Imagine your first impression transformed into a slimmer, healthier, younger you.

A contoured neck with a tight jawline creates the impression of a slimmer build and a more youthful appearance. Necks are one of the most common areas patients complain about, whether it’s a double chin, sagging loose skin, or vertical neck bands. Luckily, there has been a wave of innovation in treating neck concerns, and Reflections is able to offer patients all of the best treatment options, each tailored to specific concerns and goals.

Age, Genetics, and Lifestyle

AGE Most people find their neck ages faster than their face, giving away their age. It could be because we take better care of our faces – moisturizing, spot correcting, and protecting them from the sun – or it could be that the skin is simply thinner and less resilient on our necks. There’s even a book about how traumatic a sagging neck can be – “I Feel Bad About My Neck,” by Nora Ephron. Whatever the reason, it seems to be a common theme for 40 and 50-somethings. Time is certainly cruelest to our necks.

GENETICS Some people are just more genetically inclined to store fat in their necks, or to have loose, sagging skin. Certainly the rate at which we age is at least partially genetic. Sometimes, no matter what we do in terms of lifestyle changes, our predisposition to certain features wins out. For some it’s love handles, for others it’s a double chin.

LIFESTYLE Many times, after successful weight-loss, our bodies bear the signs of our previous weight. Neck skin is not particularly resilient. It does not tighten and shrink the same way as other skin, and it is easily damaged by weight fluctuations, sun damage, and other environmental factors.

“I had many questions and concerns and he addressed all of them. I could not have even asked for a better experience.”
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Fat, Skin, or Muscle?

The first step in selecting a proper treatment for your neck is going to be to determine which of the following tissues need to be treated. Most patients are poor evaluators of the underlying cause of their symptoms (i.e. most people can’t properly identify which of these is the real culprit). For that reason, we highly suggest you be evaluated by one of our specialists, who will discuss the underlying causes of your neck concerns, and prescribe a plan of treatment that meets your lifestyle.

SKIN loses elasticity and bounce as the collagen support system below starts to break down and the skin is weighed down upon by excess fat and loose, hanging muscles. Sun damage, oxidative stress from free radicals, and other environmental factors further damages the skin.

FAT accumulates from genetics, lifestyle, and as part of the natural aging process. In fact, studies have indicated 60% of Americans have excess, unwanted fat in their neck. Excess fat in the neck, or double chin, can be very difficult to lose, especially when there is a genetic component at play.

MUSCLE separation in the neck creates vertical bands, while overall muscle looseness, caused by gravity and age, creates generalized sagging in the neck. The two most visible and oft-complained-about muscles in the neck are the platysmal muscles. Everyone has 2 platysmal muscles. They are rectangular muscles that come from either side of the neck to connect in the center front from below your chin to about two-thirds of the way down your neck. When they separate, you can see the edges that were once connected creating two vertical lines that run from below the chin down to the collarbone.

What Should I do About My Neck?

Double Chin (pockets of fat under the chin or submental area, down through the neck)

Fat under the chin is a very common complaint, even in very young patients. There has been an explosion of technologies marketed to treat this concern. Let’s outline the benefits and limitations of each:

COOLMINI BY COOLSCULPTING is the only FDA-Approved Non-Invasive treatment to reduce fat in the submental area (double chin). Non-invasive means there are no needles, no incisions, and in this case, there’s also no anesthesia or downtime. This technology uses targeted cold to freeze your fat cells, which your body then eliminates naturally over time. It’s the most discreet procedure in the industry in terms of downtime or signs that you’ve had a procedure, because there are none! If you don’t want anyone to know you’ve done anything, this is the treatment for you.

KYBELLA – If you’re looking for a completely non-invasive option, then injectables are the way to go. Kybella® is an FDA-approved, specialized injectable treatment option that is formulated to metabolize fat under the chin. Kybella, the best filler for chin, uses a synthetic form of deoxycholic acid, which is normally found in the stomach to help break down fat. When injected under the chin in a grid pattern, it can evenly reduce fatty tissue through a series of treatments. Kybella comes with a lot of benefits— namely that it requires no downtime or recovery. It also requires no incisions and can be performed with a topical numbing cream. If you’re at your ideal weight and are still bothered by a double chin, then Kybella can be an excellent option.

