Soft Tissue Augmentation of the Neck and Chest

Introduction

The rising popularity of aesthetic procedures on the face has created an increase in demand for cosmetic treatments of nonfacial areas. The face, neck, and chest (décolletage) undergo similar patterns of aging with loss of collagen, an increase in skin laxity, and dyschromia that is either caused or accelerated by chronic ultraviolet (UV) exposure. As more time and money are spent on facial aesthetics, the signs of aging of the untreated adjacent skin of the neck and chest become more visually pronounced. As a result, it is equally important to address these areas to provide a seamless and uniform appearance.

Laser-based energy devices such as fractioned ablative or nonablative lasers and intense pulsed light lasers address the pigmentary changes as well as the texture. Fractional radiofrequency devices improve the quality and surface of the skin, while microfocused ultrasound devices target overall skin laxity. Neuromodulators can also be used to reduce the appearance of the platysma bands of the neck to provide a nonsurgical “liquid neck-lift.” Fillers can be used to address individual rhytides as well as promote neocollagenesis to improve the overall texture and laxity of the skin. While there are multiple modalities for treatment, this chapter will focus on the use of soft tissue fillers in the rejuvenation of the neck and décolletage.