Neck Lines and Décolletage: Which Method Does What for Horizontal Lines, Vertical Bands and Sun Damage?

What is actually meant by neck lines?

The signs of ageing in the neck area cannot be gathered under a single heading. The first thing the physician does during the examination is to work out which component the complaint comes from, because a method that helps one component may have no effect at all on another.

In most people these components are present together. The layers and grading of sagging are explained in detail in the article “Sagging of the Face and Neck”, and fullness under the chin in the article “Double Chin (Submental Fullness)”.

Why do neck lines and décolletage wrinkles form?

The skin of the neck and décolletage is thinner than facial skin, contains fewer oil glands and is constantly in motion. This is why both age-related changes and sun damage are noticed early in this area.

• Sun: it is foremost among the preventable factors that speed up skin ageing. Many people who apply sunscreen to the face skip the neck and décolletage; with open-necked clothing this area stays unprotected for years.
• Age: collagen and elastin decrease, and the skin thins and loses its elasticity. This natural process cannot be stopped.
• Structure and heredity: in some people horizontal lines have been present since childhood or youth; whether the neck is short or long and the thickness of the skin are decisive.
• Smoking and sunbeds: these speed up skin ageing.
• Weight changes: weight lost quickly or repeatedly may contribute to the skin becoming loose.
• Sleeping position: vertical sleep lines can form on the décolletage, between the breasts; they are more marked in people who sleep on their side.

Does looking at your phone cause neck lines?

On social media it is often claimed, under the name 'tech neck', that bending the head forward for long periods causes horizontal neck lines. In the medical literature this term has been studied mainly in the context of poor posture and neck pain. No well-designed study directly showing that screen time increases neck lines could be found while this article was being prepared.

The idea that the skin folding repeatedly in the same place may make a line more noticeable over time is plausible; however, it is an assumption, not a proven cause-and-effect relationship. Horizontal lines can also be seen in children who have nothing to do with phones, and in past generations. Raising the screen to eye level may be beneficial for the health of the neck and spine; it should not be expected to prevent or reverse lines. There is also no evidence for the neck straps, pillows and exercise programmes sold on the strength of this claim.

How much do sun protection and creams help?

The first step with evidence for this area is not to limit sun protection to the face. Dermatology organisations recommend applying a broad-spectrum product with a sun protection factor of at least 30 to all exposed skin every day, and at the same time not neglecting shade and protective clothing. The neck, the nape, behind the ears and the décolletage are the places most often forgotten. For choosing a product and the right amount, see the article “Sunscreen Guide”.

• Sun protection does not erase an existing line; it slows new damage and pigmentation, and it is also the basic condition for preserving the effect of any procedure.
• With open-necked clothing, covering the décolletage with fabric or a scarf is more reliable protection than cream.
• Creams containing retinoids can give a moderate improvement in fine lines and uneven colour in sun-damaged skin. The skin of the neck and décolletage is irritated more easily than the face; ask your physician how to start. Retinoids are not used in pregnancy.
• Moisturisers plump the skin and temporarily reduce the 'crêpe' appearance.
• There is no strong evidence that products sold as 'neck cream' are superior to products with similar ingredients used for the face. Firming creams cannot lift sagging tissue back into place.

If one of the spots on your décolletage looks different from the others, is growing, bleeds, or crusts over and does not heal, this is not an aesthetic matter; it should be shown to a physician before any procedure is considered. The details are in the article “Moles, Skin Tags and Spots”.

What does botulinum toxin do in the neck, and what does it not do?

In the neck, botulinum toxin acts only on the muscle-related component, that is, the vertical bands. When it is injected into the prominent edges of the platysma muscle, the muscle relaxes and the bands become less conspicuous. In a meta-analysis that assessed three placebo-controlled studies with a total of about a thousand participants, a significant improvement in the appearance of the bands compared with placebo was found in those treated; the effect was followed for about four months, and in these studies the frequency of side effects was not found to differ markedly from placebo.

• Suitable person: people with little skin laxity whose main complaint is bands that become prominent when speaking or tensing the muscle.
• The effect is temporary; it lessens over months and the treatment needs to be repeated.
• It does not correct excess skin or sagging. Where there is marked looseness, relaxing the bands does not change the result.
• Its effect on horizontal lines is limited; these lines are the result of skin folding, not of a muscle contraction.
• The neck lies next to muscles involved in swallowing and head movements. If the medicine spreads to the surrounding muscles, difficulty swallowing, a change in the voice or weakness in the neck may occur; this is why the treatment should be performed by a physician who knows the anatomy well.

