Introduction

“Turkey neck” describes age-related changes of the cervicomental region—skin laxity, submental fat, and platysmal banding—that soften the jawline and disrupt the cervicomental angle. Many patients want visible improvement without surgery. This guide outlines how to evaluate the neck, match the right non-surgical modalities, and sequence treatments for safe, reproducible outcomes. If you’re building or refining protocols, you can deepen skills with anatomy, device, and injection masterclasses inside Empire On-Demand. The sections below summarize indications, strengths, and limits for ultrasound skin-lifting, radiofrequency microneedling, fractional lasers, deoxycholic acid for submental fat, targeted neuromodulator for platysmal bands, and supportive skincare/lifestyle—all anchored to peer-reviewed evidence and FDA labeling.

The Aging Neck at a Glance

Snippet: Turkey neck is a multifactorial problem—skin, fat, muscle, and skeletal support—so combination therapy wins.

• Skin: Dermal collagen/elastin decline and chronic photoaging → crepiness and laxity.

• Fat: Submental adiposity blunts the cervicomental angle even when BMI is normal.

• Muscle: Hyperactive/loose platysma forms vertical bands and pulls the jawline downward.

• Framework: Mandibular resorption and soft-tissue descent reduce lower-face support.

Clinical implication: Map which components dominate for each patient; treat the dominant driver first (e.g., submental fat before skin tightening; bands before jawline fillers).

Candidate Selection & Planning

Snippet: Best results occur in mild–moderate laxity or fat; advanced redundancy still favors surgery.

• History: Weight change, sun exposure, smoking, medications, dysphagia risks.

• Exam: Skin quality, submental fat (pinch/ultrasound), platysmal banding (animation), mandibular support, cervicomental angle.

• Expectations: Explain that non-surgical outcomes are incremental and develop over 2–6 months; maintenance is needed.

Modality 1: Microfocused Ultrasound with Visualization (MFU-V)

Snippet: Ultrasound energy can lift soft tissue of the neck/submentum with real-time imaging; ideal when laxity exceeds crepiness.

• Evidence summary: MFU-V has clinical studies demonstrating lifting/tightening of facial and neck tissue with safety documented in prospective studies and consensus papers. 

• Strengths: Deeper focal coagulation points; good for redefining the cervicomental angle in mild–moderate laxity.

• Limits: Discomfort (manage with analgesia); not a substitute for surgical platysmaplasty or skin excision.

• Pearl: Align vectors with patient-specific descent patterns; photograph chin-to-clavicle distance and angle for objective review.

Modality 2: Radiofrequency Microneedling (RFM)

Snippet: RFM improves laxity + texture/crepiness, complementing ultrasound or lasers.

• Evidence summary: Reviews and clinical studies support RFM for lower face/neck rejuvenation with collagen remodeling and skin laxity improvement. 

• Strengths: Treats multiple layers, including dermal texture; pairs well with ultrasound (deep) or lasers (epidermal/dermal).

• Limits: Series of sessions; transient edema/erythema; energy settings must respect thinner neck dermis.

• Protocol tip: Use conservative depth/energy on the lateral neck to avoid track marks; add topical anesthetic and forced-air cooling.

Modality 3: Fractional Lasers (Ablative & Non-ablative)

Snippet: For crepey skin and photoaging, fractional lasers (CO₂ or 1550 nm) enhance texture and fine lines on the neck.

• Evidence summary: Studies report neck rejuvenation benefits with fractional CO₂ and emerging data with 1550-nm NAFL for wrinkles/texture on the neck. 

• Strengths: Texture/crepiness correction; pigment improvement.

• Limits: Neck has fewer adnexal structures—use lower density/energy than face to reduce risk of scarring/dyschromia.

Modality 4: Deoxycholic Acid (DCA) for Submental Fat

Snippet: FDA-approved injectable deoxycholic acid reduces submental fat and sharpens the cervicomental angle.

• Label evidence: KYBELLA® is indicated to improve moderate to severe submental fullness in adults; use outside the submental area is not recommended. 

• Strengths: Non-surgical debulking where fat dominates.

• Limits: Swelling, tenderness, temporary numbness; multiple sessions; avoid marginal mandibular nerve injury (stay 1–1.5 cm below mandibular border).

• Sequencing: Debulk first, then reassess whether ultrasound/RFM or neuromodulator adds incremental benefit.

When discussing patient selection, reference the official FDA label for dosing, grid patterns, contraindications, and warnings for deoxycholic acid to ensure compliance.

Modality 5: Neuromodulator for Platysmal Bands

Snippet: Targeted botulinum toxin into the platysma softens vertical bands and counteracts depressor pull on the jawline.

• Evidence summary: A systematic review documents efficacy and safety of botulinum toxin for mild–moderate platysma bands; updates and contemporary guidance further refine technique and dosing. 

• Technique pearls: Inject at multiple points along visible bands with conservative dosing; avoid deep medial injections to reduce dysphagia risk. Anatomy-first planning is essential. 

Want hands-on neck/jawline toxin strategy? See advanced neck/jawline microtox concepts inside Advanced Botox & Dermal Filler Training — Level II for planning, dilution strategies, safety pearls, and live case demonstrations.