Kybella works best as a series of treatments— usually, around 3-5 spaced one to two months apart. This gives the body plenty of time to gradually break down fat under the chin between treatments. It’s common to experience some minor swelling and sensitivity, but this subsides quickly. During a consultation, our cosmetic physicians can create the ideal Kybella treatment plan for you and your goals for a refined and sculpted jawline.

THERMITIGHT is a radiofrequency treatment that can reduce excess fat and/or tighten loose skin. This is the least invasive treatment, with the shortest downtime to provide a good result for both of these concerns, which has made it a really popular treatment among our patients.

THERMIRF – Despite our best efforts, gravity eventually wins. Over time, the skin begins to sag and droop, especially in areas like the chin and neck. The ‘turkey wattle’ is probably one term that comes to mind if this sounds familiar. Fortunately, one of the greatest things to emerge from the cosmetic treatment market in the last decade is the variety of non-surgical alternatives. One is ThermiRF®, a non-surgical double chin reduction procedure that tightens the skin where age and gravity have taken their toll. ThermiRF delivers its skin-rejuvenating energy via a thin wand that is placed under the skin using a tiny incision. This radiofrequency energy generates controlled heat, causing the deep layers of the skin to contract and build new collagen. Because the energy doesn’t pass through the tender upper layers of skin, ThermiRF can deliver results that over-the-skin laser treatments like Ultherapy® or Thermage® might not be able to achieve.

After ThermiRF treatment, you’ll see results that emerge over the course of three to six months as the skin contracts and builds new collagen. Although it requires minimal downtime, most patients see firming results that last for one or two years after treatment. To keep up your results, you can opt for maintenance treatments along with our selection of other non-surgical skin rejuvenation options.

LASER LIPOSUCTION – Although liposuction requires small incisions and some downtime, this liposuction alternative can produce some of the most transformative results. Laser liposuction works by inserting a thin laser fiber through a tiny incision where it can liquefy fat and tighten the skin through gentle heating. This means laser liposuction can be an excellent option for patients who have both sagging fat and lax skin. Once the fat is easily removed with a surgical vacuum, the incisions are closed, and you can return home. It can be performed at our Martinsville and Livingston offices with our Comfort Calm Local Anesthesia, meaning there’s no need for general anesthesia and the risks that come with it.

Along with the immediate results that emerge in the days after the procedure, the treated skin will continue to refine and tighten over the course of the following weeks and months. This happens as the skin continues to build new collagen, stimulated by laser liposuction’s heating process. One of the biggest benefits of laser liposuction is that you’ll only need one session for excellent results. However, it can come with some discomfort and swelling afterward, so expect to take a few days off of work and social engagements while you recover and rest.

Crepey, Loose, Hanging Neck Skin (Turkey Neck)

Skin quality in the neck tends to become poor earlier in life than for other areas of the body. You should do your best to protect this area from sun damage, environmental damage, and dehydration with a good skincare routine. However, we also find patients do best with periodic maintenance treatments for this skin.

THERMAGE feels like a warm massage, but the powerful radiofrequency energy delivered will stimulate the building of new collagen and improve skin tone and thickness. Thermage is a non-invasive procedure with no downtime and is so comfortable that there’s no anesthesia, either.

LASER SKIN RESURFACING can repair sun damage, remove dark and red spots, tighten and tone the skin, and provide skin texture remodeling. Our most popular lasers for neck skin tightening treatments are Q-Switched lasers, the Fraxel Re:Pair CO2 laser, and the Lutronic eCO2.

RADIOFREQUENCY (RF) MICRONEEDLING is the newest fractional skin resurfacing technology, and it’s completely changing the way we treat necks. Lasers must push their energy through the top layers of the skin, regardless of whether they will benefit from that energy or not. Microneedling allows us to deliver the energy only at the needle’s tip, and to set that tip depth precisely to target energy exactly where you need it. Additionally, by not treating the skin’s surface with energy, we reduce the risk of pigmentation changes in sensitive skin types, and we reduce the period of redness or visible downtime patients may experience with lasers or other treatments.

