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Resurfacing of the facial skin for wrinkle reduction is well known to be effective. Such laser improvements have been particularly enhanced by the use of fractional ablative laser treatments. The deeper penetration of the vertical laser columns, albeit on just a fraction of the skin’s surface, causes collagen production and skin tightening not previously seen. But venturing off of the face onto the neck and chest, however, is more precarious with laser resurfacing or even deeper chemical peels.

Although the neck is right under the jawline and adjacent to the face, it reacts differently to skin resurfacing efforts. Complications such as delayed wound healing and pigmentation changes are not rare and have been seen with every laser approach. The conclusion historically is that only very light laser treatments with minimal improvements can reduce the risks of these after treatment problems.

Why the neck and chest is different has been theorized due to a change in the anatomy of the skin. The dermal component of the skin is definitely thinner and has less pilosebaeous units per square centimeter. Since most skin cell regeneration (re-epithelization) comes from these hair-sweat gland follicles, healing is slower and more challenged by thermal injury. The thinner dermis also lends itself to greater thermal injury at similar laser setting that are used on the face.

Fractional laser resurfacing offers a theoretical improvement to traditional laser resurfacing of the neck. Its microscopic vertical columns leaves normal skin tissue between them, acting as a reservoir of uninjured fibroblasts and pilo-sebaceous units to provide a good healing source. With a treated to untreated skin ratio ranging from 5% to 22% (Sciton Fractional Laser), there is plenty of healing cells available to expedite wound healing. The traditional higher incidence of complications in neck resurfacing should therefore be appreciably reduced with fractional laser techniques. In my experience this is certainly true and much better skin improvements are seen. Skin texture, wrinkle reduction and small amounts of skin laxity are improved.

An important distinction, however, should be pointed out between improvements in neck skin texture and laxity. I see too many people who erroneously believe that neck laser skin resurfacing is going to create the effect of a facelift. (neck-jowl lift) This is certainly not the case except in the slightest of degrees. The amounts of improvements seen in laxity reduction will not make most of the patients I see happy. This is asking too much of laser therapy even though some make market it as a non-surgical facelift.

Dr. Barry Eppley
Indianapolis, Indiana

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