Neck rejuvenation: pros and cons of laser, ultrasound, and injectable options

On a video call last week, I caught my profile in the tiny picture-in-picture square and winced at the fine necklace lines and soft edges under my chin. I’ve always taken good care of my face, but my neck has been the quiet historian of late nights, sun exposure, and years of looking down at screens. I started reading, asking questions, and—most importantly—sorting hype from helpful. This post is my running journal of what I’ve learned about three popular non-surgical options for the neck: lasers, ultrasound, and injectables. I’ll lay out where each one shines, where it falls short, and the trade-offs that actually matter when you’re the person in the chair.

Why my neck became my test lab

I used to think of “neck rejuvenation” as an all-or-nothing topic—either a surgical lift someday or acceptance today. The reality is more nuanced. Our necks age in several ways at once: texture (crepey skin and sun spots), laxity (a subtle skin “drape”), bands from the platysma muscle, horizontal lines from movement and posture, and sometimes a little extra submental fullness (the “under-chin” pad). No single tool fixes all of that. So I started mapping concerns to treatments.

• Texture and tone (crepiness, fine lines, spots): often discussed with laser resurfacing. See a plain-language overview of resurfacing risks and recovery from Mayo Clinic.
• Laxity and lift (soft contour, early jowling): targeted by microfocused ultrasound devices that heat deeper layers in precise lines; FDA guidance frames these as “focused ultrasound stimulator systems for aesthetic use” with defined risk controls (FDA special controls).
• Muscle bands and motion lines (vertical platysmal bands, “necklace” lines): can be softened with injectables like botulinum toxin (for bands) and hyaluronic acid fillers (for horizontal lines). See AAD on fillers and the current U.S. label instructions for neck band injections with onabotulinumtoxinA (FDA label 2024).

Right away, one high-value takeaway clicked for me: the best outcomes often come from stacking modalities over time (for example, a conservative laser regimen for texture, ultrasound for lift, and injectables for bands/lines), not forcing one tool to do a job it’s not designed for.

What lasers really do under thin neck skin

Lasers can refresh the surface—think tone, fine lines, and that crinkly crepe that shows up in certain lighting. Nonablative lasers stimulate collagen with minimal downtime; ablative/fractional lasers remove columns of skin to remodel more aggressively. That said, neck skin is thinner, heals differently than cheeks, and can scar more easily if treated like the face. Older and newer peer-reviewed reports warn that the neck is a higher-risk zone for hypertrophic scarring, especially with aggressive ablative CO₂ passes (Avram 2009; Ramsdell 2012). Patient-education pages echo that laser resurfacing has real downtime and side-effects, which tend to be milder with nonablative approaches (Mayo Clinic).

• Pros I noted
  • Targeted improvement in texture, fine lines, and sun spots.
  • Fractional/nonablative settings can be tuned to neck’s tolerance to lower risk.
  • Pairs well with ultrasound or injectables in staged plans.
• Cons to keep in mind
  • Does not lift tissue the way deeper energy does; don’t expect a “tightened jawline” from superficial lasers alone.
  • Neck is prone to scarring if treated too aggressively; expert, conservative protocols matter (peer-review notes).
  • Downtime, sun protection, and antiviral/antibiotic prophylaxis may be needed per clinician judgment.

My rule of thumb: I’d use lasers to polish the “canvas” (tone/texture), not to chase laxity. I also ask the clinician to show neck-specific before/afters, not just cheek results.

Ultrasound when I want lift, not resurfacing

Microfocused ultrasound with visualization (MFU-V, commonly known by a brand name) delivers energy at specific depths to create thermal coagulation points that trigger collagen remodeling over months. The FDA places these in a class with defined “special controls,” emphasizing evidence for intended use and risk management (FDA guidance; codified at 21 CFR 878.4590). Systematic reviews and trials suggest modest but meaningful lift in appropriately selected necks, with results accumulating at 3–6 months (Contini 2023).

• Pros I noticed
  • Targets deeper support layers; fits the “soft drape” problem better than surface lasers.
  • Non-incisional with minimal social downtime (tenderness, transient swelling).
  • Can be combined with other modalities on different days for a layered plan.
• Cons and caveats
  • Results are gradual, not dramatic; patient selection is everything.
  • Procedure discomfort can be real; talk through pain management.
  • Like any device, it has specific risks the FDA enumerates and manufacturers must address; providers should describe these and their mitigation steps (FDA special controls).

To calibrate my expectations, I read summaries indicating MFU-V can improve neck laxity in mild to moderate cases, sometimes comparable to radiofrequency in head-to-head studies, while being associated with more procedural pain but similar safety signals (Dermatol Surg 2017; systematic review 2023).

Where injectables shine and where they don’t

Two different neck problems often get grouped together under “injectables,” so I teased them apart:

• Platysmal bands (vertical cords): These are dynamic muscle bands. Botulinum toxin relaxes them temporarily, softening the cords and the “pulldown” on the jawline. As of the latest U.S. labeling update, onabotulinumtoxinA includes instructions for treating vertical neck bands in adults (FDA label, 2024), and randomized trials in 2025 report improved appearance and patient-reported outcomes (PubMed 2025).
• Horizontal “necklace” lines: These are creases from movement and skin quality changes; hyaluronic acid fillers can soften them when placed carefully and superficially. See the AAD overview and a representative study using hyaluronic acid in neck lines (Tseng 2019).
• Under-chin fullness (submental fat): Deoxycholic acid (Kybella) is FDA-approved for submental fat only—not for other areas of the neck; labeling outlines indications, limitations, and risks (FDA label, Kybella).

