Solutions for the aging neck, decolletage, and hands

Sometimes the changes we see in the mirror as we age will bother us. If you’re unhappy with some aspect of your appearance, there are many non-invasive ways to make improvements.

My last two posts went over non-surgical solutions for wrinkles and sagging skin of the face, and treatment options for issues specific to the eyes, nose, ears, lips, and even eyelashes. Restoring a youthful appearance generally requires addressing more than just the face, however.

Many of us go to great lengths to care for our faces but pay far less attention to our neck, chest, and hands. A wrinkled, weathered looking neck or decolletage will immediately draw attention away from even the most youthful looking face. So, let’s review some of the aesthetic concerns of the neck, decolletage, and hands and our options for improving them non-invasively.

The Neck

Necklace lines

Horizontal lines we develop across the neck as we age are called “ necklace lines” because they can sort of resemble a necklace (or several). Loss of collagen and elastin over time means the skin isn’t as resilient as it once was. Everyday movement of the neck begins to etch permanent lines into the epidermis. Staring down at smartphones and tablets is responsible for the development of early necklace lines in many people.

Loose Skin

The skin of the neck is thinner than the skin on the face or other parts of the body. It gets stretched, twisted, and turned all day. Collagen production decreases with time causing it to become less elastic and prone to wrinkles and sagging. Gravity doesn’t help matters. Meanwhile, the muscles of the neck become lax, compounding the loose, crinkly appearance.

Necklace lines and laxity (loose skin) of the neck can be treated non-surgically using a combination of collagen building treatments.

  • PDO threads can be placed under the skin of the neck to encourage the formation of new collagen.
  • Ultherapy is a popular choice for firming the neck due to the penetrative ability of ultrasound waves. Ultherapy can cause a contraction of the underlying tissues, ultimately leading to a tighter, firmer neck.
  • Microneedling helps build thicker, firmer skin.
  • Adding platelet rich plasma (PRP) to microneedling treatments encourages cells to generate even more collagen, resulting in healthier, more plump looking skin.
  • Laser treatments like the Aerolase and Clear + Brilliant can be done in conjunction with any of the above to give a big wake up call to collagen creating fibroblasts.

Of course, sunscreen, quality skincare, diet, and lifestyle play a huge role in the resilience and thickness of our skin as we age too.

How PDO threads are inserted

Dr. Gerald Pierone Jr. at One Aesthetics recommends a combination of Ultherapy and PDO threads for treating necklace lines and loose neck skin. He says they work synergistically to give the best result possible without surgery.

I recently visited One Aesthetics to address my necklace lines and the beginning of crepey, loose neck skin. I was first treated with Ultherapy. After that, Dr. Pierone inserted forty smooth threads into my neck. Remember that threads initiate a healing response that stimulates the creation of new bundles of collagen. The result is firmer, thicker skin. Watch him insert the threads below. It may look a bit scary, but Dr. Pierone numbed my neck beforehand, so the procedure was painless:

Once he placed all the threads, he removed the needles. I had very minimal bruising. The threads will dissolve over the next six months. It takes about that long to see the ultimate effects of the Ultherapy as well.

Photo credit: Dr. Gerald Pierone Jr. Patient before and after PDO threads to tighten and smooth skin of the neck.

Platysmal Bands

Along the sides of the neck, we have a broad sheet of muscle called the platysma muscle. This muscle allows the mouth to widen and draws the corners of the mouth down. You can sometimes see it flex a bit when you clench your teeth. We’ve already gone over how loss of collagen causes the already thin skin of the neck to become even thinner. The thinner skin makes the muscle below more apparent. At the same time, the platysmal muscle becomes lax with age. This creates the appearance of vertical bands or cords in the neck that protrude.


Platysmal bands

Botox injected along the length of the platysmal muscle softens and relaxes the protruding bands. A small amount of Botox where the platysmal connects to the mandible can also provide improved definition to the jawline area. This is sometimes referred to as the Nefertiti Lift.

Treatments that encourage collagen can also improve the appearance of platysmal bands a bit. PDO threads, Ultherapy, microneedling, PRP, and laser treatments all help to plump and thicken the skin of the neck, which can make the bands less visible. If the bands are quite strong, however, relaxing the muscle with Botox will likely still be necessary.

Skincare ingredients that help protect the collagen we still have (sunscreens, antioxidants) and promote the production of more collagen (vitamin C, peptides, retinol, growth factors, etc.) are also part of the equation for keeping the neck looking as youthful as possible.

