Neck Wrinkles Treatment Without Surgery: Two Kinds of Lines

I'm Dr. Jong Hoon Lee, a director at Gangnam HERA in Seoul. I'm a foundation member of the Korean Academy of Facelift & Contouring, a board member of the International Petit Medical Society, and a co-author of LIFTINGOLOGY: Science and Clinical Practice in Aesthetic Medicine. As soon as the cold wind starts — turtleneck and scarf season — the questions about neck lines come in. So in this video I explained how we treat neck wrinkles without surgery.

My short answer: first work out whether the lines are horizontal or vertical, because they are different problems. Horizontal lines respond well to soft filler placed precisely; crepey vertical lines respond well to a diluted CaHA skin booster; stretched muscle bands may need threads, or ultimately surgery.

Why are horizontal and vertical neck lines different?

Because they have different causes. Horizontal lines are mostly something you are born with; vertical lines come with aging.

• Horizontal neck lines — the creases that run around the neck — are, in most cases, congenital. Even young patients have them.
• Vertical neck lines come with age, and there are two kinds. One is the fine, crepey lines that form as the skin loses elasticity. The other comes from the platysma, a thin sheet of muscle in the neck: as it loosens, it forms visible bands that run up and down.

Which of these you have decides the treatment. That is why I always look at the neck at rest and while you make an expression before suggesting anything.

How do you treat horizontal neck lines without surgery?

At HERA we treat them with a soft filler placed exactly in the crease. Other approaches exist — some clinics use wrinkle-relaxing injections, others collagen boosters such as Juvelook — but in my experience, when a soft filler is placed accurately, horizontal lines improve better than people expect.

The important word is soft. There is a ratio at which the filler fills the line easily without feeling lumpy under the skin, and getting that right is the know-how. We treat many horizontal neck lines this way. You can read more about the treatment on our neck line filler page, and about what filler can and cannot do on the neck in neck filler: what it can smooth and what it cannot lift.

What are the options for vertical neck lines?

It depends on how strong the platysma bands are and how the lines behave when you move. In order:

1. Very strong bands: surgery is the final option and the one that lasts longest from a single procedure. It is a surgical decision and a different conversation from this article.
2. Bands that have stretched noticeably, but you don't want surgery: threads can lift them. Who a neck thread lift suits, and what it cannot do covers this in detail.
3. Bands that are not severe, but fine vertical lines crinkle up every time you make an expression: this is where a CaHA skin booster is a strong option.

What is CaHA, and why use it as a skin booster?

CaHA stands for calcium hydroxylapatite. It was first used as a volumizing "calcium filler"; now we dilute it and use it as a skin booster. At HERA, this is our DCLASSY CaHA Filler treatment.

Fine lines appear in many places as we age — around the mouth, on the lips, on the neck, on the backs of the hands. The thickness and elasticity of the skin are completely different in each of those areas, so how we mix CaHA, what we mix it with, and at what ratio — 1:2, 1:3, or a three-part 1:1:1 mix — all change with the area. That flexibility is what makes it useful for the neck.

How does CaHA build collagen?

Mainly by stimulating the cells that make collagen directly, rather than through inflammation. Some collagen stimulators work largely by triggering a controlled inflammatory response. CaHA's collagen response from inflammation is very small — not zero, but small. Instead, the calcium itself stimulates the fibroblasts, the cells that produce collagen.

Compared with a PLLA-type booster such as Juvelook, the difference is that CaHA stimulates not only collagen but also elastin and the extracellular matrix (ECM), the material that fills the space between cells. That helps fill in fine lines more completely. The effect is not a sudden surge of collagen; it encourages collagen production slowly and over the long term.

Why you see something right away

You can see an effect straight after injection. That is because the product is roughly 30% calcium hydroxylapatite and roughly 60–70% carrier gel, called CMC, which has some viscoelasticity. The early effect comes from the gel; as the gel fades, the calcium particles take over by building the skin's own structure.

How is CaHA placed in the neck?

With a blunt-tipped cannula through four or five tiny entry points, spread evenly under the skin. The neck has many small vessels, so bruising is a real possibility. A cannula with a rounded tip reduces that risk. Through four or five small entry points, I fan the CaHA across the inner layer of the skin, which builds a firmer, more even surface.

CaHA is usually the main treatment, but energy-based devices that work on the shallower layers — Thermage or Potenza, for example — can make it more effective when combined. Most patients, though, need only one of these. Re2O, a newer collagen booster I have talked about for fine lines, scars and pores on the face, can also give a similar synergy on the neck when used well.

How many sessions, and how long does it last?

For CaHA on the neck we usually suggest a second session about two months after the first, and two sessions are often enough for a satisfying result. Dose and dilution matter enormously. Juvelook is also diluted heavily and now comes in more types than before; with Juvelook we usually suggest about three sessions, one every four to six weeks. With CaHA the interval is longer and the result tends to last longer. If you are comparing the two, our Juvelook PLLA guide explains that side.

In the end, the result depends on who treats you, the dilution, the ratio and how the products are mixed.

The honest limits

These treatments can give a very good result, but unfortunately none of them is permanent. Habits matter as much as treatment: looking down for long periods keeps folding the neck in the same place. If you take care of your neck and have treatment at sensible intervals, you can keep a firm, younger-looking neck — but maintenance is part of the plan. Bruising, swelling and small lumps can occur after any neck injection and usually settle within days; how your skin responds is individual and your plan is confirmed in consultation. And if your platysma bands are very strong, I will tell you honestly that non-surgical treatment has limits.

You can see real HERA results in our before-and-after gallery.