The Neck and Décolletage, Why They Age Differently
Medically reviewed by
4 independent reviewers
Andrew Conrad Barile, PT, DPT
Doctor of Physical Therapy (DPT) | Licensed Physical Therapist (PT) | CEO and Founder, Xtreem Pulse LLC
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Dr. Andrew Conrad Barile is a Doctor of Physical Therapy and the CEO and Founder of Xtreem Pulse LLC, the engineering company behind PureLift. He earned his Doctorate in Physical Therapy from Daemen College and is a licensed physical therapist.
He brings over two decades of clinical and entrepreneurial experience across physical therapy, craniosacral therapy and medical device innovation, built on a working knowledge of human anatomy and muscle physiology.
For PureLift LAB he reviews how current is delivered across all ten levels, from sub-sensory nanocurrent and skin-level microcurrent to motor-level EMS, and how the Infuse pass fits into the same ten-minute routine.
Bertica M. Rubio, M.D.
Board-Certified Physician, Dartmouth Medical School | Medical Director, Antiaging Regenerative Medicine Clinic
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Dr. Bertica M. Rubio is a board-certified physician and Medical Director of the Antiaging Regenerative Medicine Clinic in Redlands, California. She earned her Doctor of Medicine from Dartmouth Medical School and completed her pediatrics residency at UC Irvine Medical Center.
With decades of clinical experience, she specialises in age management medicine, regenerative medicine, wound healing and growth factor therapies, and her practice integrates evidence-based medical science with advanced aesthetic treatment.
For PureLift LAB she reviews articles for medical accuracy across the whole dial, from the gentle nanocurrent and microcurrent settings through to muscle-level EMS and the Infuse pass.
Daniel Grinberg, MD, FACS
Board-Certified Otolaryngologist | Head and Neck Surgeon | Fellow, American College of Surgeons | Mount Sinai
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Daniel Grinberg, MD, FACS is a board-certified otolaryngologist and head and neck surgeon at ENT and Allergy Associates in West Nyack, New York. He earned his medical degree from Columbia University College of Physicians and Surgeons.
He completed his otolaryngology residency at New York University Medical Center, serves as Assistant Clinical Professor at Mount Sinai School of Medicine, and is a Fellow of both the American College of Surgeons and the American Academy of Otolaryngology.
For PureLift LAB he brings a wider clinical lens, connecting at-home facial stimulation from microcurrent to EMS to the anatomy underneath, with the same rigour we apply to every device specification.
Prof. Dr. med. Ivo Buschmann
Chair of Angiology, Medizinische Hochschule Brandenburg | Clinic Director, University Clinic for Angiology
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Prof. Dr. med. Ivo Buschmann is Chair of Angiology at the Medizinische Hochschule Brandenburg Theodor Fontane and Clinic Director of the University Clinic for Angiology at the Brandenburg University Hospital.
He trained at the University of Hamburg, was a Max Planck Society Fellow at the Max Planck Institute for Heart and Lung Research, and held senior consultant posts at the Charite Universitatsmedizin Berlin before his appointment as Chair in 2016.
One of Europe's leading authorities on arteriogenesis, with over 150 peer-reviewed publications and US and EU patents, he reviews for PureLift LAB how the evidence on electrical stimulation is read and where its limits lie.
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Neck and chest skin is thinner than facial skin, has fewer oil glands, and almost nobody applies sunscreen there consistently.
This article covers what actually decides the answer, such as:
- Why the skin here is different
- The platysma
- What causes which problem
- What a device can do here
- How to work the area safely
and many more!
Underneath it runs the platysma, a broad sheet of muscle continuous with the layer in the lower face, which is why jaw and neck changes arrive together.
Key Points:
Sunscreen on the neck and chest prevents more than any treatment reverses, and it is the step people skip.
The platysma is continuous with the lower face, so treating the jaw and ignoring the neck treats half the structure.
Horizontal neck lines are largely creasing from posture and sleep position rather than laxity.
Check your model's instructions before using a device on the neck, because coverage varies.
Avoid the front of the throat entirely and stay to the sides.
Why the skin here is different
It is thinner than facial skin, with less of the underlying support and fewer oil glands, so it dries out faster and shows texture sooner.
It also receives a fraction of the care. Most people apply sunscreen to the face and stop at the jawline, which over twenty years produces exactly the mismatch that sends them looking for a solution.
The chest gets the same treatment, plus direct sun exposure from open necklines, which is why the vertical creases there are so common and so stubborn.
The platysma
A broad thin sheet of muscle running from the collarbone up over the jaw, continuous with the layer in the lower face. It is the muscle that stands out in cords when someone tenses their neck.
Because it is continuous with the structure above, tone in the neck and tone in the jawline are not separate questions, and working the jaw while ignoring the neck addresses half of one structure.
That is also why the change people call a softening jawline so often reads as a neck change from the side.
What causes which problem
Horizontal lines across the neck are mostly creases, from posture, from looking down at a phone, and from sleep position. They are a folding problem rather than a laxity problem and they respond poorly to anything except not folding the skin.
Crepey texture is a dermal change, thin skin with reduced collagen, and it responds to the same things facial laxity does: retinoids used cautiously, sun protection, and professional heat-based treatments.
Vertical cords standing out are the platysma, and that is muscle.
A heavier area under the chin is usually volume and support rather than skin, and it is the part a home device addresses least.
What a device can do here
Work the platysma, which is muscle and therefore within reach of EMS. Kavanagh and colleagues measured an 18.6 percent increase in cheek muscle thickness over 12 weeks of motor-level facial stimulation (10.1111/jocd.12007), which is facial rather than cervical and is the closest category evidence there is.
Drainage, since the neck is where the facial lymph route exits, so the neck strokes are useful whether or not you are working the muscle.
What it does not do is remove horizontal creases, replace volume under the chin, or thicken the dermis.
How to work the area safely
Check the instructions for your model first, since neck coverage differs between devices and the instruction is specific to what you own.
Stay to the sides of the neck. Avoid the front of the throat entirely, where the thyroid and the carotid sit, and do not work over the area if you have any thyroid condition without asking a clinician.
Use a lower level than you use on the face. The skin is thinner and more sensitive here, and a level that is comfortable on the cheek can be unpleasant on the neck.
Work upward on the sides of the neck for muscle, and downward toward the collarbone for the drainage pass, finishing there.
Keep the skin damp with a water-based serum, which dries faster here than on the face. Three minutes per side is the maximum on any PureLift model.
The part that matters most
Extend your skincare below the jawline. Sunscreen, moisturiser and whatever else you use on your face, applied to the neck and chest as a matter of routine.
It prevents more than any device or treatment reverses, it costs nothing beyond the extra pump of product, and it is the single recommendation on this page most likely to matter in ten years.
For the layer map, see the six layers of the face, and for the drainage strokes, drainage massage technique.
Two related questions come up often alongside this one, and we have answered both in full: what changes below the jaw and what does not, and what microcurrent does about a double chin.