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We live in a world in which we are all hopelessly reliant on our mobile devices. And these days, this attachment often starts at a young age. A Kleiner Perkins Caufield & Byers report shows that the average American in 2017 spent 5.9 hours of their day engaged with digital media content.1 On average, most Americans check their phone 46 times per day, and that number is almost double for those between the ages of 18 and 24.2 Therefore, it’s not surprising that because they are constantly bending their necks downward to look at mobile devices, young people (under the age of 35) are developing wrinkles in the neck area at a much earlier age than their predecessors did. This early emergence of neck aging—characterized by horizontal neck lines and crepey neck skin—has been dubbed #TechNeck.

At NicholsMD, we have refined an off-label, three-step protocol that helps our patients minimize the appearance #TechNeck. This combination treatment is done in only one session, takes approximately 45 minutes, lasts six to nine months, and should only be done by an experienced injector.

Step One: High-Frequency Micro-Focused Ultrasound Energy

The first step of the #TechNeck treatment is the use of high-frequency micro-focused ultrasound energy with ultrasound visualization (MFU-V). We use a Merz product called Ultherapy. The principle of high-frequency micro-focused ultrasound energy is to induce cellular damage of the target area by producing microthermal injuries through the accumulation of high-frequency ultrasound beams without causing any damage to the epidermis or surrounding tissue.3 We average 100 Ultherapy lines per treatment, using both the 1.5mm and 3.0mm transducers.

Step Two: Neurotoxin Injection

For Step Two of the #TechNeck treatment, we inject a neurotoxin to relax the muscles of the platysma. We use 40-60 units of neurotoxin and inject in a zig-zag fashion around the horizontal neck rhytids.


Dr. Nichols discusses her approach to managing #TechNeck in a DermTube video.

Step Three: Hyaluronic Acid Filler

The finishing touch of the #TechNeck procedure is to inject a hyaluronic acid dermal filler into the horizontal neck rhytids to smooth and fill the lines. The filler is injected using a microdroplet technique along the horizontal lines. We use on average two syringes of filler per patient.

A tip: We have found using BD Insulin, Ultra Fine needles to be effective in minimizing potential bruising and increasing patient comfort.

These three steps of the #TechNeck treatment help to correct and prevent the consequences of hours of daily use of technological devices. Results can usually be seen within seven to 10 days, once the neuromodulator has fully set in. Bruising and a temporary “tight” feeling of the neck with movement are the most common reported symptoms from our patients.

Practice Management Notes

  • Include a photo on your cosmetic questionnaire showing what TechNeck looks like. Until this treatment becomes mainstream, like we predict it will, patients may not know what you’re referencing without a visual.
  • Package this treatment as one combination treatment, rather than three individual treatments. This way, patients understand that best results require all three steps.
  • Counsel patients on ways to further prevent TechNeck, such as by holding the phone in front of your face but also by putting the phone down.
  • Host a “Preventative Aging” night and feature the TechNeck as one of your treatments.

Disclosure: This is an off-label treatment and should only be done by an experienced board-certified physician specialized in aesthetics.

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