Horizontal Neck Lines & Wrinkles

The neck is a visible area of change as one ages. The youthful neck is characterized by a taut neck skin without lines or excess droopy skin, a distinct lower jaw border, good muscle tone, and a well-defined angle between the chin and the neck. Neck rejuvenation is an essential complement to achieving comprehensive and harmonious facial rejuvenation. A youthful, aesthetic neck imparts the image of an individual who is energetic and in good health.

How Does It Manifest?

Horizontal neck lines manifest as shallow skin depressions running across various levels of the neck. They are usually fixed, and do not disappear with different neck postures or facial expressions. They interrupt the smooth neck contour and impart an aged appearance and may adversely affect the individual’s body image and social functioning.



How does it arise?

Horizontal neck lines are usually the result of strong direct platysma muscle action on the overlying skin, which may happen developmentally, or as a result of aging. After the third decade of life, the skin becomes thinner and less elastic due to reduced production of elastin and collagen fibers. Changes in adipocyte (fat storage cells) metabolism results in loss of fat volume and thickness. The soft tissue layer overlying the platysma muscle becomes thin and the action of the muscle becomes more prominent. Horizontal neck lines are often more prominent in smokers due to accelerated atrophy of the neck skin.



There are two options for the treatment of horizontal necklines: micro-botulinum toxin injection, and structural fat grafting. Successful facial rejuvenation reverses these ageing changes.

Botulinum toxin injection

Microbotulinum toxin injection is commonly used to treat horizontal neck lines and attains a high level of satisfaction in most cases. The popularity of botulinum toxin injection has grown rapidly since the 1990s, and it is now one of the most commonly administered procedures in the world. 

Individuals with shallow, horizontal neck lines and with minimal skin laxity are ideal candidates for micro-botulinum toxin injection.

Botulinum toxin causes partial weakening of the platysma muscle that is involved in the formation of horizontal neck creases. The platysma muscle lies close to the muscles for speech and swallowing, and the injection dose and technique have to be modified. Injection of the horizontal neck creases is a delicate art balancing the desire to remove the creases whilst avoiding weakness of speech and swallowing.

The effects of botulinum toxin generally take 1 to 3 days to be observed, and will last for 4 to 6 months. Repeat treatments are necessary for maintenance of the result.

Individuals are advised to avoid vigorous massage to the treatment area for 2 hours following the injection. This is to prevent spread of the botulinum toxin, which may result in potential unintended adjacent muscle paralysis. Individuals may resume their usual activities immediately following the procedure.

Structural Fat Grafting

Structural fat grafting involves harvesting fat from areas of excess, purifying it, then grafting it in volume-deficient areas. A high proportional survival of fat cells may be attained with the use of specialized fat grafting cannulas available at Picasso Plastic Surgery. Structural fat grafting delivers elegant and long-lasting results. Structural fat grafting is a minimally-invasive ambulatory surgical procedure performed under local anesthesia, with optional intravenous sedation if requested.

Individuals with any degree of horizontal neck lines and seeking long-term improvement may consider structural fat grafting. Structural fat grafting may be simultaneously performed in other areas of hollowing and volume loss such as the face, neck and hands, and deliver benefit in multiple sites in one single procedure. Those with severe hollowing will benefit from significant cost saving in the long term as compared with recurrent treatment using large volume filler injection.

Common sites for fat harvest include the inner thighs, hips, flanks and lower abdomen. Small incisions are made near the areas of intended liposuction, and local anesthetic is infused for optimal intra- and post- operative pain relief. The fat is broken up and aspirated under negative pressure. It is purified before being grafted into the horizontal neck creases using purpose-made fat grafting cannulas for optimal survival. Grafting is performed through 1-mm incisions that are well-concealed within the neck creases.

Many individuals are able to return to work on the day after the surgery. Depending on the extent of fat harvesting performed, most of the swelling and bruising will resolve by the 5th postoperative day. Stitch removal is usually performed on the 5th postoperative day.

Individuals are advised to avoid pressure on the grafted areas to optimize graft survival. Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed with extra pillows when asleep at night. Bruising may be minimized by avoidance of strenuous activity for the first 2 weeks.

After structural fat grafting is performed, blood vessels grow into the fat grafted area (neovascularization). The degree of neovascularization determines the proportion of fat graft survival. In general, 60 to 80% of the grafted fat will survive and the appearance at 2 months postoperatively is normally representative of the long-term result. The body absorbs the non-surviving fat during the first two months. The fat grafts that survive persist for many years.

Other Neck Procedures & Treatment