Hi Dr. Yang,
I am 26 yrs old and have deep wrinkles on my neck that look like rings and they run horizontally. I refer to it as turtle neck. There are four (rings) deep creases on my neck. I consulted a plastic surgeon and he recommended botox. I consulted a dermatologist and he said I should avoid botox because that is best for correcting platysma bands which run vertically. He told me fillers would be best. I was thinking about fat injection because I don’t like artificial products. What do you think doctor? Do you recommend anything else like chemical peel or something? I have a disease called vitiligo and I have to stay away from lasers.
Thanks a lot
These line are also called necklace lines. I would not call them “wrinkles” from aging, because it can be seen young people, and is not a sign of aging. In general people who have these lines have more fat on their necks and this causes fullness, with necklace lines in between these full areas.
Botox on the neck area is best used for vertical muscle bands, which young people rarely if ever have. I agree with the dermatologist on that point. You can fill them if you want to, but if you were to see me for a consultation, I would instead look for examples of normal people who have the same lines and it does not detract from their attractiveness. It might help with these lines very slightly, but it would not be a good long term solution for these lines. Imagine using Botox on these lines every 3-4 months for the rest of your life.
If regular fillers are not of interest to you, then fat transfer/fat grafting is an option. If you have a thinner neck with some necklace lines then this may be an option. Since fat grafting of these lines is not a “routine” procedure, I do not know of any reported success rate for necklace lines. In general, surgeons who regularly perform fat transfer/grafting, will fully inform their patients that fat transfer is used to build structure on the face and is not great as a wrinkle or line filler. Although there are reported cases of happy patients who have had fat injected into their smile lines, I think that they are the rare patient and most people will not have the fat survive in the smile lines. This is probably the best option, but is not a proven method.
The necklace lines are formed because there is less fat along the necklace lines, and more fat on the skin above and below those lines. Chemical peels or lasers will not help with wrinkles caused by this reason. Older people who have laxity (lack of elasticity) or sun damage to their skin, causing the wrinkles on their face are candidates for skin resurfacing. In general, surgeons and dermatologists don’t perform chemical peels on the neck. The facial skin is better suited for these skin resurfacing procedures. The neck skin is too delicate. At most, a very light chemical peel may be performed to help with the texture and some pigmentation issues with the neck and declottage area, but the strength of the chemical peel can’t be too strong. Stay away from this option.