Multi-point treatments of the lower face and neck aimed at defining the jawline are also promoted; their effect is mild and is not seen in everyone. For the general properties of the medicine and what to watch for after the procedure, see the article “Botulinum Toxin”.

Can filler and skin booster injections be used for horizontal neck lines?

Injecting thin, soft hyaluronic acid fillers and skin boosters into or beneath horizontal lines has become common. A systematic review bringing together eleven published studies on this subject (379 people in total) reported improvement in the appearance of the lines and in measurements of skin quality. The same review classified the level of evidence as low; most of the studies are small, short and without a comparison group. In about half of the participants the treatment had to be repeated within a year, and mild, temporary side effects were reported in about one in seven.

Because the skin of the neck is thin, injections here carry a risk of their own: when the product is placed more superficially than it should be, or a product of unsuitable density for the area is chosen, firm lumps (nodules) lined up along the line can form, which can be felt and are sometimes visible. In the literature, nodules lasting for months and resistant to several attempts at dissolving have been reported as cases after hyaluronic acid treatment of neck lines. The true frequency of such problems is not known.

• Bruising, swelling and redness are common and mostly pass within days.
• Irregularity, the line temporarily looking more noticeable, and nodules have been reported.
• As with every filler treatment, there is a risk of infection and, though rare, of vascular occlusion; if you have increasing pain, paleness of the skin or a mottled purplish discolouration after the procedure, contact the physician who performed the treatment without delay.
• With products that are diluted and injected into the neck and décolletage to stimulate collagen production, the risk of nodules is of particular importance; these products cannot be dissolved. The details are in the article “Collagen-Stimulating Fillers”.
• The evidence for the use of polynucleotides, exosomes and similar products on the neck and décolletage is limited; they should be regarded as being at the research stage.

For the differences between the product groups and their levels of evidence, see the article “Skin Booster Injections”. It is important to ask what will be used on you by its content rather than its name, and to find out whether the product can be dissolved.

Do energy-based devices tighten the neck and décolletage?

Focused ultrasound, radiofrequency and radiofrequency microneedling aim to stimulate collagen production by heating the deep layers of the skin. They can give moderate tightening in mild to moderate laxity; the result appears slowly over months, varies from person to person, and in some people there is no noticeable change. Where there is marked excess skin, the contribution of these methods falls short. The details are explained in the article “HIFU (High-Intensity Focused Ultrasound)” and in our article on radiofrequency.

On a neck and décolletage where sun damage is the main issue, by contrast, the target is colour and texture. Vascular lasers or intense pulsed light can be used for redness and fine blood vessels, pigment-targeting lasers for dark spots, and fractional lasers for fine wrinkles and poor texture. There is an important limit here: the skin of the neck and décolletage heals more slowly than the face and is more prone to scarring and colour change. For this reason, lower energy and more caution are used in this area than on the face; the same result as on the face should not be expected. The types of laser and the methods used for pigmentation are explained separately in the relevant procedure articles on our site.

Which method is considered for which problem?

When is a surgical assessment more realistic?

If there is excess skin on the neck, bands that are prominent even at rest and loss of the angle between the area under the chin and the neck, the change that can be achieved with non-surgical methods is limited. Patient information from dermatology organisations also states that surgical procedures such as a neck lift give results to an extent that none of the non-surgical options can reach, while the recovery time and risks are greater.

This does not mean that everyone should have an operation. What it means is this: in marked sagging, rather than trying one session of devices and injections after another, seeking the opinion of a physician in a surgical specialty allows you to weigh the options more accurately. Surgery does not correct sun damage, dark spots or skin quality either; these are dealt with separately.

Realistic expectations

• Horizontal neck lines can be softened with today's methods but not erased completely; structural ones are particularly resistant.
• No single method acts on all four components. Being clear about which component bothers you prevents unnecessary procedures.
• The effect of injections and devices is temporary; repeat treatment is needed to maintain it, and this should be discussed at the outset.
• Because the risk of scarring, pigmentation and nodules is higher on the neck and décolletage than on the face, a 'little and cautious' approach is the rule in this area.
• If sun protection is not kept up, the effect of no procedure is preserved for long.
• In before-and-after images on social media, head position, the angle of the chin and lighting can by themselves change the appearance of the neck.