Rethinking the aging neck: how age and modifiable risk factors are associated with neck skin quality

Abstract Background The neck is a visible marker of aging and a growing focus in aesthetic medicine. Compared to the face, neck skin quality has been underexplored, despite its aesthetic importance in the aging process. This study evaluated whether modifiable health-related risk factors better predict neck skin quality than chronological age. Methods In a cross-sectional study, adults aged ≥ 55 years completed a survey on demographics, metabolic health, sun exposure, sunscreen use, tobacco/alcohol use, exercise, and stress, plus the FACE-Q™ Appraisal of the Neck. Neck skin elasticity parameters (Young’s modulus, viscoelasticity, retraction time) were objectively measured under standardized conditions. Univariate tests and multivariable linear regression (adjusted for age, gender, ethnicity) assessed associations between elasticity and risk factors. Results Thirty-six participants (mean age 64.3 ± 7.8) were included. Young’s modulus was lower in males, in diabetes/metabolic syndrome, and with ≥ 3 sun-induced skin changes, and was inversely related to BMI. Viscoelasticity was lower in diabetes/metabolic syndrome, with ≥ 3 sun-induced changes, and without daily neck sunscreen use. Age was not significantly associated with any objective parameter. FACE-Q scores trended with higher viscoelasticity. In multivariable models, daily neck sunscreen predicted greater viscoelasticity, while obesity predicted the opposite. Conclusions In older adults, neck skin viscoelasticity relates more to modifiable risk factors, particularly photoprotection and obesity, than to chronological age. Incorporating risk factor screenings into aesthetic consultations may help promote healthy behaviors that prolong the results of rhytidectomies, and objective tools like viscoelasticity can aid longitudinal monitoring. Level of evidence Level III, prognostic study.