An aesthetic medicine doctor: patients say they've lost their jawline, but it's actually their neck that's ageing

"My skin is like paper" - that's how many patients describe their neck to Dr. Beatriz Beltrán, an internist and aesthetic medicine specialist. Dry, wrinkled, fragile and inelastic. For her that's a good first diagnosis, because it points to what doctors call crepey skin: a problem with the quality of the tissue, which loses density and reflects light less well.

The most common mistake, she says, is to talk about an "aged neck" as one single problem. Horizontal lines from movement and posture, crepey skin, the vertical bands of the platysma muscle, sun spots and the lost angle between neck and chin are all different things. An imprecise diagnosis means an imprecise treatment.

Why the neck ages before the face

The skin on the neck is thinner, has fewer oil glands and less ability to renew itself. It's constantly moving, it gets sun, perfume and friction from clothes - and in everyday skincare it's usually forgotten. Virtudes Ruiz, a surgeon and aesthetic doctor, adds that the neck has fewer fibroblasts, the cells that produce collagen and elastin, and all three layers of skin are thinner than on the face. The platysma muscle pulls downwards and in some people forms visible "cords", especially on long, slender necks. Vertical pressure wrinkles appear on the décolletage, most often in women who sleep on their side.

That's why patients rarely say "my neck has sagged". They say "I've lost my jawline" or "I used to have a sharper angle". Beltrán says the neck has to be looked at together with the chin, the jaw and the oval of the face, and the goal is not to tighten it at any cost but to restore definition without an artificial result.

What the clinics offer

The list is long. Focused ultrasound (Ultherapy) is her favourite for the jawline, and she says her clinic has used it on more than 1,000 patients. Medical cryolipolysis, according to the doctor, removes about 40 percent of fat tissue in a single session, but only if it is genuinely medical-grade and reaches -11 degrees. Then come EM Face Submentum, five weekly 20-minute sessions, poly-L-lactic acid injections over three sessions, with effects that can last more than two years, and Fotona's Tightsculpting laser. Polynucleotides, she says, improve skin quality without changing volume.

Worth noting: almost all of these figures come from the doctor herself and her own clinic, with no study cited. That doesn't mean they're wrong, but it does mean they're being quoted by someone who sells the treatments. Cosmetics - sun protection, antioxidants, well-tolerated retinoids, peptides and ceramides - help, but according to Beltrán they don't replace medical treatment once the skin has already lost density.

The cheapest part of the recipe anyone can start tonight: moisturiser and sunscreen on the neck too, just like on the face and hands. How many of us apply cream down to the chin and stop right there?