Neck and Chest Issues
Protecting the skin on the neck and chest
Your face isn’t the only area that needs protection. The skin on the neck and chest gets almost as much sun and weather as the face, and yet it is thinner. Our Resources section has articles on sunscreens, Repair Creams, antioxidants, and vitamin-based products that protect your skin, prevent damage, and are dermatologist recommended.
Skin on the face, neck, and chest don’t match
I started sunscreening my face in my mid-20s, but it took me several years to realize that my neck and chest were getting almost as much sun as my face. Yet I was leaving my neck and chest completely unprotected!
Some of you may have been doing the same thing for longer, in which case you may be noticing a mismatch between the skin on your face and the skin on your neck and chest. The problem may be your skin is brown and blotchy, red and blotchy or both.
Creams will only go so far in the neck and chest if the sun damage to skin is bad. If creams cannot help, you may need laser treatments. Remember, if you make the investment in laser treatments, be sure to use sunscreens, antioxidants, and laser treatments once a year to maintain that investment.
Brown spots from age and sun damage
Brown skin spots are essentially sun damage. You may have had them as freckles when you were younger, but they get larger and often darker as you get older. Be sure to have a dermatologist examine your skin before any cosmetic treatments are performed to make sure you don't have a skin cancer.
The first thing to do about brown spots and sun spots on skin is to prevent more of them by sunscreening. Make sure you use a sunscreen that protects you from UVA radiation by having at least 5-10% zinc or titanium or 3% mexoryl.
You can also try over-the-counter "bleaching" creams if your age spots are localized or not too bad. "Bleaching" creams don't really bleach, rather they temporarily decrease the production of brown pigment in your skin. Drugstore skin bleaching lotion contains 2% hydroquinone and are not very effective. They will cost under $50 and can be found at your drugstore.
Bear in mind that continued sun exposure will stimulate the growth of brown spots, so that the bleaching creams will not protect you against the regrowth of brown spots or the development of new ones. Only sunscreen can do that.
Prescription bleaching creams all contain 4% hydroquinone plus or minus other ingredients like hydroxy acids, sunscreens, or tretinoin. These are more effective but still temporary. For some patients who are allergic or don't want to use a hydroquinone cream, I have also used plant-based bleaching creams. These ingredients are ones like arbutin, thymol, and kojic acid. They seem to be less effective than the prescription creams.
Microdermabrasion and light peels are also options for mild to moderate brown spots. A good aesthetician can perform microdermabrasion or a low-strength peel, and these can often give good results but need to be done in a series, usually to 3-6 treatments, to be effective. Costs vary widely but a series might run $250-$800 depending on how many are done and what is used.
A medium peel, like a TCA peel, can also give good to excellent results but should be done by an experienced dermatologist.
The most effective treatment option for brown spots is a series of laser treatment. Lasers for brown spots are also, unfortunately, the most expensive.
An IPL laser (also called photorejuvenation) usually gives excellent results. A series of five treatments will cost you anywhere from $1,500 to $2,500, but often an IPL will also reduce redness, stimulate mild collagen growth, and add to your skin’s glow. You will need maintenance treatments when brown spots reappear, usually once or twice a year.
The fractional lasers are newer and may be the best option if you also have wrinkles or acne scarring. Many clinics, including ours, are reporting excellent results. The non-ablative fractional lasers, like the Fraxel, have a 2-day downtime, and cost $2,000 to $6,000 for a series of 3 to 5 treatments. Some people see results quickly with the Fraxel; but results will improve over 2-6 months. The ablative fractional lasers, like the Active FX, have a 4-8 day downtime, and cost $1,000 to $2,000 per treatment.
See Dr. Irwin's Guide to Fractionated Carbon Dioxide (CO2) Lasers
Neck and chest are red and blotchy
Having redness or broken blood vessels on your neck or even your nose does not mean that you are an alcoholic, contrary to popular myth. Often people with Celtic genes develop redness or even broken blood vessels on the nose, face and sometimes the neck and chest. Redness and dilated blood vessels can also be caused by rosacea, sun damage, or certain diseases. You'll need a dermatologist to help you figure out the cause of your redness.
