The neck is the subject of a lot of interest lately – both concerns about the appearance of the neck and the widely-publicized debut of two new non-surgical treatments to remove neck fat. With the convergence of both of these, our office is getting calls and emails from people eager to learn more. How much of a concern is this really? One study showed that 68% of men and women had some concerns with their neck.
Why the neck and why now.
Interest in our overall appearance and particularly the appearance of the neck seems to be driven by a couple of phenomenon.
- Communication via cell phones and tablets: If you are using Facetime, Skype, or video conferencing, the normal angle that you will hold your device will not put your neck at its optimal position for it to look the best. This can also extend to computer conferencing depending upon the height of your camera. Selfies can make matters worse depending upon how you hold our camera.
- Being more competitive in the job market: This is something that I have heard from my patients, both men and women. Many are encountering younger individuals in the workplace, or individuals who appear to be more youthful. Most feel that they will be viewed as more competitive if they look more youthful themselves (so much for the wisdom of experience!). Also, I have some other patients who are in front of the TV camera on a regular basis, and the better their neck looks, the better they look.
First things first: The anatomy of the neck.
Before we talk about the new technologies that have emerged to help us get our lean and mean neck, it helps to understand the parts of the neck that can be treated. These are: skin, muscle, and submental fat. Since most folks I know love animals, let’s use them as examples.
Some people have fullness of the neck, beneath the chin (think bullfrog). If this is the only problem, there are a lot of things we can do, especially with these new options. Fat reduction is where these new treatments are focused.
However, if there is a lot of loose skin in addition to the fat (think Shar-Pei or Basset Hound), fat reduction alone will not take care of the problem. This will require a lifting procedure like a facelift or neck lift to remove the excess skin.
If there are very prominent muscle bands (like a Labrador Retriever), these need to be repaired surgically with a face or neck lift, although sometimes Botox can help.
But if it’s just fat, fat that’s always been there and ain’t going anywhere on its own, we’ve got some great new treatments (and a time-honored one as well).
The gold standard: Liposuction of the neck.
The way we have traditionally treated fat of the neck has been with liposuction. This remains an excellent treatment and one to which all other treatments should be comparedLiposuction of the neck requires a brief surgical procedure. Once you are asleep, the neck is infused with fluid to help with bruising and fat removal, and then the fat is removed with small cannulas through several 2 millimeter incisions. Afterwards I have my patients wear a wrap around the neck night and day for one week, and just at night for another week. So there is some down time, and surgery is involved, but you’re one and done.
Then came Lipo-Dissolve, which never really caught on.
In terms of other treatment options, injection lipolysis came next. Simply put, this is the injection of a chemical into the neck that will dissolve the fat. Ten years ago you may have heard about “Lipo-Dissolve”. This involved the injection of different recipes of chemicals to reduce fat in many areas of the body. But there was not true regulation, and no standardization of the treatments. Thus, the results were variable and frequently not the best. It’s not a procedure we ever did in our office.
The New Kids on the Block: Kybella and CoolMini
Kybella: Inject away your double chin.
Our current option, Kybella, has been well researched and is FDA-approved. It is now available here in Knoxville. The chemical used is deoxycholic acid which is produced by our livers to help digest fat. The treatment protocols for its use are well-established and all injectors are required to undergo training. These are great improvements and make this treatment a viable option. During a treatment session the patient will have multiple small injections of the drug into the neck. There is some discomfort at the injection sites and as the chemical begins to work, which can be managed by the application of ice (briefly!). Each treatment takes around 30 to 45 minutes. However, there will be significant swelling of the neck after each treatment for up to a week. Further, you will need at least two treatments and some people can need up to four or five sessions. Treatments can be done every six weeks.
The advantages of Kybella are that it is totally non-surgical– a real plus for some people. However, multiple treatments are required and the recovery from each treatment is almost like recovering from surgery. It’s sort of a non-surgical with surgical side effects. But, it does work.
CoolMini: Freeze away your double chin.
What’s next? Enter the CoolMini. We have been working with CoolSculpting since 2012 and have found it to be an excellent method of reducing fat through cooling, (Cryolipolysis). A device is applied to the area of fat to be treated, and the area is cooled to close to freezing. This causes crystals to form within the fat which cause their destruction. (Pretty much all of us have had this done in the office and we know it works!)
Recently a new applicator has been developed that allows us to treat the neck. The FDA just approved the CoolMini and it’s available now in our office. Most people just need two treatments, although some may need more. Treatments are done about a month apart and each takes about an hour. Afterwards there is a bit of redness, and some mild swelling which rarely lasts more than a day. So, for this treatment, there really is no down time. And this is what is so exciting about the CoolMini. It’s a true non-surgical with non-surgical recovery. Here are some photos from the clinical trials.
Liposuction vs Kybella vs CoolMini
So, how do you choose between the options? Well, from my standpoint, I love to operate. I know liposuction works, the results can be impressive, and it’s a single treatment. Kybella is a great tool to have at our disposal. But if I were having it done, I would really need to plan on how I would deal with the swelling after the treatments. (Turtle necks might work in the winter.) The CoolMini, on the other hand, is where we expect to see the greatest interest. It’s only disadvantage will be that it takes more than one treatment, but there is no down time, and very few side effects.
In keeping with the movie Jerry Maguire line, “Show me the money!”, how do these stack up? I thought you’d never ask.
- Liposuction of the neck costs $2698 – soup to nuts. (A little less if you are paying with cash).
- Kybella comes in at $2400 for two treatments. If you need more than two treatments (and most do), each will be an additional $1200.
- CoolSculpting with the CoolMini is $1475. This also includes two treatments. Additional treatments, if needed, are $750.
Clearly cost is not everything; you need to consider recovery, downtime and convenience. But, you do the math…..just saying.
Other Ways To Improve the Appearance of the Neck
So, it that all there is? Not quite. There are two other tricks in our bag primarily for the skin of the neck, as in the quality of the skin. These will give improvement in the appearance of the skin of the neck with a little bit of skin tightening.
Skin care products designed for the special needs of the neck.
First are two skin care products: Nectifirm, something we have had for a while and Neck-Cessity, which is a new product from mybody Skin Care. Nectifirm is a cream which includes peptide and antioxidants that will improve the texture of neck skin. People who are using this do see a difference and like it. Neck-Cessity is an all-in-one serum which contains similar firming peptides and antioxidants, but adds retinol to increase cell turnover and combat dark spots on the neck and chest.
New skin care procedure that’s also great for the neck.
We have also started using our SkinPen on the neck, and we’re planning to have fun with this! You may have heard of something called “microneedling”. Well, the SkinPen is essentially the same idea but with a much more advanced, comfortable and predictable delivery. It’s a great procedure for the face (all of us in the office are trying to get on to Christy’s schedule on a regular basis for this) and we are now using it on the neck as well. Of all the new skin care procedures we have brought into the office, the SkinPen has been one of the best and most exciting. It’s definitely here to stay.
So, lots of options for the neck. Where do you start, and how do you choose? You first need to consider what the issue is for your neck: is it just fat, or are there other concerns? Then you can consider which option fits into your schedule, your lifestyle, and your budget. But if you really want to cut to the chase, come into our office and we can help guide you. What’s right for you, is what works for you.
All the best,
David B. Reath, MD