Key facts
- What HIFU addresses
- Laxity of neck skin and platysma, and the blunted angle under the jaw where that laxity sits
- What it does not
- Horizontal necklace lines, crepey texture on its own, muscular platysmal bands, redundant skin
- Depths used
- Mostly 3.0 mm and 1.5 mm; 4.5 mm only where the pinch shows enough depth, usually under the jaw
- Kept away from
- The thyroid and the midline structures of the front of the neck, and the nerve course at the jaw edge
- Alternatives assessed
- Botulinum toxin for bands, skin-quality work for crepe and lines, VF Lift, Time Freeze Laser LCLR®, referral
- Fee
- Set in writing after assessment; see how fees are quoted
Why does the neck age differently, and which of its problems does HIFU reach?
The neck ages differently from the face because its skin is thinner, it has fewer oil glands and less subcutaneous fat, and it sits over a broad sheet of muscle, the platysma, that prints lines when it contracts. Four problems result and tend to arrive together: horizontal necklace lines, crepey texture, laxity that blunts the angle under the jaw, and vertical platysmal bands. HIFU reaches one of them. Focused ultrasound heats points in the lax skin and platysma so they contract and remodel, which is a laxity treatment. The ageing neck page sets out all four; this page is about where HIFU fits.
A necklace line is a crease, folded into the skin by years of flexion and now by looking down at screens, and heating the layer beneath it does not unfold it. Crepe is a loss of skin quality that heat alone tends to make look thinner and shinier unless texture is treated too. Bands are muscle, and muscle answers to botulinum toxin rather than to heat. Laxity is the part HIFU is built for.
Which depths are used on the neck, and why is 4.5 mm often left out?
On the neck the 3.0 mm cartridge does most of the work in the dermis, with the 1.5 mm cartridge over the thinnest skin at the front and across any crepe, and the 4.5 mm cartridge reserved for the submental area and the region just under the jaw where the pinch shows enough tissue for its focal point to sit in the platysma. Across much of the front and sides of the neck there is not that depth, and a 4.5 mm focal point placed there lands in the small amount of fat or against deeper structures rather than in the layer intended.
The thyroid and the midline of the front of the neck are not treated over, and lines near the jaw edge respect the course of the marginal mandibular nerve. Lines run along the direction of laxity, across the front of the neck and up under the jaw, rather than down the length of it. As the HIFU page explains, the number of lines follows the map, and on the neck that map is set by how thin the tissue is zone by zone.
“The face can look ten years younger than the neck — and the neck always tells.”
Dr Sin YongOn the ageing neck
Who suits HIFU on the neck, and who does not?
HIFU suits a neck whose main problem is early to moderate laxity: the skin under the jaw has softened and the angle has blunted, the pinch shows a thin fold of skin rather than fat, and there is no heavy band or large amount of redundant skin. It also suits a neck being treated as part of the lower-face unit, so that a firmed jawline is not left sitting above a neck that has not been addressed.
A neck whose problem is lines and crepe is better served by skin-quality work, which is what the neck and hand revitalisation protocol pairs with energy for laxity. A neck with strong vertical bands is a botulinum toxin question, and heating the bands can make them more visible by firming the skin over them. A neck with a great deal of loose, redundant skin, or a very lean neck with little tissue to work in, is unlikely to benefit from focused ultrasound and may be referred to a plastic surgery specialist. Where the dermis and subcutaneous layer are the main issue, the VF Lift – Vertical Facelift, which runs on Volnewmer monopolar radiofrequency and is customised for the body as well as the face, is assessed instead, and the Time Freeze Laser LCLR® protocol is considered where compact submental fat accompanies the laxity.
What are the risks on the neck, and when should you call?
The risks on the neck follow from thin tissue. A cartridge too deep for the zone places heat in fat or against deeper structures rather than in the skin, which can leave a hollow or a tender nodule; a cartridge too superficial, or poor coupling of the transducer on a curved surface, can cause a surface welt or burn. Heat near the jaw edge can irritate the marginal mandibular nerve and weaken the corner of the mouth for a time. Redness, warmth, tenderness and occasionally a bruise are expected and settle.
A welt that does not flatten, blistering, a hard or painful lump, marked swelling or any change in mouth movement should be reported the same day. People with thyroid disease or previous neck surgery should say so at consultation, and anyone with implants, recent filler or threads in the neck is assessed individually. The complication care page lists the signs that need prompt attention.
What else is combined for the neck, and what determines the fee?
A neck plan usually pairs a laxity step with a skin-quality step, because tightening crepey skin without treating its texture leaves it looking thin. Skin boosters or fine filler for necklace lines, botulinum toxin for bands, HIFU or radiofrequency for laxity, and strict sun protection, since the neck is exposed and sun-damaged skin is laxer skin, are combined according to what the examination finds. Treating the neck as its own anatomy rather than as the end of a face session is the principle.
The fee depends on the zones and depths the examination calls for, whether HIFU is planned alone or alongside skin-quality work or botulinum toxin, and how the plan is staged. Singapore's rules prevent clinics from advertising prices, so no figures appear here; a written quote follows the consultation, as the how fees are quoted page explains.
