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The Necked Truth by Leslie Thomas

Updated: May 3, 2022


Back in 2008 Nora Ephron was on a talk show selling her book, “I feel badly about my neck, and other thoughts on being a woman”. I admit I never read the book, but the title did make me question if I was doing enough for my neck. That was roughly 15 years ago, I was 40, and the answer was “no”. Sadly, until we opened the clinic, I only made sure that I was moisturizing and adding serums to my neck every day, and not even necessarily sunscreen! Now, I try to do “all the things” for this very delicate and tricky area. Let’s look closer.

Here is a pretty lengthy list on some reasons why the neck can be so high maintenance. Hold tight, pure facts coming your way…

  • The neck usually shows aging before the face and is the hardest area to improve with treatment.

  • Not supported by other structures, facial skin has fat layers and muscles under it to support it and give it foundation and structure, the neck does not.

  • The skin is physically thinner than the skin on the face, and already contains less collagen than the face. Making it more sensitive and vulnerable to everything.

  • Has fewer sebaceous glands making it susceptible to dehydration, wrinkles are 5 times deeper here than on the face.

  • Genetic and hormonal activity affects cellular function and repair of the tissues.

  • Modern day living and technology – TECH NECK – from looking down at screens

  • Gravity is constantly pulling downward on the skin.

  • Stretching of the skin due to movement of the head and neck – most worked areas on the body, constantly turning, extending, twisting, bending.

  • Moving and positioning during sleep can also contribute to elastosis (sagging).

  • The muscles of the neck are susceptible to aging as well, the sternocleidomastoid (the muscle that protrudes when you turn your head and runs from top of chest to behind the ears) becomes more pronounced with age. The platysma (is a large flat muscle that runs from chin to upper chest) – it stretches and can look like a turkey neck – sagging AND protrusion – OH MY!

  • Constantly sun-exposed – this area is often more sun damaged than the face as it is often overlooked, sun exposure causes breakdown in collagen and elastin fibrils as well as hyaluronic acid (HA), also affecting cellular DNA which can lead to cancers and abnormal growths – wrinkles are five dimes deeper in this area.

  • Natural barrier protection is off due to sun exposure, distended capillaries can occur, dryness further contributes to damage – causing splotchy, hyper and hypo pigmented skin, CREPEY wrinkled neck and décolleté with elastosis.

  • Weight gain and loss significantly contribute to sagging in the neck – especially if also environmentally damaged

Can begin in the 20’s (for you Floridians - whaaaahhhhhhh!!!!!, and Californians)


This area is hard to treat! At the very least make sure you are using good serums and creams, whatever the brand, and sunscreen all over and every day (side and back of the neck too!) The goal is to keep it high and tight for as long as we can! Collagen and elastin stimulation is huge for offense and defense and can be performed through many modalities

including laser, heat, needling, and calcium based dermal filler. A series of or combination of modalities is always best.

One sit-up does not make my abs a poolside conversation, and neither will one neck cream. (Just an analogy, my abs are not being talked about anywhere by anyone)


1. SUNSCREEN – use daily, choose your favorite but I’m loving the Skin Medica Essential Defense with SPF 47! Sold tinted and un-tinted

2. ANTIOXIDANTS - Use daily - My favorite from the office for the body is the ENVIRON Body EssentiA (with vitamins A,C,E and alpha hydroxy lotion), I rub in on my damp skin straight out of shower, all over my body and most especially the neck in an upward motion

- other antioxidants are Vitamin C, Vitamin E, green tea, grapeseed extract, resveratrol, niacinamide

The idea is to apply the antioxidant so it will neutralize the free radical activity triggered by sun exposure, thereby stopping the cascade of ROS before it produces damaging enzymes that destroy the collagen and elastin fibrils

3. CERAMIDES – use daily - fatty structures that patch holes in outer epidermal layers, helping skin retain much more moisture, helps with smoothness, texture, fine lines, and wrinkles, helps skin function better – LOVE the Skin Medica Neck Correct Cream

4. Regular skin cancer checks

5. Alpha hydroxy acids (AHA’s) use daily, 1 ST STEP – helps shed dead, dried and pigmented cells – Skin Medica AHA/BHA cleanser, AHA/BHA cream

6. PEPTIDES – palmitoyl pentapeptide-4, trifluoroacetyl tripeptide-2, palmitoyl tripeptide-38, help restore elasticity and smoothness – Skin Medica Neck Correct Cream contains the highlighted peptide


  • AHA peels

  • LED red-light treatments

  • ENVIRON Body EssentiA – all women over 50 need to be on this for the body! It is amazing for Crepey skin all over!


  • Vitamin C – by Skin Medica

  • VIKTORIA DEANN PEPTIDES – tone, lift, pro-collagen, pro-elastin,

  • microcurrent

  • THERMI-SMOOTH - radiofrequency

  • VIVACE - radiofrequency with microneedles

  • Skin Pen - microneedling

  • RADIESSE – dermal filler made of calcium hydroxyl apatite which is hyperdiluted and applied to area sparingly to stimulate collagen and elastin and provide foundation



Use neurotoxin in the ropey areas on my neck that protrude ( the Botox, Xeomin or Dysport, helps it relax and lay flatter) – every 3 months

Use LIFT and TONE peptides by Viktoria Deann (lots of other peptides to choose from in this line) – twice a day morning and night – if you haven’t tried these peptides yes, you’re missing out!

Use ENVIRON Body Essentia on whole body and neck and dec – after every shower, so at least once a day

Use SKIN MEDICA Neck Correct Cream – twice a day morning and night

Do Skin Pen or Vivace or Thermi-smooth, laser - every 3 months to stimulate collagen

I have not used PDO threading yet, but I have had great results with other clients in this area. Probably my favorite place to use PDO threads. I am not averse to surgery in this area depending on how this sh*z goes down, which is TBD every day being from Florida. For now, this other stuff is good- but I’ve got my eye on it!

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