Nonsurgical neck tightening: What works best?

Surgical options, such as the neck lift, facelift or platysmaplasty, still reign for optimal outcomes in neck tightening. But there’s good news. Nonsurgical options are getting better and better results, according to Jason D. Bloom, M.D., a facial plastic surgeon in Ardmore, Penn.

Dr. Bloom presented “Nonsurgical neck tightening: What has worked for me and what has not” yesterday during the Vegas Cosmetic Surgery and Aesthetic Dermatology 2016 meeting in Las Vegas.

Nonsurgical neck tightening is a big deal to patients, Dr. Bloom says.

“Last year, alone, if you look at RealSelf data, there was over a million page views for nonsurgical neck lift topics, like Ultherapy (Ulthera), Thermage (Valeant Pharmaceuticals), ThermiTight (Thermi)…,” he says.

Today’s options range from devices that heat tissue from the outside in to newer technologies that work from inside out.

Treatments that tighten neck skin from the outside in start with lasers and IPL devices, according to Dr. Bloom.

“The problems [with those options] are that results have been inconsistent and multiple treatments are needed,” Dr. Bloom says.

The next generation of devices includes transcutaneous or external contact radiofrequency, which includes Thermage, Exilis (BTL Aesthetics), ThermiSmooth (Thermi) and Pellevé (Cynosure). Transcutaneous RF devices tend to use lower energies and require multiple passes to heat up a large volumes of tissue. That leads to new collagen and elastin formation.

“The problem is, as a surgeon, I want to see results that are close to surgery or something that bridges the gap to surgery. In my opinion and in my hands, external radiofrequency (and I have a number of the devices) is not so incredibly sufficient to cause a ‘clinical change,’” Dr. Bloom says.

Micro-focused ultrasound, or Ultherapy, is the first mechanism that bypasses the epidermis to work on the deeper tissues. Ultherapy, according to Dr. Bloom, produces a “nice” change if one chooses the right candidate for neck lifting and tightening.

“People who need it the least do the best,” he says. “The more lines, or treatments, you do, the better the result. There are downsides: it’s not very comfortable. To get really good results, you need to start adding lots of lines, which is expensive both for the patient and doctor. I think the results are modest.”

NEXT: Microneedles, Microinvasive Technology

Microneedles, Microinvasive Technology

Dr. Bloom says he thinks that microneedles with RF were the first technologies to “shift the needle” in nonsurgical neck tightening.

“These are injectable microneedles that elicit radiofrequency energy or heat. And there are a number of different devices, including Infini by Lutronic, the Profound by Syneron Candela, Fractora by InMode and Intensif by EndyMed,” he says.

Some feature insulated needles where the energy is at the tip; others have needles that are not insulated and the energy is throughout. In essence, the microneedles elicit fractionated radiofrequency, allowing users to vary energy and depth. Patients usually need either numbing blocks or topical numbing. The result, according to Dr. Bloom, is significant new collagen and elastin and generally happy patients.

The most recent advance, and Dr. Bloom’s go-to nonsurgical device for neck lifting and tightening, is microinvasive technology. Under this umbrella is ThermiTight (Thermi), PrecisionTx (Cynosure) and a soon-to-be-released device by InMode. These devices have the RF energy in a cannula, which goes below the skin’s surface, completely bypassing the epidermis.

“You can tighten the soft tissue and muscle of the neck at higher temperatures, without getting a burn because you’re pushing that energy deeply,” he says. “I’ve gotten some amazing results with these [microinvasive] devices. And people love it because it’s one treatment and done.”

Dr. Bloom says he tells patients he might get a 10 to 15% improvement on neck tightening with Ulthera, but a 30 to 40% with the ThermiTight.

“Then, I tell them that neck lift surgery or lower face and neck lift surgery is 100%, so I price [ThermiTight] at about 30 to 40% the cost of my neck lift,” he says.

The great thing about all of these options is that they’re getting word out that neck tightening is possible without surgery, and patients are visiting cosmetic surgeons as a result of the buzz, according to Dr. Bloom.

Disclosure: Dr. Bloom is a consultant, trainer and is on the speaker’s bureau for Allergan Medical and Merz Aesthetics. He is a consultant and is on the speaker’s bureau for Alma Lasers. He is on the speaker’s bureau and is a trainer for ThermiAesthetics, ThermiRF. He is on the speaker’s bureau, is a consultant and clinical investigator for Zeltiq Aesthetics. Dr. Bloom is a consultant is on the speaker’s bureau, is a trainer and clinical investigator for Galderma.