Neck & Décolletage
For neck lines, neck bands, loosening skin and an aging chest.
With Dr. Juliya Fisher and Dr. Shereene Idriss.
In Brief
Neck and décolletage rejuvenation treats aging below the jawline, including horizontal neck lines, vertical bands, loosening or crepey skin, and sun damage on the upper chest. We treat the face, neck and chest as one unit. Ultherapy or Morpheus8 tightens loose skin, Botox softens bands, Sculptra and Radiesse soften lines, and Fraxel fades sun damage. For jowls, see skin tightening.
Diagnosis First
The skin of the neck and chest is thinner than the face, with fewer oil glands, and it has had years of sun, often without sunscreen. Its collagen breaks down earlier too, and the damage tends to show in three ways.
- Lines. Horizontal neck lines are partly how you are built (Dr. Idriss has had hers since she was 12) and deepen with movement and with looking down at a phone. Vertical neck bands come from the platysma, the muscle under the skin of the neck. Lines on the chest are often sleep lines, pressed in overnight rather than made by expression.
- Skin quality. Thin skin loses firmness sooner, so the neck can look crepey or start to loosen under the chin while the face still looks firm.
- Sun damage. Years of sun show on the neck and chest as brown spots, redness and broken blood vessels, often on the sides of the neck (poikiloderma of Civatte), with a rough, uneven texture.
Most necks show more than one of these, so a plan here usually combines treatments.
A vertical band is a muscle; a horizontal line is the skin. The neck needs a diagnosis before it needs a device.
“Neck skin is thinner than the skin on your face, so I use a lighter hand there. I set the depth and energy for that skin, and if it needs more, we add a session instead of overdoing one.”
What We’d Skip
Thin neck skin is easy to irritate and easy to overtreat.
Don’t stop at the jawline
The face, neck and chest age as one unit. A face treated for years above a neglected neck looks pasted on, so your skincare and your plan should reach down to your chest.
Don’t use your face retinoid at full strength on your neck
Neck skin is thinner and drier, and a prescription retinoid is too strong there. Use an eye cream strength retinol, or a low strength retinol over a thick moisturizer.
Don’t expect Botox to erase horizontal neck lines
“Botox is not going to help these horizontal lines,” says Dr. Idriss. It softens the vertical bands; horizontal lines respond better to collagen stimulating injectables and devices.
Don’t choose by device name alone
On thin neck skin, settings matter as much as the machine, and radiofrequency microneedling is kept shallow and gentle. “A device is just a device. The person using the device is equally, if not more important,” as Dr. Idriss puts it.
Don’t skip sunscreen below your jaw
If two fingers’ worth of sunscreen covers your face, Dr. Idriss adds “a third one for our neck and a fourth one for our chest.” Without it, new sun damage undoes what treatment builds.
How Are Neck Lines and an Aging Neck Treated?
Bands, lines, loose skin and sun damage each take a different treatment, and many necks need two.
- Vertical neck bands. Botox relaxes the platysma muscle so the bands soften and flatten; Botox Cosmetic is FDA approved for moderate to severe vertical neck bands (platysma bands). It does not treat horizontal lines.
- Horizontal neck lines and crepey skin on the neck or chest. Sculptra & Radiesse are collagen stimulating injectables; in neck lines, Radiesse is used highly diluted. Diluted Radiesse is FDA approved for wrinkles of the décolleté; on the neck, and Sculptra on the neck or chest, they are used off label, at your doctor’s judgment.
- Loose skin under the chin and on the neck. Ultherapy uses focused ultrasound to build new collagen beneath the skin, with little or no downtime. It is FDA cleared to lift loose skin under the chin and on the neck, and to improve lines on the chest.
- Sun damage, brown spots and rough texture on the neck and chest. Fraxel Dual Laser, a non ablative fractional laser, treats discoloration and texture across the neck, chest and hands.
- Deep sleep lines on the chest. Regenerative Fat Transfer moves a small amount of your own fat into the lines, under local anesthesia; Dr. Idriss used her own fat for the lines on her chest.
For crepey skin, radiofrequency microneedling such as Morpheus8 is often paired with an injectable for a better long term result.
The Treatments
We use six treatments for the neck and chest, often two together. Botox for neck bands is in the side by side below.