Pros I value: Injectables are targeted, often quick, and can be switched “off” (toxin wears off; HA fillers can be dissolved). Cons I respect: Vascular compromise from filler is rare but serious; the FDA has a clear, readable safety brief that I think every patient should skim before consenting (FDA filler safety).

The side-by-side cheat sheet I wish I’d had

• Goal: surface refresh (fine lines, crepe, spots) → Laser leads. Start nonablative or conservative fractional settings on the neck; expect planned downtime and strict sun care (Mayo Clinic).
• Goal: subtle lift/definition (early laxity, jawline softness) → Ultrasound leads. Results accrue over months; you’ll need patience and photos for fair judging (FDA guidance).
• Goal: bands or lines → Injectables. Toxin for vertical bands (label now guides neck band treatment; FDA 2024). HA fillers for necklace lines (select cases; study). Deoxycholic acid only for under-chin fat (FDA Kybella).

Simple frameworks that helped me choose

Instead of “what’s the best treatment,” I started asking “what’s the best sequence for my priorities and budget?” My three-step filter:

• Step 1 Notice: What bugs me most in daylight photos—texture, laxity, bands, lines, or under-chin fullness? Circle only two.
• Step 2 Compare: For each circled item, match the primary modality (laser, ultrasound, or injectable) plus one optional adjunct. Keep downtime realistic.
• Step 3 Confirm: Ask the clinician to show neck-specific cases, explain their complication plan (e.g., how they handle filler vascular events), and review the relevant FDA/AAD materials together (FDA filler do’s/don’ts; AAD fillers).

Little habits I’m testing in real life

I can’t control collagen biology, but I can control the basics that make any procedure safer and more effective:

• Neck sunscreen ritual: Broad-spectrum daily, reapply when outdoors. Lasers especially need impeccable sun care post-treatment (see cautions in Mayo Clinic’s explainer).
• Photo discipline: Same lighting, angle, and posture, monthly. Ultrasound changes are subtle at first; consistent photos keep me honest.
• List your meds and history: Cold sores, recent procedures, supplements that affect bleeding—all belong on the intake (the AAD’s prep list for fillers is a good model of what to disclose: AAD prep).

Signals that tell me to pause

Necks deserve caution. Here are my plain-English “pump the brakes” moments and what I’d do:

• Someone proposes aggressive ablative CO₂ on the neck on your first pass. I’d ask why, given the higher scarring risk reported in the literature (Avram 2009), and consider conservative settings or nonablative first.
• Provider can’t articulate FDA labeling or limits (e.g., deoxycholic acid is for submental fat only). I’d request we review the label together (Kybella label).
• No plan for rare complications (like filler vascular events). The FDA’s consumer update lays out major risks and good practices to discuss (FDA).
• Unlicensed setting or counterfeit products. Professional societies have flagged safety incidents; verify credentials and product sourcing (ASPS patient-safety note).
• Skin of color considerations: I ask specifically about device settings and protocols adjusted for my skin type, since pigment shifts are a known risk with lasers; educational pages from dermatology groups stress customization (AAD safety).

What I’m keeping and what I’m letting go

I’m keeping three principles on a sticky note by my mirror:

• Match tool to job: Laser = surface; Ultrasound = lift; Injectables = bands/lines/fat pocket (within labeling).
• Neck is special: Start gentler than face, especially with lasers, because the risk calculus is different.
• Slow stacking wins: Plan a sequence across seasons instead of cramming everything into one month.

And I’m letting go of the idea that one appointment can solve a decade of habits. If anything, reading primary sources and patient-education pages helps me say “no” to overpromises and “yes” to thoughtful plans. For quick refreshers, I bookmark: Mayo Clinic on laser resurfacing, FDA filler safety, AAD fillers, and the FDA ultrasound device guidance.

FAQ

1) How long do ultrasound results take to show on the neck?
Answer: Most people notice gradual changes over 2–3 months as collagen remodels, with further improvement up to 6 months in published trials and reviews of microfocused ultrasound (systematic review 2023).

2) Are lasers safe for the neck if I have darker skin?
Answer: They can be, but settings and device choice matter to avoid pigment shifts. Discuss your skin type and test spots; dermatology groups emphasize individualized parameters and experienced operators (AAD safety). Conservative, fractional/nonablative options are often preferred for the neck.

3) Can Botox fix tech-neck lines?
Answer: Botulinum toxin helps vertical platysmal bands. Horizontal “necklace” lines are usually better addressed with skincare, collagen-stimulating procedures, or carefully placed hyaluronic acid filler in select cases (AAD fillers; HA study). Recent labeling specifically guides injections for vertical bands (FDA 2024).

4) Is deoxycholic acid (Kybella) an option for all neck fat?
Answer: No—its FDA indication is limited to submental fat under the chin. Using it elsewhere on the neck is not established or recommended by the label (FDA Kybella).

5) How do I reduce my risk of complications with fillers in the neck?
Answer: Choose a qualified, licensed clinician; disclose your medical history; and review an emergency plan for rare vascular events. The FDA’s consumer guide is an excellent pre-visit read (FDA filler safety).

Sources & References

• Mayo Clinic — Laser resurfacing overview (2024–2025)
• FDA — Focused ultrasound stimulator system special controls
• FDA — OnabotulinumtoxinA labeling update (2024)
• FDA — Kybella (deoxycholic acid) label
• American Academy of Dermatology — Fillers overview

This blog is a personal journal and for general information only. It is not a substitute for professional medical advice, diagnosis, or treatment, and it does not create a doctor–patient relationship. Always seek the advice of a licensed clinician for questions about your health. If you may be experiencing an emergency, call your local emergency number immediately (e.g., 911 [US], 119).