Fighting the signs of an aging neck

She had never really liked her wide nose, which didn't resemble the cute, perky noses of her two children. And then, sitting in her cosmetic surgeon's office in Warrenville, Carol saw the life-sized photos of her 51-year-old neck.

They'd have to do something about her wattle.

"I look in the mirror and go, uh-oh," Carol confided. So her nose job got an add-on: a neck lift. "If I do this, hopefully it will make me look the same age I feel inside."

By 45, loose skin, weakened muscles and fat deposits under the chin give some people a "turkey wattle," said Dr. Terry Donat, a board-certified cosmetic surgeon and otolaryngologist with DuPage Medical Group.

Donat's patient, who didn't want her last name used, isn't alone in her insecurity. In her new collection of essays entitled "I Feel Bad About My Neck," screenwriter Nora Ephron advises women to start hiding their necks at age 43.

As she explains it: "Our faces are lies and our necks are the truth. You have to cut open a redwood tree to see how old it is, but you wouldn't if it had a neck."

Some people ask for a neck lift after they see what a brow lift will do for their upper face, Donat said. All of a sudden their neck looks even older. But he also performs neck lifts without touching the upper face.

Tina Karl, 47, a patient coordinator in Donat's office, had a neck lift in August. She thought her neck had aged faster than her face.

"I think jowls are a huge aging factor, especially on a woman's face," Karl said. "You can put on as much eye makeup and blush as you want, but you can't cover that up."

A tighter neck

How your neck ages is due mainly to genes, though smoking, sun damage and weight also play a role. You have to lose a significant amount of weight before it starts to come off your face, Donat says, and if your skin has lost elasticity, it won't spring back as well.

Someone with a little extra fat under the chin but healthy, elastic skin could have liposuction alone to define the jawline, said Dr. Greg Wiener, a board-certified cosmetic surgeon in Chicago. Newer lipo techniques use ultrasound or lasers to help break up and liquefy the fat before suctioning, creating a smoother result.

"The suctioning is much more gentle so you don't have the bruising as with traditional liposuction," Wiener said. "I can define someone's jaw that way and make them look fantastic without a lot of surgery."

But loose, hanging skin won't improve without surgery, he said.

"If the skin is thinner, if it's got wrinkles, if there's anything approaching a turkey gobbler, then you've got to do the neck lift," Wiener said.

The procedure can be performed under general or local anesthetic and takes one to two hours. The surgeon makes an incision behind the ear and tightens the layer of muscle and tissue underlying the skin; the skin is draped on top and sutured in place.

The surgeon can also make a small incision under the chin to suction excess fat and repair the neck muscle, which often separates into two vertical bands that extend down from the chin.

Risks of the procedure include bleeding, infection and nerve injury. Most patients will experience bruising and swelling, and will wear a neck wrap (called a "jaw bra") for a week or so.

Liposuction alone of the neck can cost $1,000 to $3,000, while a neck lift starts at $3,000, Donat said. Insurance usually doesn't cover cosmetic procedures.

Are there alternatives to surgery? Yes, but none as effective, doctors said. Injected fillers enhance volume and fight wrinkles, not turkey gobblers. Botox has been used to disguise neck bands, but Donat said he's not impressed with the results.

Fractional laser treatments can do minimal tightening, but won't improve hanging skin, Wiener said.

Rested and fresh

Barbara Gabel, 62, noticed her face and neck aging about five years ago. She had small jowls and wrinkles, and she felt she looked tired.

"You look tired and angry, and you're not," said Gabel, who lives in Morris. "When you get a certain age, you cannot help it, your neck starts to look old."

Gabel opted for a face, neck and brow lift. Donat operated in April. Gabel told her friends, but kept the operation a secret from her mother until she saw her three weeks later.

"When I went to see her, she said, 'Wow, have you lost weight?'" Gabel said. "My own mother just thought I looked rested and fresh."

Her neck, Gabel says, looks "fabulous."

Most people have similar goals, Donat said.

"At most you can roll someone back 10 or 15 years," he said. "We never stop the aging process. There is no such thing as anti-aging. But we can restore someone to a more natural, refreshed, rejuvenated self."

What if you're still young? You can't prevent all the signs of aging, but simple measures can stave off the decline, doctors said.

Eat a healthy diet and don't smoke, which decreases the elasticity of your skin. Use sunscreens with SPF 30. Whatever you use to moisturize and fight wrinkles on your face, spread on your neck, too. Wiener likes products with retinol, which stimulates skin cell turnover, and topical vitamin C, an antioxidant.

"Start doing that stuff in your 30s, and you're possibly going to avoid some of these issues, at least in the early term," Wiener said.

A new wrinkle

Doctors have discovered it's not just gravity pulling your skin down as you age. It also might be your shifting bone structure.

Using CT scans of 100 men and women, researchers at Duke University Medical Center found human skull bones continue to grow as people age. The forehead moves forward, while the cheek bones move backward. The result is less support for the overlying muscles and skin -- and that means drooping and sagging. Women seem to undergo more dramatic changes than men.

Rather than tightening and lifting soft tissues to create a more youthful look, cosmetic surgeons may do better to restore the face's underlying bony framework, said Dr. Michael Richard, a surgeon at the Duke Eye Center.

Back at you

Holiday travel can take a toll on your body. Before you lift your heavy suitcase into the trunk, the National Athletic Trainers' Association has some tips for a healthy back:

• Stretch. Muscle stiffness lowers the body's ability to move freely, leading to pain or injury.

• Lift properly. Stand with a wide stance and a slight bend at your hips and knees. Tighten your stomach as you lift and keep your back as flat as possible.

• Sleep well. Chose a firm mattress, and sleep in a position that maintains the natural curve of your back.

• Have good posture. Sit with your hips and knees at right angles. Stand with your chest forward and stomach tight. Don't stand or sit in the same position for too long.

Smoke out

Last Thursday was the American Cancer Society's Great American Smokeout. But if you need another reason to quit smoking, here's one for your pocketbook. A study in the American Journal of Public Health found people who smoke are more likely to suffer financial stress, such as not having enough money to pay household bills.

In the study, 71 percent of current smokers said they had experienced financial stress, compared to 50 percent of people who had quit smoking. Researchers theorized it could be due to the cost of cigarettes or health conditions linked to smoking.

--Susan Stevens