How to get 'Nefertiti Neck'

How to get 'Nefertiti Neck'

Cheek by jowl

Text: Renée Batchelor

Image: Image of Christy Turlington: Arthur Elgort/Conde Nast via Getty Images

Yes, it's a thing. Singaporean plastic surgeon Dr Marcus Wong tells us all about the neck enhancing procedures that can give you a slimmer, more elongated profile

Do you feel bad about your neck? Or is it a part of your body you have never really scrutinised. Believe it or not, the neck is an area of concern for many women. The late director Nora Ephron (of When Harry Met Sally fame) even wrote a book called 'I Feel Bad About My Neck: And Other Thoughts On Being A Woman' back in 2006. The truth is that the neck — and surrounding areas like the jowls, chin and jawline — is one of the hardest places to treat, but one where age shows up quite obviously.

Other than plastic surgery and a lifetime wearing turtlenecks in our tropical weather, what can one do? Dr Marcus Wong, a plastic surgeon at Wong’s Plastic Surgery Centre, offers the 'Nefertiti Neck Lift Treatment' a series of tiny multiple injections of botulinum toxin into the neck cords or platysma muscles, which extend from the collar bone to the jawline. This can help reduce the appearance of jowls and turkey neck and define the jawline, shaving years off your appearance.

Also, there are other treatments that can be done in combination with the Nefertiti Neck Lift such as thread lifts and collagen-stimulating treatments to lift the sagging around the middle part of the face. We ask Dr Wong all our burning questions about these procedures and why we lose definition in that area as we age.

In your experience at what age do women start to be concerned about the way their necks look and what are their concerns?
When women embark on minimally invasive treatments, they usually pay attention to the face — as this is where the first signs of ageing begin to appear, in the early 30s or even earlier depending on lifestyle and habits.

Women take note of changes to their neck and jowl and seek treatments for them much later as these changes occur later, from the late 30s onwards. As a woman approaches middle age, not only do her cheeks and forehead lose volume due to ageing, the volume of connective tissue holding the muscle, bone and facial tissue together begins to decrease, as do the bone mass of the skull. As facial tissues lose structural support, they begin to sag, something also known as mid-face sagging. Compared to Caucasian women, Asian women, even the younger ones, can be especially prone to mid-face sagging with their short and/or receding chins and thicker and heavier skin.

As we age platysmal bands in our necks (the muscles that run from either side of your neck, extending from the jawline right down to the collar bone) shorten and pull on the jawline, contributing to a jowly appearance. A sedentary lifestyle exacerbated by frequent looking down at electronic devices such as phones and laptops with little or no exercise could also shorten the platysmal bands. In some women this might contribute to a condition called the turkey neck where the skin on the neck is loose, like a turkey's wattle. Turkey neck tends to occur much later from the late 40s upwards. 

What causes neck muscles to shorten (are they factors such as age, posture, genes or body weight)? Can the condition be improved with exercise and postural changes or is that a limit to what can be done before cosmetic intervention is needed?
Genes and a healthy lifestyle (or lack thereof) could increase or decrease your chances of developing jowls and turkey necks. Keeping within the healthy weight range could reduce your chances of accumulating fat under your chin that could contribute to jowls. However I have seen some patients who are safely within their healthy weight range who seem to retain fat under their chin no matter how hard they exercise. There are some other patients who continue to retain fat deposits under their chin even after having lost a lot of body weight. On the other hand, if you are naturally lean, you are likely to develop turkey neck earlier rather than later which can be exacerbated by frequent, vigorous exercise.

Why are Asians more likely to have short necks compared to their Caucasian counterparts? 
Asians are shorter and smaller than Westerners, which means smaller and shorter neck muscles compared to Westerners. Facial features such as short or receding chins and heavier and thicker facial skin make Asians more prone to jowling compared to Westerners. Because of their thinner skins compared to Asians, Caucasians tend to wrinkle as they get older rather than develop jowls. 

What treatments can be done to counter these effects?
Jowling caused by the sagging of the tissue of the mid-face should be dealt differently from jowling caused by the shortening of the platysmal bands. In some patients, both need to be treated for best effect.

Jowling caused by the sagging of the tissue of the mid-face has been treated conventionally with filler injections to replace the volume loss in the cheeks. However, a newer and perhaps better treatment is to lift and tighten the mid-face sagginess with Happy Lift threads. After disinfecting the area to be treated and administering lidocaine injections to make the treatment more comfortable, the threads are anchored on either side of the face near the temples and inserted through the facial tissue to lift it.

Compared to other threads, Happy Lift threads are made of poly-L-lactic acid and caprolactone (PCA), which lasts longer about 12 to 15 months as compared to PDO (Polydiaxanone) threads that last three to six months. PCA also gives greater elasticity and lower plasticity compared to PLA threads. This means, compared to poly-L-lactic acid or PLA threads, Happy Lift PCA threads can return to their original shape and length even after dramatic facial movements, ensuring the longevity of the lifting effect.

Unlike some conventional sutures which are smooth, Happy Lift threads have tiny barbs which offer both an immediate lifting effect and a secondary long-term lifting effect. After the barbs are positioned they can be opened like tiny umbrellas to form a support structure that lifts sagging skin to give the immediate, mechanical lifting effect. The secondary lifting effect is caused by the barbs stimulating the skins own fibroblasts to synthesise the extracellular matrix and collagen needed to lift and hold the soft tissues in its place.

Jowling caused by the shortening of platysmal bands can be corrected by placing multiple injections of small amounts of a botulinum toxin such as Dysport into the platysmal bands. This will relax the muscles and lengthen them, decreasing the jowling effect. The effects of the botulinum toxin injections can last up to six months.

Christy Turlington in Vogue in 1987 sporting the enviable, long neck that women are after

How long do the effects of a thread lift last?
Depending on the thread's material, the effects of thread lifts can last up to two years. Other than collagen, the threads also stimulate the production of elastin and hyaluronic acid while inducing angiogenesis, a process where new blood vessels branch out from pre-existing blood vessels. These natural responses in the treated area continue for six to 12 months to provide a gradual and natural revitalising and lifting effect which persists even after the threads themselves have been absorbed into the skin after about 12 months.

Is there any downtime? What are the possible side effects from these treatments?
For thread lift treatments, any dimpling or bruising around the exit and entry points for the threads should go away within a week. You are recommended not to have any dental surgery for the next two weeks.

For botulinum injections, the needle marks should disappear within two to three days. Most side effects are transient. If you experience any of these side effects for more than two weeks, please see your aesthetic physician or surgeon.

Who makes a suitable candidate for these treatments?
Thread lift treatments are suitable for those who have loss of volume in the face and/or sagging facial skin due to ageing. They are also suitable for those who have an unsymmetrical face — where one side has considerably less volume than the other — and for those who have lost skin elasticity.

For the botulinum toxin injections, ideal candidates should be lean or within an acceptable weight, with a defined (not a weak) jawline and who have laxity along the jaw and neck. 

Other than treatments what else can you do to prevent sagging of the facial skin and shortening of the necks?
Reduce the salt in your food intake which could bring about water retention and make you appear bloated. Master facial contouring skills with makeup and finally, try dance, yoga or any stretching exercises that can improve your posture.

Dr Marcus Wong practices at Wong's Plastic Surgery Centre