Beyond the Face: A Clinical Approach to Neck and Décolleté Rejuvenation

In the contemporary aesthetic medicine landscape, the therapeutic focus is progressively broadening: from an almost exclusive focus on the face to a more comprehensive approach, also encompassing adjacent anatomical areas.

One of the aesthetic concerns most frequently encountered by patients is the discrepancy between a well-groomed, youthful-looking face and a neck or décolleté that more clearly show the signs of aging.

Today, interest is therefore extending to extra-facial rejuvenation, with the neck and décolleté increasingly integrated into combined and minimally invasive clinical protocols, aimed at improving skin quality, texture, hydration and firmness.

Extrafacial skin aging: anatomical peculiarities

The neck and décolleté have different anatomical and functional characteristics than the face, which can make them particularly vulnerable to photoaging, environmental stress, and age-related changes.

1. Structural fragility:
   The skin of the neck is particularly thin and has fewer adnexal structures and pilosebaceous units than the skin of the face. This characteristic requires special attention in the choice and intensity of treatments, especially when using resurfacing or peeling procedures.
2. Progressive loss of tissue support.
   With aging, changes occur in the extracellular matrix, collagen, elastin, and underlying tissues. The progressive reduction in skin quality and elasticity contributes to the appearance of sagging, micro-wrinkles, and the characteristic horizontal lines of the neck, often referred to as "necklaces of Venus."
3. Muscle Dynamics and "Tech Neck"
   The neck is constantly subjected to flexion, extension, and rotation movements. Over time, the activity of the platysma can also contribute to the appearance or accentuation of vertical lines. Added to this is the so-called "Tech Neck": frequent flexion of the head while using smartphones and other devices can accentuate the horizontal lines of the neck, even in younger patients.
4. Chronic photodamage.
   The neck and décolleté are frequently exposed to solar radiation but often receive less consistent photoprotection than the face. Cumulative exposure to UV rays contributes to the deterioration of the dermal matrix and can manifest as dyschromia, loss of elasticity, roughness, and alterations in skin texture.

Minimally invasive solutions: towards a multimodal approach

Surgery remains a fundamental option for sagging and significant structural changes. However, in recent years, the range of non-surgical and minimally invasive treatments available to address the various factors that cause aging in the neck and décolleté has significantly expanded.

The contemporary clinical approach therefore tends to be personalized, combined and multi-layered, selecting the treatment based on the anatomy and the prevalent imperfection.

Surface action: texture and discoloration

When the focus is on the skin's surface, appropriately selected chemical peels can promote epidermal renewal, improve texture, and help manage superficial discolorations.

The Nebula | ACTO₂ two-phase peels from the Supernova line by Ksurgery MED, for example, were developed to achieve a controlled exfoliating action and can also be used on the neck and décolleté as part of specific protocols.

Skinbooster and revitalization: improving skin quality

An increasingly important role in the treatment of these areas is played by injectables aimed at improving skin quality, including formulations based on hyaluronic acid.

However, treating the neck and décolleté requires special attention to product selection and its rheological characteristics. The shallow depth and thickness of the skin make it essential to use appropriate formulations and techniques, aiming to achieve homogeneous integration into the tissues and limit the risk of surface irregularities.

Hyaluronic acid and skin quality

Hyaluronic acid plays a central role in hydration and extracellular matrix homeostasis. Injectable formulations developed to improve skin quality can help improve parameters such as hydration, elasticity, texture, and the appearance of superficial wrinkles.

This is the context in which Opéra® REV Evolution L by Ksurgery MED comes in , a skin booster based on 20 mg/ml cross-linked hyaluronic acid , in a 3 ml format, developed to allow the treatment of large areas and also indicated for the neck, décolleté and hands.

The choice of injection technique, depth, and distribution method must be tailored to the product's characteristics, the anatomy of the treated area, and the individual patient's condition. Microdeposits, linear techniques, or cannula distribution can be evaluated by the physician with the goal of achieving uniform and natural distribution of the product.

Beyond the Face: A New Vision of Aesthetic Harmony

Neck and décolleté treatments are no longer simply a complement to facial rejuvenation.

The evolution of aesthetic medicine is leading towards an increasingly global evaluation of skin quality, in which uniformity of tone, texture, firmness and luminosity are considered within an integrated strategy.

Intervening early and with personalized protocols therefore allows for a more harmonious result, avoiding the visual discrepancy between a treated face and extrafacial areas that more clearly show the signs of aging.

Essential bibliography

1. Fabi SG, Burgess C, Carruthers A, et al. Consensus Recommendations for Combined Aesthetic Interventions Using Botulinum Toxin, Fillers, and Microfocused Ultrasound in the Neck, Décolletage, Hands, and Other Areas of the Body. Dermatologic Surgery. 2016;42(10):1199–1208.
2. Goldie K, Kerscher M, Fabi SG, et al. Skin Quality – A Holistic 360° View: Consensus Results. Clinical, Cosmetic and Investigational Dermatology. 2021;14:643–654.
3. Roberts WE, et al. Neck Aging and Rejuvenation: A Balanced Approach to Assessment and Treatment. Dermatological Reviews. 2024;5(3).
4. Bukhari SNA, Roswandi NL, Waqas M, et al. Hyaluronic acid, a promising skin rejuvenating biomedicine: A review of recent updates and pre-clinical and clinical investigations on cosmetic and nutricosmetic effects. International Journal of Biological Macromolecules. 2018;120(Pt B):1682–1695.
5. Yutskovskaya YA, Kogan EA. Improved Neocollagenesis and Skin Mechanical Properties After Injection of Diluted Calcium Hydroxylapatite into the Neck and Décolletage: A Pilot Study. Journal of Drugs in Dermatology. 2017;16(1):68–74.
6. Cavallini M, Bartoletti E, Maioli L, et al. Consensus report on the use of PN-HPT™ (polynucleotides highly purified technology) in aesthetic medicine. Journal of Cosmetic Dermatology. 2021;20(3):922–928.