- FDA cleared for the neck and chest
UltherapyFocused ultrasound to lift loose skin under the chin and on the neck 
Sculptra & RadiesseCollagen stimulating injectables for neck lines and chest wrinkles
Morpheus8Radiofrequency microneedling to firm crepey neck skin
Fraxel Dual LaserA fractional laser for sun damage and texture on the neck and chest
Regenerative Fat TransferYour own fat for deep lines on the chest
Side by Side
Each treatment answers a different neck or chest problem, and your doctor often combines two.
| Treatment | How it works | Suited to | Downtime | Sessions | Results |
|---|---|---|---|---|---|
| UltherapyFocused ultrasound | Focused ultrasound builds new collagen beneath the skin without breaking the surface | Loose skin under the chin and on the neck; lines on the chest | None; brief redness or swelling possible | Usually one | 2 to 3 months |
| Sculptra & RadiesseCollagen building biostimulators | Injectables that prompt your skin to build its own collagen; Radiesse can be diluted for thin skin | Horizontal neck lines and crepey skin; wrinkles of the décolleté | Little; possible swelling or bruising | Sculptra: a series; Radiesse: as your plan needs | Radiesse right away; Sculptra over months |
| Morpheus8RF microneedling | Fine needles release radiofrequency heat beneath the surface, set to a careful depth on the neck | Crepey, thinning skin on the neck, often with an injectable | 4 to 5 days of pink, slightly bumpy skin | One or a short series | Over months; full effect at about 6 months |
| Fraxel Dual LaserNon-ablative fractional laser, 1550 nm and 1927 nm | A fractional laser treats microscopic columns of skin and leaves the skin around them intact | Sun damage, brown spots and rough texture on the neck and chest | Shorter than ablative lasers; a few days of redness and peeling | 1 to 5, set after your skin’s first response | After the first session, improving over time |
| Regenerative Fat TransferYour own fat, moved in one visit under local anesthesia | A small amount of your own fat is taken and placed in one visit, under local anesthesia | Deep sleep lines on the chest | Days for the face; donor area sore 1 to 2 weeks | Not always one; no more than every 4 to 5 years | Settles over months; not all of the fat stays |
| BotoxAlso Dysport, Xeomin and Jeuveau | Relaxes the platysma muscle that pulls the neck into vertical bands | Vertical neck bands; not horizontal lines | None; a small bruise is possible | One; repeat once movement returns | Builds over 10 to 14 days; peaks at 2 to 4 weeks |
“I look at the face, neck and chest together, because that is how everyone else sees them. A plan that stops at the jawline never looks finished.”
In Their Words
“
I decided to visit Dr. Fisher after all the reviews I had read about her online and she did not disappoint! Right from the initial consultation through the ultherapy session today she was professional, thorough and considerate while giving recommendations and administering treatment. She put me completely at ease from the get go and my experience with her was a 11/10! And I will be returning! Thank you Dr. Fisher!
Chitra R.
“
Absolutely love Dr. Idriss. She has a very thoughtful approach to her practice and really wants you to look and feel like the best version of you. I’ve been seeing her for years and trust her completely with all my skincare needs. She is also just a lovely person and my appointments are always a pleasure.
Ekaterina B.
“
Highly recommend Dr. Fisher! She truly cares about your skin health before anything else, which made the experience incredibly comforting and informative. I left feeling not only great about my results but like I’d actually learned something about my skin. Dr. Fisher takes the time to explain every detail and makes you feel completely welcome. …
Tyler G.
“
I would recommend Dr Idriss a thousand times over and over. She is extremely knowledgeable, knows what will work and what won’t and will always give you an honest recommendations. You will never feel pushed into moving forward with any injections or procedures.
Hiva F.
Bryant Park, New York
Your Dermatologists
Founder
Dr. Shereene Idriss
Candid advice, subtle results.
Board-certified, Practicing since 2013
Dermatologic Surgeon
Dr. Juliya Fisher
Ultherapy and lasers for the neck and chest, set for thin skin.
Double Board-certified, Columbia Mohs fellowship
Both doctors share one philosophy, so either is a good place to start. Book online with Dr. Fisher, or call (212) 612-1520 for Dr. Idriss.