavy oils. “Over time, rich creams cause irritation in the crease lines, which shows up as red rings,” he warns. His RéVive Fermitif Neck Renewal Cream (£100 for 75ml) is therefore light-textured and quickly absorbed yet potent, with an epidermal growth factor to increase cell renewal and grain-derived proteins to soothe and counteract sagging. Another firming option is NaturaBissé Tensolift Neck Cream (£160 for 50ml), which has an anti-sagging polymer, skin-brightening plant extracts and refreshing hyaluronic acid.
More fluid and easily absorbed than sticky creams, serums make ideal daytime neck therapy. “Tech neck” sufferers will welcome YSL’s optimistically named Forever Youth Liberator Y-Shape Concentrate (£65 for 30ml), which contains Glycanactif-Y to stimulate glycans, complex sugar molecules in the skin that enable cell communication and trigger collagen production. EDF Medispa’s Fieldgrass recommends Dr Gabriela’s Magic Beauty Face Lift Serum (£168 for 30ml), a peptide-rich, moisture-intensive fluid formulated to enhance the effects of her Lace Lift. Before a “low-cut” event, Fieldgrass also slathers on Biologique Recherche Biomagic Mask (£92), which, she says, tones, lifts and brightens skin in 15 minutes. Kanebo’s gel-like Sensai Cellular Performance Throat and Bust Lifting Effect (£85 for 100ml) also improves firmness and minimises wrinkles.
Thanks to impressive clinical credentials, SkinCeuticals is something of a dermatologists’ favourite. Dr Sarah Tonks recommends its AGE Interrupter (£143 for 48ml), so named because its cocktail of antioxidants helps neutralise Advanced Glycation End products caused by oxidative stress. (Those criss-cross lines behind my ears are classic signs of AGE.) During the day, wear it over Phloretin CF Gel (£150 for 30ml), which contains high levels of skin-brightening vitamin C; at night over high-potency, collagen-stimulating Retinol 1.0 (£69 for 30ml). All dermatologists stress that during the day, sunscreen provides critical protection against pigmentation and redness, not least after laser treatments, which sensitise skin to sunlight. Over my serum, I’m currently using Bioderma’s excellent Photoderm AR SPF 50 (£15.80 for 30ml), whose soothing ingredients and forgiving tint calm any redness left by my new nightly routine. Having eschewed clinical procedures – for now – I’m instead trialling the Tria Age-Defying Laser (£450), a hand-held class-one laser device that, according to US dermatologist and laser expert Dr Zakia Rahman, will boost my collagen quota and improve uptake of my serums into the bargain. “This laser is far weaker than fractional lasers used in clinics. It might take eight weeks to achieve results comparable with a single clinical session, with the advantage of no downtime,” she says.
A week on, and already the brown blotches near my jaw are beginning to disperse. My neck feels a touch tight, but looks more even toned and – I may be imagining this – a fraction firmer. I’m encouraged. While not exactly putting my neck on the line, you could say I’m in it up to my ears…
See how our editor Gillian de Bono fared when she tried the anti-ageing face procedure Thermage, or follow Spa Junkie as she tackles pigmentation problems and fine lines in a non-invasive superfacial.