The neck and décolleté have been notoriously challenging to improve for skin professionals. There are a variety of reasons for this including internal factors, the neck’s relative sensitivity to aggressive treatments and the myriad of complex concerns that often present together. Traditional approaches to resolve conditions like deep neck folds, poikiloderma and laxity often leave us with less than satisfying outcomes. But, there are exciting new approaches that make significant, long-term improvements possible.
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The neck and décolleté have been notoriously challenging to improve for skin professionals. There are a variety of reasons for this including internal factors, the neck’s relative sensitivity to aggressive treatments and the myriad of complex concerns that often present together. Traditional approaches to resolve conditions like deep neck folds, poikiloderma and laxity often leave us with less than satisfying outcomes. But, there are exciting new approaches that make significant, long-term improvements possible.
The Anatomy of the Neck
Anatomically speaking, the neck faces a few specific challenges. The skin is less resilient than the skin on the face because of less subcutaneous fat and the benefits it provides; it has less overall circulation leading to slower healing times and more rapid aging from sun excesses. The neck is a toxin storage location for pesticide exposure, and it contains structural fat pads that, when diminished, lead to more obvious signs of laxity than the face.
Skin professionals will typically be less aggressive when it comes to acid peels, as a result of the compromised nature of this area of skin. Medical laser treatments have had varied success, but physicians will often shy away from heating the surface skin and focus more on heating the deeper layers to improve laxity. Let’s address these areas and the recommended treatments by the specific signs of aging or conditions, since each sign is derived from a combination of events.
Sun vs. Pesticide Exposure
Deep neck folds are one of the most challenging problems today. Through my experience, these are not the result of lost collagen, as that would create smaller lines and wrinkles and is heavily dependent on the amount of sun damage. Sun exposure is a funny thing, modest sun actually increases collagen production. It is the accumulated sunburns that cause a net loss of collagen with each event. This means that individuals who present with deep neck folds in their 30s and even 40s do not often meet this criteria. This is especially true in today’s overkill of sunscreen use and sun avoidance.
Deep folds in this age group are primarily due to the swelling of the subcutaneous fat. The cause of this is pesticide exposure, typically in childhood, but can be from adulthood as well. These estrogenic toxins are dumped into the neck fat as a protection mechanism and tend to stay there for decades, if not a lifetime, because of repeated exposure and immune weakness that make it an unsafe environment for the body to release them back into circulation for removal. The connection between estrogenic pesticide exposure and stubborn weight gain is very strong, so one might be tempted to classify the folds as the result of obesity. However, the neck is often one of the last places to gain weight if the weight is from overeating or another source. America has the highest pesticide use of any country in the world by far.
Topical peptides, retinols or other ingredients for collagen production will not touch the deep lines. Acid peels and laser treatment will also be ineffective since the problem is not a collagen problem, and neither of those have ever proven to create long-term increases in collagen density. In theory, you could use a device that increases lipolysis, but the inability to precisely control how much and how even the fat loss would be makes that a questionable choice.
Related: Undoing Damage to the Dec and Neck
My Treatment Approach
Remove the toxins through supplements that bind or accelerate the liver’s processing of them. These ingredients include DIM, activated charcoal, glutathione and more. The process takes time and requires that they remove themselves from repeated exposures.
Poikiloderma Problems
Poikiloderma is a very challenging but related condition, as it is also caused by estrogenic pesticides. While I have not completely identified the reason that these individuals develop diffuse telangectasias and related pigmentation instead of swelling fat cells, my guess is it depends on the type of toxin involved. The reason for the capillaries is the skin is requesting vascular support due to the toxicity of the poisons stored in the subcutaneous fat. The reason for the pigmentation is that the skin in this area now becomes compromised, so it creates an umbrella of protection for itself over the region.
The treatment options have included a lifetime of lightening through tyrosinase inhibitors, laser or acid peels and little else. None of these have produced satisfactory results and they often leave the skin patchy and damaged. Telangectasias are not “broken.” They are a support mechanism for skin trauma to improve circulation in damaged areas.
My Treatment Approach
Through an independent clinical trial using zinc finger technology, I have been able to heal and clear over 60% of them. You do not want to close capillaries in the skin as loss of circulation is the primary cause of aging. It is important to note that this condition cannot be healed if the pesticides are not removed, so the same process of supplements mentioned above is required to make that possible over several months.
All About That Neck... Damage
Neck lines and laxity of the neck are the most common signs of aging and, again, extremely challenging to address. I tend to stand alone in believing that this has little to do with collagen losses in the dermis. Instead, this is a structural fat loss problem. Structural fat pads are not only in the face; they are also found in the neck. We lose these skin-firming and gravity-fighting structures as we age, but the losses are accelerated by having a body fat composition below (roughly) 15% in women or below 7% in men. These individuals often exercise, and since the body uses fat for fuel, it will steal from the fat pads once the subcutaneous fat reaches these low levels. I estimate its effect to be about 80% of the cause of wrinkles in the skin. Obviously, it does not help things if someone has had many sunburns over their lifetime as well.
The loss of structural fat pads is the primary reason fillers have been so prevalent. However, fillers in the neck are not a great option. Acids and lasers can be attempted, but the neck is not tolerant to a lot of heat. The primary options being used are lasers or injections that scar the loose skin to the underlying structures. This can produce temporarily satisfying results, but it often does not do well as the client ages. Topically, due to the delicate nature of the neck skin, a low trauma, high fibroblast targeting approach is required (See Ingredients for Collagen Deposition Sidebar).
My Treatment Approach:
Restore their fat pads through unique strategies that involve specific blends of sea buckthorn oil. As it turns out, with the right mixture of fatty acids, you can provide your body with the fats that it uses in the structural fat pads, which are distinct from the fats that it puts into subcutaneous fat cells.
Related: Skin Care Ingredients to Protect Your Neck
Décolleté Damage
The décolleté is no different, in that it needs products that address sun damage primarily. It does not have a structural fat pad, and it is not a deposition zone for pesticides. However, if you have rashes or acne in that region, then the cause is chlorine exposure, which the primary source of that is tap water ingestion. This is another toxin that can be bound and removed with the ingredients highlighted above.
The most common issue is sun damage, and since this skin is a little more tolerant to heat, there are many procedures that can lighten pigmentation. Once again, I advise against traumatic procedures, since they will increase the likelihood of a worsening of the pigmentation over time. The ingredients discussed above for aging skin are the same that I would recommend for the chest.
Taking a Holistic Approach
Most skin conditions, including aging, have a combination of internal and more superficial structural concerns. My preference is a holistic approach that does not involve trauma and addresses the problem from the inside out. Permanent improvements to these skin conditions are possible when you address the real source of the problem.
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Ben Johnson, MD, is a physician, inventor and entrepreneur who has spent the last 25 years dedicated to solving some of the world’s most challenging skin and health conditions. He holds multiple patents related to skin care and wellness as a result of his research and philosophies pertaining to the skin-body connection. Dr. Johnson founded Osmosis Beauty with a revolutionary approach that is changing the direction of skin care away from excessive exfoliation and renewing the focus of dermal remodeling, barrier and DNA repair, and detoxification.
