Energy devices
Energy devices
Though one must proceed carefully with laser resurfacing due to the lack of pilosebaceous units and the increased risk of scarring, short-pulsed carbon dioxide laser is likely safe and effective for the skin of the neck. It can be used to improve mottled pigmentation, texture, mild rhytides and the necklace line. One retrospective study demonstrated a 39% reduction in rhytides in 308 subjects without any pigmentation or scarring.36 The erbium laser on lower depth settings was also found to be safe and effective for the neck. The advent of nonablative and ablative fractional laser resurfacing has also created more options for neck skin rejuvenation. Nonablative fractional laser has minimal downtime, but requires multiple treatments to be effective. Fractional carbon dioxide can be used, but with low-energy settings and one pass. There have been reports of scarring with the fractional carbon dioxide19 laser and an increased risk of hypopigmentation.
For moderate lifting and tightening with minimal down time, high intensity–focused ultrasound can be moderately effective for the appropriate patient. This technology penetrates deeper into the skin and remodels collagen and possibly the SMAS. It improves jowls and will improve the cervicomental angle. Though it is tempting to treat the neck only, there will be better results if the lower face is also treated, since this will
provide additional lift, tightening, and harmony. High-intensity ultrasound can be painful. One author (HBG) will perform micro field blocks with 1% lidocaine and 1/100,00 epinephrine, wait for 15 to 20 minutes so there is no swelling and the liquid has been absorbed so it does not modify the effectiveness of the treatment. Patients are uniformly comfortable with this technique. In general, there is no downtime with this procedure, and results may require 6 to 12 months. Using multiple treatments, this modality can also be used to reduce neck circumference.37
Fractional radiofrequency needling is another novel energy device that can improve neck contour. The RF generates heat transmitted fractionally by small needles into the dermis. In studies, these devices have been shown to lift, tighten, smooth, and volumize. In one study, fractional RF was measured to having the equivalent effectiveness of onethird of rhytidectomy.38,39 For the neck, some of these RF microneedling devices have modified the angle and depth of their needles for deeper penetration. This has resulted in fat reduction, and improved the cervicomental angle in one unpublished study. This modality will result in downtime. There can be extensive swelling of the neck that may last 1 week. Similar to ultrasound, optimal results may require 6 to 12 months. Another RF-based technology—thermistor-regulated—has been shown to significantly increase neck tightening with minimal recovery time (Fig. 79-2).
Figure 79-2. Profound RF. (A) Before. (B) Three months post submental Profound using the SubQ handpiece.