Submental Fullness

Submental fullness is a fullness under the chin, AKA “double chin.” While it’s common in overweight individuals, you don’t have to be overweight to have submental fullness. It can be due to genetics, or the fat pads of the chin and jawline can slide and redistribute during facial aging, leading to the appearance of a double chin later in life.

Submental fullness is corrected with Kybella injections.  Kybella breaks down fat cells so that they can be eliminated by the body as waste.  A series of treatments is recommended, usually at four to six-week intervals.  There is typically some skin tightening or retraction that occurs as a result of Kybella as well. A bit of inflammation follows the injections and that’s what’s thought to stimulate collagen. The various modalities mentioned above for loose skin can be used if there is still some skin laxity following Kybella treatment.


Poikiloderma is the name of a condition where the skin of the neck and chest are covered in hyperpigmentation and broken capillaries.  Years of unprotected sun exposure is the primary culprit. The thin skin of the neck and chest (especially in fair-skinned individuals) is most vulnerable. Often the middle portion of the neck (that is shaded by the chin) isn’t affected. It’s thought that hormonal factors may play a role, as well as certain skincare or perfume that may be sensitizing.

The Aerolase laser is an excellent option for treating poikiloderma. It not only helps to fade hyperpigmentation quickly but also zaps away broken capillaries (or telangiectasia.) Aerolase is a non-invasive, no downtime procedure. Read more about it here. (The Clear + Brilliant laser works well for hyperpigmentation, but broken blood vessels are best addressed by the Aerolase.)

Sunscreen and avoiding the sun at peak hours is the best way to prevent poikiloderma. If you are prone to poikiloderma, avoid applying perfume or other fragranced products on or near the neck and chest. You may benefit from exfoliants like alpha hydroxy acid or retinol as well.

The Decolletage

Wrinkles, laxity, and hyperpigmentation are all common complaints when it comes to aging of the decolletage area. Just like the skin on the neck, decreased collagen production leads to thinner, less resilient skin. UV exposure compounds the damage. For women, lines can also form from the weight of one breast pulling on the skin, like while sleeping on your side.

For the most part, aesthetic concerns of the decolletage can be treated with the same modalities used for the neck.

Ultherapy and PDO threads can be used to improve wrinkles and laxity of the chest skin. Microneedling, PRP, and laser treatments are also useful to combat the loss of collagen and hyperpigmentation often seen in the decolletage area.

Photo credit: Before and after Ultherapy

Medical grade silicone can be helpful if you’re a side sleeper. SilcSkin is one example of a specially shaped silicone pad that helps the skin lay flat at night. The pads also create an occlusive environment between your skin and the silicone overnight, which is said to promote collagen. Several companies make similar medical grade silicone products. (Amazon will likely have the best price.)

There are silicone pads for different areas of the face too, but I would always find them stuck to my pillow upon waking. Someone with dry skin might have better luck. The chest pads seem to stay in place the best overnight. Your skin should be completely clean and dry before application.

The Hands

Loss of fat, visible veins, and hyperpigmentation (sun spots, age spots, etc.) are three elements that come together to increase the visual age of your hands. There is a different way to treat each issue, and like most everything we’ve discussed, a combination of treatments is likely to bring about the most satisfying result.


OO Photo credit: Merz Aesthetics (hand grading scale)

Hyperpigmentation is treated the same way it would be on the face or neck:  The Aerolase laser or Clear + Brilliant are both excellent for reducing unwanted pigment. Loss of fatty tissue in the hands is easily remedied with injectable dermal fillers. Less prominent veins in the hands will be disguised by filler. Very prominent veins can be treated with sclerotherapy. (Sclerotherapy is the injection of a solution into a vein to collapse said vein.)

Photo credit: Dr. Gerald Pierone Jr. (Female patient before and after dermal fillers for hand volume.)

Our hands can see more sun than our face does, so keeping them looking youthful requires frequent application of sunscreen. This can prove difficult, as we wash our hands several times a day. It’s a good idea to carry a small bottle of high SPF hand cream in your purse or car as a reminder.

Any skincare you use on your face can be used on the hands as well. If you don’t want to “use up” all your good skincare on your hands, you can mix a bit of prescription retinoid in with some hand or body lotion. Use the retinoid in the evening and sunscreen during the day to keep the skin of your hands looking as healthy as possible.

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