ULTHERAPY is a treatment that harnesses the full power of ultrasound energy by focusing waves of ultrasound to precisely target the collagen and deeper tissues of the neck and face. Because this procedure is non-invasive and does not treat the skin’s top layers, there is no downtime or recovery period. However, because of the strength of the energy delivered, Ultherapy can create very dramatic skin tightening results. The most dramatic results are seen after 2 to 3 treatments. Results appear up to 6 months after treatment, as the results are due to the growth of new collagen bundles below the skin’s surface.

THERMITIGHT is a minimally invasive radiofrequency treatment that targets the collagen bundles from below the skin. Because the energy is precisely delivered, and because ThermiTight provides a high level of energy output, the results are natural but very noticeable. Results develop over a period of several months, as the body grows new collagen, making the process very discreet. This procedure can cause some redness or swelling, which usually resolves within a few days.

PRECISION TX is a laser that tightens the neck skin from the inside. The collagen bundles that support your skin are like a fiber mat at the very bottom of your skin, separating it from the fat below. By treating the skin from underneath, we are able to target the collagen first for the most dramatic tightening and thickening of the skin. Studies have shown PrecisionTX works 27 times more effectively than fractional lasers at thickening and tightening the skin.

Vertical Neck bands and Sagging Neck Muscles

If you have two vertical folds on either side of your neck, your platysmal muscles have separated over time. In medical textbooks, these bands are called platysmal bands. This is a normal part of the aging process. However, the only way to resolve this issue is by rejoining these muscles with sutures. A platysmaplasty or neck lift is the only treatment that addresses this underlying muscle separation. Many times, patients will seek out alternative treatments to a necklift because they are concerned with the idea of having surgery. However, at Reflections we perform Necklifts under Local Anesthesia, so the patient experiences a safer and more comfortable procedure. As you can see below, the results of a neck lift can be profound, while still looking completely natural.


As you can see in the images above, the platysmal muscles had separated, creating two visible vertical lines down the neck. This was corrected with a necklift surgery, performed under local anesthesia. Click the Necklift link above to view more before and afters from necklift procedures.

Which Option is Best for Me?

The most important consideration for your double chin options is whether you’re looking to treat fat, sagging skin, or both. For sagging skin, ThermiRF can be an effective option but doesn’t offer significant fat reduction. Conversely, Kybella is best at reducing fat but not excess skin. If you’re looking for the best of both worlds, then laser liposuction may be your best option. When considering the right one for you, however, it’s important to consider whether you’re okay with a minimally-invasive procedure or not. If not, our cosmetic physicians can recommend the ideal non-surgical treatment package for you during a consultation.

Additionally, it’s important to keep in mind that surgical neck lift procedures are sometimes the best way to achieve your anti-aging goals. In this case, both excess fat and sagging skin can be addressed to an even greater degree. Your cosmetic physician may even recommend a facelift or mini-facelift as well so that your results match your profile. We can assess your goals and make sure you understand your options for effective rejuvenation with the procedures that fit you best.

Non-Invasive, Minimally Invasive, and Surgical Treatment Options

As you can see above, Reflections offers a wide variety of non-invasive, minimally invasive, and surgical treatment options for the neck. We believe having all of the best tools at their disposal allows our physicians to create the best, most-natural-looking results, using treatments that fit our patients’ lifestyle needs, like safety and downtime. We invest heavily in this belief, both through the purchase of so many technologies, but also in the experience, skill, and expertise of our team of cosmetic medicine specialists.

Medical Director at

Dr. Mitchell Chasin founded Reflections Center for skin & body as a place where physicians specializing in cosmetic medicine could focus on helping empower patients to feel their most beautiful. Dr. Chasin believes strongly that the best cosmetic physicians are those who are dedicated to mastering their craft through continuing education and collaboration with the industry’s top doctors.