Skincare & Lifestyle: The Long Game

Snippet: Topicals won’t lift tissue, but they extend and protect device/injectable gains.

• Protocol: Broad-spectrum SPF on the neck/décolleté; retinoids (as tolerated), antioxidants, peptides, and barrier repair.

• Behavioral factors: Smoking cessation, weight stability, and photo-avoidance are powerful adjuncts.

• Advanced adjuncts: For practices exploring systemic and topical peptides to support collagen biology and recovery timelines, Empire’s curriculum on peptide science provides clinical frameworks and safety considerations—see Peptide Therapies Treatment Training.

Putting It Together: Sample Non-Surgical Pathway

Snippet: Combine modalities based on the dominant driver; reassess after each phase.

1. Baseline: Standardized photos (front/oblique/profile), video for band activation, and objective angle measurements.

2. Phase 1 (Weeks 0–6):

   • If fat dominates → DCA grid per label (1–2 sessions). 

   • If bands dominate → low-dose platysma neuromodulator (map bands in animation). 

3. Phase 2 (Weeks 6–12):

   • MFU-V for lifting vectors when laxity persists. 

   • RFM for laxity + crepiness; adjust depths for neck. 

4. Phase 3 (Month 3–4):

   • Fractional CO₂ or NAFL 1550-nm for texture and fine rhytids if needed.

5. Maintenance:

   • Neuromodulator every 3–6 months for bands; device boosters every 6–12 months; year-round SPF/topicals.

Risk Management & Counseling

Snippet: Set expectations, dose conservatively, and document thoroughly.

• Neuromodulators: Discuss rare risks (transient dysphagia/dysphonia) from diffusion—stay superficial/intra-platysmal. 

• DCA: Swelling is expected; counsel on temporary numbness and grid-related induration; obey no-treat zones near the mandibular nerve. 

• Devices: Respect neck skin biology (thinner dermis, fewer adnexal units); under-treat rather than over-treat on first pass. 

• Informed consent: Emphasize that severe redundancy may still require surgical referral.

When to Refer for Surgery

Snippet: Severe skin excess, platysmal separation, or heavy jowling that persists after debulking/lifting → surgical consult.

Non-surgical tools can’t excise redundant skin or repair significant platysmal dehiscence. Establish a referral pathway to a board-certified facial plastic or plastic surgeon for neck-lift/platysmaplasty in advanced cases.

Call to Action

Build a predictable, protocol-driven neck program that patients trust. Expand your curriculum with hands-on anatomy, safe injection strategy, and device sequencing inside Empire On-Demand, then refine your neuromodulator technique with Advanced Botox & Dermal Filler Training — Level II and strengthen your adjunctive recovery/skin optimization insights with Peptide Therapies Treatment Training.

FAQs 

1. Can non-surgical treatments replace a neck-lift?
   Not when there’s severe excess skin or platysmal separation; they work best for mild–moderate laxity and fat.

2. How soon do patients see results?
   Neuromodulator benefits appear in ~1–2 weeks; ultrasound/lifting and RFM continue improving over 2–6 months as collagen remodels. 

3. How long do results last?
   Typically 6–18 months depending on modality, skin biology, and maintenance.

4. Is deoxycholic acid off-label in the jowls/other areas?
   Yes—only submental fat is FDA-indicated; other areas are not recommended. 

5. What if submental fat and bands coexist?
   Debulk with DCA first, then address bands and residual laxity with neuromodulator and/or ultrasound. 

6. Is RF microneedling safe on the neck?
   Yes, with conservative depths/energies and appropriate passes; studies support improved laxity/texture. 

7. Which laser is best for crepiness?
   Fractional CO₂ shows long-term improvement; 1550-nm NAFL is an emerging, gentler option. 

8. How do I minimize neuromodulator complications in the neck?
   Map animated bands, use conservative aliquots, and avoid deep medial placement to limit dysphagia risk. 

9. Can I combine MFU-V and RFM?
   Yes—many practices stage MFU-V for lifting and RFM for skin quality/dermal tightening. 

10. How do I document outcomes?
    Use standardized photography angles, neck angle measurements, and patient-reported outcomes to guide maintenance.

References

• Sugrue CM, Kelly JL, McInerney N. Botulinum Toxin Treatment for Mild to Moderate Platysma Bands: A Systematic Review. Aesthetic Surgery Journal. 2019. 

• KYBELLA® (deoxycholic acid) Prescribing Information. AbbVie; 2024. Indication, dosing, limitations of use. 

• DailyMed. Deoxycholic acid injection (KYBELLA). 

• Fabi SG, Few JW. Practical Guidance for MFU-V to improve satisfaction/comfort. Aesthetic Surgery Journal. 2020. 

• JAAD / JCAD clinical evaluations of MFU-V for face/neck lifting and long-term efficacy. 

• Wang Q, et al. Radiofrequency Microneedling: Clinical Applications (scoping review). Aesthetic Plastic Surgery. 2025. 

• RFM neck rejuvenation technical overview (PDF). 

• Neck rejuvenation with fractional CO₂: long-term results. J Clin Aesthet Dermatol. 

• 1550-nm NAFL for neck rejuvenation: safety/efficacy study. Lasers Med Sci. 2025. 

• MDPI review on platysma anatomy & BoNT injection targeting. Toxins (Basel). 2022.