If the redness is due to a sun damaged neck, or you have rosacea that is under control, you may want to consider IPL/photorejuvenation laser treatments to reduce the redness. These treatments cost $1,000 to $2,500 for a series of five treatments. The results are often excellent and take effect in about 6 months, as you complete your series of 5 treatments. You'll need maintenance treatments once or twice a year. If redness is due to rosacea, the first step to finding rosacea treatments is to look at lifestyle changes, like diet and exercise.
See Dr. Irwin's article on Rosacea In Depth
Some people get little lines or bands running horizontally across their necks. Because they can look almost like necklaces, they are called necklace lines. Some people get them relatively young, even in their 20s or 30s. You may even notice them on children.
Your best treatment option is a small amount of Botox. Be sure to find a skilled doctor for this because the skin is thin on the neck. An inexperienced doctor could cause weakness of the neck muscles or difficulty swallowing. The fractional lasers can also help soften necklace lines, but they are not a home run.
The costs should be $200 to $400, and you may get a good result. You will need to retreat this area every 3 to 6 months. Also, be sure to use skin care products to protect your neck and chest.
See Dr. Irwin's Guides to Which Products Do You Really Need?
Wrinkles and crinkly skin on the neck
As we age, some of us notice that the skin on our neck acquires the texture of crepe paper. Others notice the skin can get a little loose. What can you do about loose, crinkly, or crepey skin on the neck?
Up until recently, there was no really good non-surgical option for loose or crepey skin on the neck. But, the fractional lasers have shown some promising results for this problem. A fractional laser treatment will usually cost $1,000-$2,000 per treatment, and you will probably need two to four over a 4-6 month period. The ablative fractional lasers, like the Active FX, have a downtime of 4-8 days, and cost about $1,000-$2,000 per treatment also.
I’m eager to see more data to clarify who will benefit, how many treatments are needed and which fractional lasers work best for this. As of now, the results seem a bit variable. Some people get very little result and some get good results. If you budget can take it, you may want to consider this option.
Here are some things that I know do not work well for wrinkles on the neck:
The cords on the neck stand out
Some of us notice that we seem to be getting prominent vertical bands that stick out near the upper part of our necks (the platysmal bands). The two options to treat this are Botox, if these bands are minimal, or surgery.
For $200 to $400, the Botox may work to relax the muscles that make these bands stick out, but it will only work if the banding is early. If the bands have been there for some time or are very prominent, Botox will not work and surgery is your best option.
An inexperienced doctor can cause weakness of the neck muscles or difficulty swallowing, so find an experienced dermatologist.
See Dr. Irwin's Guide to Botox
Wrinkles and lines on the chest
Some of us get wrinkles on our chest from our sleeping positions. I know that I sleep often on my side and will wake up in the morning to find lines and wrinkles on my chest. But wrinkles develop on the chest from sun damage too.
The best way to treat chest wrinkles is with fractional lasers. At this point, there is a range of results from good to excellent depending on the laser and the provider. Talk to your dermatologist about what results to expect at that laser center.
Some doctors are also using Sculptra or Botox on the chest. The skin is thin on the chest, so please only see expert injectors for this to avoid lumpiness.
See Dr. Irwin's Guide to Sculptra
Next, learn about Mouth and Lip Issues
See Dr. Irwin's expert answers to other's reader's questions on neck and chest issues:
Is sunscreen really needed if I'm at home? Problems with pigment increase after peels. Can Thermage, Exilis and Ultherapy be used for prevention? Are Dysport/Botox and Sculptra compatible? A problem! Which retinol is best for use on the delicate eye area? How does radiofrequency (Thermage & Exilis) compare with Ultherapy? All these different forms of Retin A (Renova, Atralin, tretinoin) -- arghhhh!
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